A longitudinal study of the vaginal flora over a menstrual cycle

Keane, Frances; Ison, Catherine; Taylor‐Robinson, David

doi:10.1258/0956462971920631

Cited by 155 publications

(116 citation statements)

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“…Fluctuating pH values have been demonstrated in longitudinal studies, 3 and may be attributed to menstrual cycle phase, recent sexual intercourse and presence of semen, or use of scented soap. 4 Vaginal pH has not been characterised in adolescent menstrual cycles as younger subjects 21 are usually excluded because of erratic cycle patterns.…”

Section: Discussionmentioning

confidence: 98%

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Factors affecting vaginal pH levels among female adolescents attending genitourinary medicine clinics

Brabin

Roberts²,

Fairbrother³

et al. 2005

Sexually Transmitted Infections

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Objectives: Vaginal pH is related to hormonal status, and adolescents experience disturbed hormonal patterns following menarche. We assessed hormonal factors and risk of abnormal vaginal pH and bacterial vaginosis (BV) among adolescents attending genitourinary medicine (GUM) clinics. Methods: In a cross sectional study adolescents within 5 years of menarche, (17 years, or with oligoamenorrhoea were recruited. Vaginal pH and BV were assessed and among those not using hormonal contraceptives, estrone-3-glucuronide (E3G) and pregnanediol-3a-glucuronide (P3G) concentrations were measured. Results: Among 102 adolescents, 59.8% (61) had a high vaginal pH (.4.5), which was higher than the prevalence of BV, detected in 33% (34). No association was found between presence of sexually transmitted infections (STI) and vaginal pH. In logistic regression, after controlling for BV and condom use, vaginal pH was positively associated with cervical ectopy (OR = 2.5; 95% CI 1.0 to 6.6, p = 0.05) and STI treatment history (OR = 2.5; 95% CI 0.9 to 6.5, p = 0.07), and negatively associated with use of DepoProvera (OR = 0.1; 95% CI 0.03 to 0.6, p = 0.003) and recent onset (,12 months) of sexual activity (OR = 0.2; 95% CI 0.1 to 0.7, p = 0.004). Among 23 adolescents not using hormonal contraceptives, a high pH occurred more often in abnormal compared to normal menstrual cycles (OR = 10.8; 95% CI 1.4 to 85.4; p = 0.026). E3G concentrations were inversely correlated with vaginal pH in the follicular phase (Spearman: r = 0.51; p = 0.024). Conclusions: Ectopy and abnormal menstrual cycles are common features of adolescence. Their presence is associated with increased risk of abnormal pH, and may also predispose to BV.

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Section: Discussionmentioning

confidence: 98%

“…One menstrual cycle study 4 described a rise in pH before detection of BV but this was not confirmed by other research. 3 It is uncertain whether the high pH levels associated with BV are a cause or product of the syndrome. Glycogen may be metabolised to lactic acid by vaginal bacteria and/or by the epithelium itself.…”

Section: Discussionmentioning

confidence: 99%

Factors affecting vaginal pH levels among female adolescents attending genitourinary medicine clinics

Brabin

Roberts²,

Fairbrother³

et al. 2005

Sexually Transmitted Infections

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“…Conceptually, this is important since vaginal communities continually experience various kinds of chronic and acute disturbances caused by human behaviors such as the use of antibiotics, hormonal contraceptives and other methods of birth control, sexual intercourse, vaginal lubricants, douching, and many others. In addition, the structure and composition of vaginal microbial communities are known to be influenced by natural changes in normal healthy women, including aging, time in the menstrual cycle, menstruation, pregnancy, and stress (6,11,16,24). Very little is known about the biotic or abiotic factors that control the dynamics of the vaginal microbiota.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Self-Collected and Physician-Collected Vaginal Swabs for Microbiome Analysis

