The Vaginal and Urinary Microbiomes in Premenopausal Women With Interstitial Cystitis/Bladder Pain Syndrome as Compared to Unaffected Controls: A Pilot Cross-Sectional Study

Abstract

Interstitial cystitis/bladder pain syndrome (ICBPS) may be related to an altered genitourinary microbiome. Our aim was to compare the vaginal and urinary microbiomes between premenopausal women with ICBPS and unaffected controls. This cross-sectional study screened premenopausal women with an O'Leary-Sant questionnaire (ICBPS if score ≥6 on either index; controls <6 on both). Women completed questionnaires on health characteristics, pelvic floor symptoms (OABq, PFDI-20), body image (mBIS), and sexual function (PISQ-IR). Bacterial genomic DNA was isolated from vaginal and clean-catch urinary specimens; the bacterial 16 rRNA gene was sequenced and analyzed using the QIIME pipeline. We performed UniFrac analysis (β-diversity) and generated Chao1 estimator (richness) and Simpson index (richness and evenness) values. We analyzed 23 ICBPS and 18 non-ICBPS patients. ICBPS patients had increased vaginal deliveries, BMI, and public insurance as well as worsened OAB-q, PFDI-20, mBIS, and PISQ-IR domain scores. Lactobacilli was the most abundant genus in both cohorts, and anaerobic or fastidious predominance was similar between groups ( p = 0.99). For both the urine and vagina specimens, Chao1 and Simpson indices were similar between ICBPS and unaffected women. Weighted and unweighted UniFrac analyses showed no differences between groups. A significant correlation existed between the urinary and vaginal Simpson indices in ICBPS women, but not in unaffected women. Premenopausal women with ICBPS, despite worsened socioeconomic indicators and pelvic floor function, were not found to have significantly different urinary and vaginal microbiomes compared to women without ICBPS.

Introducing Lu-1, a Novel Lactobacillus jensenii Phage Abundant in the Urogenital Tract

“…Currently, there is debate as to whether the vaginal and urinary tract communities are distinct microbiota or if they are interconnected. 16S rRNA gene sequence studies have identified the same genera across the two sites [2,3]. Whole genome sequencing of vaginal and urinary tract isolates of the same species from the same individual suggests that the two microbiota are connected [4].…”

“…Lactobacilli are a prominent member of the healthy female urogenital tract [1]. 16S rRNA gene sequencing and shotgun whole genome sequencing of the vaginal and urinary tract microbiota have identified the same species in both niches, suggesting that the two microbiota are in fact interconnected [2][3][4]. The healthy vaginal microbiota is often dominated by one of four Lactobacillus species: Lactobacillus crispatus, L. iners, L. gasseri, or L. jensenii [5,6].…”

The Bladder is Not Sterile: an Update on the Urinary Microbiome

“…In women, a single, small study of catheterized urine samples revealed decreased bacterial diversity, with reduced Lactobacillus levels and increased proinflammatory cytokines in IC/BPS compared with controls [22•]. Three studies examining voided urine samples in women with IC/BPS were unable to identify differences in individual taxa between control subjects and IC/BPS participants [55][56][57], but did observe trends towards differential abundances of several species, such as increased L. gasseri and lower Corynebacterium prevalence in IC/BPS patients. Earlier studies using both voided and catheterized specimens are similar, visualizing overall changes in diversity without unique disease-associated species.…”

Commentary: The Vaginal and Urinary Microbiomes in Premenopausal Women With Interstitial Cystitis/Bladder Pain Syndrome as Compared to Unaffected Controls: A Pilot Cross-Sectional Study

“…Therefore it was very interesting to read this study combining the analysis of the urinary and vaginal microbiome (Meriwether et al, 2019). During enrollment patients were thoroughly screened for interfering conditions such as menopausal status, pelvic organ prolapse beyond the hymen, foreign bodies in the vagina, active urinary or genital tract infection and current treatment for ICBPS.…”