The means by which vaginal microbiomes help prevent urogenital diseases in women and maintain health are poorly understood. To gain insight into this, the vaginal bacterial communities of 396 asymptomatic North American women who represented four ethnic groups (white, black, Hispanic, and Asian) were sampled and the species composition characterized by pyrosequencing of barcoded 16S rRNA genes. The communities clustered into five groups: four were dominated by Lactobacillus iners, L. crispatus, L. gasseri, or L. jensenii, whereas the fifth had lower proportions of lactic acid bacteria and higher proportions of strictly anaerobic organisms, indicating that a potential key ecological function, the production of lactic acid, seems to be conserved in all communities. The proportions of each community group varied among the four ethnic groups, and these differences were statistically significant [χ 2 (10) = 36.8, P < 0.0001]. Moreover, the vaginal pH of women in different ethnic groups also differed and was higher in Hispanic (pH 5.0 ± 0.59) and black (pH 4.7 ± 1.04) women as compared with Asian (pH 4.4 ± 0.59) and white (pH 4.2 ± 0.3) women. Phylotypes with correlated relative abundances were found in all communities, and these patterns were associated with either high or low Nugent scores, which are used as a factor for the diagnosis of bacterial vaginosis. The inherent differences within and between women in different ethnic groups strongly argues for a more refined definition of the kinds of bacterial communities normally found in healthy women and the need to appreciate differences between individuals so they can be taken into account in risk assessment and disease diagnosis. T he human body harbors microorganisms that inhabit surfaces and cavities exposed or connected to the external environment. Each body site includes ecological communities of microbial species that exist in a mutualistic relationship with the host. The kinds of organisms present are highly dependent on the prevailing environmental conditions and host factors and hence vary from site to site. Moreover, they vary between individuals and over time (1). The human vaginal microbiota seem to play a key role in preventing a number of urogenital diseases, such as bacterial vaginosis, yeast infections, sexually transmitted infections, urinary tract infections (2-9), and HIV infection (10, 11). Common wisdom attributes this to lactic acid-producing bacteria, mainly Lactobacillus sp., that commonly inhabit the vagina. These species are thought to play key protective roles by lowering the environmental pH through lactic acid production (12, 13), by producing various bacteriostatic and bacteriocidal compounds, or through competitive exclusion (13-16). The advent of culture-independent molecular approaches based on the cloning and sequencing of 16S rRNA genes has furthered our understanding of the vaginal microbiota by identifying taxa that had not been cultured (17-24). However, this technique is limited by high cost and low throughput, hence only small ...

Objectives Some vaginal bacterial communities are thought to prevent infection by sexually transmitted organisms. Prior work demonstrated that the vaginal microbiota of reproductive-age women cluster into five types of bacterial communities; 4 dominated by Lactobacillus species (L. iners, L. crispatus, L. gasseri, L. jensenii), and one (termed community state type (CST) IV) lacking significant numbers of lactobacilli and characterized by higher proportions of Atopobium, Prevotella, Parvimonas, Sneathia, Gardnerella, Mobiluncus, and other taxa. We sought to evaluate the relationship between vaginal bacterial composition and Trichomonas vaginalis. Methods Self-collected vaginal swabs were obtained cross-sectionally from 394 women equally representing four ethnic/racial groups. T. vaginalis screening was performed using PCR targeting the 18S rRNA and β-tubulin genes. Vaginal bacterial composition was characterized by pyrosequencing of barcoded 16S rRNA genes. A panel of eleven microsatellite markers was used to genotype T. vaginalis. The association between vaginal microbiota and T. vaginalis was evaluated by exact logistic regression. Results T. vaginalis was detected in 2.8% of participants (11/394). Of the eleven T. vaginalis-positive cases, eight (72%) were categorized as CST-IV, two (18%) as communities dominated by L. iners and one (9%) as L. crispatus-dominated (p-value:0.05). CST-IV microbiota were associated with an 8-fold increased odds of detecting T. vaginalis compared to women in the L. crispatus-dominated state (OR:8.26, 95% CI:1.07–372.65). Seven of the 11 T. vaginalis isolates were assigned to two genotypes. Conclusion T. vaginalis was associated with vaginal microbiota consisting of low proportions of lactobacilli and high proportions of Mycoplasma, Parvimonas, Sneathia, and other anaerobes.

This study examined the barriers and facilitators of HIV counseling, testing, and referral service (HIV CTR) acceptance among 278 youth aged 12-24 years old. Participants completed a questionnaire before health education sessions with trained counselors. Information was collected on individual characteristics, HIV testing acceptance, risk behaviors, reasons for having never been tested, and what would make it easier to get tested for HIV. Ninety percent of the respondents were minority and 52% were female with an average age of 15 years. High-risk minority youth who had never received HIV CTR listed low perception of risk and never having been offered a test as reasons for not having been tested. Increased availability of oral and rapid testing methods as well as free testing services were listed as facilitating their acceptance of HIV testing. Older youth aged 18-24 years reported that HIV tests in which results can be received rapidly and confidentially would encourage them to obtain HIV testing services. Early identification approaches should be tailored to increase the access to and acceptance of HIV-testing services among the adolescent and young adult populations.

The diagnosis of migraine headache in children and adolescents is complex and not well understood. This study was conducted to compare diagnostic rates, using various criteria for pediatric migraine, and specific symptom characteristics in a sample of children referred for care to a specialized pediatric headache clinic. A structured interview was used at the patient's initial assessment visit to elicit symptom patterns and therapies attempted for headache. Clinical diagnoses were based on consensus agreement reached by a multidisciplinary team. Statistically derived diagnostic rates based on International Headache Society (IHS), Prensky, Vahlquist and our own criteria were significantly lower than clinical diagnostic rates. IHS diagnostic rates were differentially distributed as a function of race, but no other effects were found for demographic variables on diagnostic rates. Specific symptom patterns, however, varied as a function of race, gender and age of the child. The results underscore the need for comprehensive, developmentally based models of the evolution of migraine headache as a foundation for future research and the further development of clinically sensitive diagnostic criteria for pediatric migraine.

Study findings address a major gap in the community partner research literature. Health researchers and policymakers need an effective partner selection framework whereby community-researcher partnerships can develop a solid foundation to address public health concerns.