et al. 2010

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To our knowledge, no data are available on whether the microbial species composition and abundance sampled with self-collected vaginal swabs are comparable to those of swabs collected by clinicians. Twenty healthy women were recruited to the study during a routine gynecological visit. Eligible women were between 18 and 40 years old with regular menstrual cycles. Participants self-collected a vaginal swab using a standardized protocol and then were examined by a physician, who collected an additional five swabs from the lateral wall of the mid-vagina. In this study, the self-collected and three physician-obtained swabs were analyzed and compared using terminal restriction fragment length polymorphism and sequence analyses of the 16S rRNA genes. Vaginal microbial community comparative statistical analyses of both T-RFLP and 16S rRNA gene sequence datasets revealed that self-collected vaginal swabs sampled the same microbial diversity as physician collected swabs of the mid-vagina. These findings enable large-scale, field-based studies of the vaginal microbiome.In recent years, "cultivation-independent" methods based on the analysis of 16S rRNA gene sequences directly extracted from biological samples are widely used to explore microbial diversity in various habitats (7,27,28). Using these methods, organisms are classified based on phylogenetic differences that are reflected in sequence polymorphisms of their 16S rRNA genes. The use of these approaches obviates the need to cultivate organisms, permits high-throughput analysis of samples, and provides precise and detailed information about the populations present. Using 16S rRNA gene analysis, the species (phylotype) composition and abundance in microbial communities can be readily determined, and similarities and differences among microbial communities can be quantitatively discerned. Despite difficulties in comparing data generated by different so-called "universal" PCR primer pairs, each introducing small biases (8, 36), this validated method has become the favored approach to characterizing the mutualistic microbial populations residing on and in the human body, including the gastrointestinal tract (4, 37), skin (4, 10), subgingival crevice (19), and vagina (4, 9, 15, 42). Importantly, the data obtained can be statistically analyzed to test the significance of changes that occur within individuals over time, or between individuals and treatment groups. These methods include terminal restriction fragment length polymorphisms (T-RFLP) (41) and high-throughput pyrosequencing of bar-coded 16S rRNA gene analysis (12,22).Surveys of vaginal microbial communities using cultivationindependent methods have been initiated under the NIH Roadmap Human Microbiome Project (14). Surveys of the vagina are important for a number of reasons. The beneficial effects of the endogenous microbiota on women's health in obstetric and gynecologic outcomes are numerous but poorly understood. A proper understanding of community membership, relative abundance, and variations therein are crit...

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“…Vaginal microbial ecologies are also highly affected by the menstrual (estrous) cycle phase (Onderdonk et al, 1986;Keane et al, 1997;Narushima et al, 1997;Gajer et al, 2012). In humans, high midcycle estrogen levels accompanied by increased glycogen production, lead to Lactobacillus proliferation (Wylie and Henderson, 1969;Singh et al, 1972;Boskey et al, 1999Boskey et al, , 2001.…”

Section: Factors Affecting Vaginal Microbial Ecologiesmentioning

confidence: 99%

The primate vaginal microbiome: Comparative context and implications for human health and disease

Stumpf

Wilson

Rivera

et al. 2013

American J Phys Anthropol

115

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The primate body hosts trillions of microbes. Interactions between primate hosts and these microbes profoundly affect primate physiology, reproduction, health, survival, and ultimately, evolution. It is increasingly clear that primate health cannot be understood fully without knowledge of host-microbial interactions. Our goals here are to review what is known about microbiomes of the female reproductive tract and to explore several factors that influence variation within individuals, as well as within and between primate species. Much of our knowledge of microbial variation derives from studies of humans, and from microbes located in nonreproductive regions (e.g., the gut). We review work suggesting that the vaginal microbiota affects female health, fecundity, and pregnancy outcomes, demonstrating the selective potential for these agents. We explore the factors that correlate with microbial variation within species. Initial colonization by microbes depends on the manner of birth; most microbial variation is structured by estrogen levels that change with age (i.e., at puberty and menopause) and through the menstrual cycle. Microbial communities vary by location within the vagina and can depend on the sampling methods used (e.g., swab, lavage, or pap smear). Interindividual differences also exist, and while this variation is not completely understood, evidence points more to differences in estrogen levels, rather than differences in external physical environment. When comparing across species, reproductive-age humans show distinct microbial communities, generally dominated by Lactobacillus, unlike other primates. We develop evolutionary hypotheses to explain the marked differences in microbial communities. While much remains to be done to test these hypotheses, we argue that the ample variation in primate mating and reproductive behavior offers excellent opportunities to evaluate host-microbe coevolution and adaptation. Am J Phys Anthropol 57:119-134,

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A longitudinal study of the vaginal flora over a menstrual cycle

Cited by 155 publications

References 0 publications

Factors affecting vaginal pH levels among female adolescents attending genitourinary medicine clinics

Factors affecting vaginal pH levels among female adolescents attending genitourinary medicine clinics

Comparison of Self-Collected and Physician-Collected Vaginal Swabs for Microbiome Analysis

The primate vaginal microbiome: Comparative context and implications for human health and disease

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