title: Extravaginal reservoirs of vaginal bacteria as risk factors for incident bacterial vaginosis.
abstract: BACKGROUND
  Bacterial vaginosis (BV) represents shifts in microbiota from Lactobacillus spp. to diverse anaerobes. Although antibiotics relieve symptoms and temporarily eradicate BV-associated bacteria (BVAB), BV usually recurs. We investigated the role of extravaginal BVAB reservoirs in recurrence.
  
  
  METHODS
  Risks for BV acquisition over the course of 1 year were defined. DNA in vaginal, anal, and oral swab samples from enrollment was subjected to quantitative polymerase chain reaction assays targeting 16S ribosomal RNA genes of Gardnerella vaginalis, Lactobacillus crispatus, BVAB1, BVAB2, BVAB3, Megasphaera spp., Lactobacillus jensenii, and Leptotrichia/Sneathia spp. A case-control approach analyzed BVAB detection at enrollment for case patients (BV acquisition) versus controls (none).
  
  
  RESULTS
  Of 239 women enrolled without BV, 199 were seen in follow-up, and 40 experienced BV; 15 had all samples for analysis. Detection of G. vaginalis in oral cavity or anal samples and Leptotrichia/Sneathia spp. in anal samples was more common at enrollment among case patients, who also had higher concentrations of these bacteria and Megasphaera relative to 30 controls at each site. In contrast, L. crispatus was detected more frequently in anal samples among controls.
  
  
  CONCLUSIONS
  Women who acquire BV are more likely have previous colonization of extravaginal reservoirs with some BVAB, and less likely to have L. crispatus, suggesting that BVAB may be acquired vaginally from extravaginal reservoirs.
authors.affiliation: Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, WA, USA. jmm2@uw.edu
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Marrazzo
authors.forename: Tina L
authors.initials: TL
authors.lastname: Fiedler
authors.forename: Sujatha
authors.initials: S
authors.lastname: Srinivasan
authors.forename: Katherine K
authors.initials: KK
authors.lastname: Thomas
authors.forename: Congzhou
authors.initials: C
authors.lastname: Liu
authors.forename: Daisy
authors.initials: D
authors.lastname: Ko
authors.forename: Hu
authors.initials: H
authors.lastname: Xie
authors.forename: Misty
authors.initials: M
authors.lastname: Saracino
authors.forename: David N
authors.initials: DN
authors.lastname: Fredricks
mesh_terms: D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000382:microbiology*; D001419:Bacteria / Q000235:genetics / Q000302:isolation & purification*; D016022:Case-Control Studies; D015331:Cohort Studies; D004269:DNA, Bacterial / Q000235:genetics; D004197:Disease Reservoirs / Q000382:microbiology*; D005260:Female; D005500:Follow-Up Studies; D006194:Gardnerella vaginalis / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D007778:Lactobacillus / Q000235:genetics / Q000302:isolation & purification; D045183:Leptotrichia / Q000235:genetics / Q000302:isolation & purification; D045851:Megasphaera / Q000235:genetics / Q000302:isolation & purification; D054892:Metagenome; D009055:Mouth / Q000382:microbiology*; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D012307:Risk Factors; D016585:Vaginosis, Bacterial / Q000453:epidemiology / Q000382:microbiology*; D055815:Young Adult
chemical_list: D004269:DNA, Bacterial; D012336:RNA, Ribosomal, 16S