title: Longitudinal analysis of vaginal microbiome dynamics in women with recurrent bacterial vaginosis: recognition of the conversion process.
abstract: Bacterial vaginosis (BV) affects ∼ 30% of women of reproductive age, has a high rate of recurrence, and is associated with miscarriage, preterm birth, and increased risk of acquiring other sexually transmitted infections, including HIV-1. Little is known of the daily changes in the vaginal bacterial composition as it progresses from treatment to recurrence, or whether any of these might be useful in its prediction or an understanding of its causes. We used phylogenetic branch-inclusive quantitative PCR (PB-qPCR) and Lactobacillus blocked/unblocked qPCR (Lb-qPCR) to characterize longitudinal changes in the vaginal microbiota in sequential vaginal self-swabs from five women with recurrent BV, from diagnosis through remission to recurrence. Both patients with acute BV samples dominated by G. vaginalis recurred during the study with similar profiles, whereas the three patients with acute BV samples dominated by other anaerobes did not recur or recurred to an intermediate Nugent score. L. iners dominated remission phases, with intermittent days of abnormal microbial profiles typically associated with menses. The exception was a newly discovered phenomenon, a sustained period of abnormal profiles, termed conversion, which preceded symptomatic acute BV. Species known to have antagonistic activity towards Lactobacillus were detected in pre-conversion samples, possibly contributing to the decline in Lactobacillus. Lb-qPCR scores define two categories of response in the initial post-treatment visit samples; scores <5 may correspond with poor response to treatment or rapid recurrence, whereas scores >8 may predict delayed or no recurrence. Amsel criteria or Nugent scores did not have this potential predictive capability. Larger studies are warranted to evaluate the prognostic potential of detecting conversion and poor Lb-qPCR scores at the post-treatment visit of recurrent BV patients.
authors.affiliation: Department of Biochemistry, Wayne State University School of Medicine, Detroit, Michigan, United States of America ; Division of Infectious Diseases, Wayne State University School of Medicine, Detroit, Michigan, United States of America.
authors.forename: Janet A
authors.initials: JA
authors.lastname: Lambert
authors.affiliation: Department of Biochemistry, Wayne State University School of Medicine, Detroit, Michigan, United States of America.
authors.forename: Susan
authors.initials: S
authors.lastname: John
authors.affiliation: Division of Infectious Diseases, Wayne State University School of Medicine, Detroit, Michigan, United States of America.
authors.forename: Jack D
authors.initials: JD
authors.lastname: Sobel
authors.affiliation: Department of Biochemistry, Wayne State University School of Medicine, Detroit, Michigan, United States of America.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Akins
mesh_terms: D000208:Acute Disease; D000328:Adult; D018407:Bacterial Physiological Phenomena; D005260:Female; D006801:Humans; D007778:Lactobacillus / Q000502:physiology; D008137:Longitudinal Studies; D064307:Microbiota; D010802:Phylogeny; D016133:Polymerase Chain Reaction; D012008:Recurrence; D013045:Species Specificity; D014621:Vagina / Q000382:microbiology*; D014626:Vaginal Smears; D016585:Vaginosis, Bacterial / Q000188:drug therapy / Q000382:microbiology*