title: The complex vaginal flora of West African women with bacterial vaginosis.
abstract: BACKGROUND
  The spectrum of bacteria associated with bacterial vaginosis (BV) has recently expanded through taxonomic changes and the use of molecular methods. These methods have yet to be used in large-scale epidemiological studies in Africa where BV is highly prevalent.
  
  
  METHODS
  An analysis of samples obtained during a clinical trial of the management of vaginal discharge in four West African countries. Samples were available from 1555 participants; 843 (54%) had BV. Nucleic acids of 13 bacterial genera or species potentially associated with BV were detected through the polymerase chain reaction.
  
  
  RESULTS
  The associations between various components of the vaginal flora were complex. Excluding Lactobacillus, the other 12 micro-organisms were all associated with each other at the p≤0.001 level. The prevalence of various bacterial genera or species varied according to age, sexual activity and HIV status. In multivariate analysis, the presence of Gardnerella vaginalis, Bifidobacterium, Megasphaera elsdenii, Dialister, Mycoplasma hominis, Leptotrichia, and Prevotella were independently associated with BV as was the absence of Lactobacillus and Peptoniphilus. However, Mobiluncus, Atopobium vaginae, Anaerococcus, and Eggerthella were not independently associated with BV. Unexpectedly, after treatment with a regimen that included either metronidazole or tinidazole, the proportion of patients with a complete resolution of symptoms by day 14 increased with the number of bacterial genera or species present at enrolment.
  
  
  CONCLUSIONS
  Numerous bacterial genera or species were strongly associated with each other in a pattern that suggested a symbiotic relationship. BV cases with a simpler flora were less likely to respond to treatment. Overall, the vaginal flora of West African women with BV was reminiscent of that of their counterparts in industrialized countries.
authors.affiliation: Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Canada. jacques.pepin@usherbrooke.ca
authors.forename: Jacques
authors.initials: J
authors.lastname: Pépin
authors.forename: Sylvie
authors.initials: S
authors.lastname: Deslandes
authors.forename: Geneviève
authors.initials: G
authors.lastname: Giroux
authors.forename: François
authors.initials: F
authors.lastname: Sobéla
authors.forename: Nzambi
authors.initials: N
authors.lastname: Khonde
authors.forename: Soumaila
authors.initials: S
authors.lastname: Diakité
authors.forename: Sophie
authors.initials: S
authors.lastname: Demeule
authors.forename: Annie-Claude
authors.initials: AC
authors.lastname: Labbé
authors.forename: Nathalie
authors.initials: N
authors.lastname: Carrier
authors.forename: Eric
authors.initials: E
authors.lastname: Frost
mesh_terms: D000328:Adult; D000349:Africa / Q000453:epidemiology; D001419:Bacteria / Q000145:classification* / Q000235:genetics / Q000472:pathogenicity*; D004279:DNA, Viral / Q000235:genetics; D016021:Epidemiologic Studies; D005260:Female; D006801:Humans; D016133:Polymerase Chain Reaction; D016032:Randomized Controlled Trials as Topic; D014621:Vagina / Q000382:microbiology*; D016585:Vaginosis, Bacterial / Q000453:epidemiology* / Q000382:microbiology*; D055815:Young Adult
chemical_list: D004279:DNA, Viral