title: Correlates of the molecular vaginal microbiota composition of African women.
abstract: BACKGROUND
  Sociodemographic, behavioral and clinical correlates of the vaginal microbiome (VMB) as characterized by molecular methods have not been adequately studied. VMB dominated by bacteria other than lactobacilli may cause inflammation, which may facilitate HIV acquisition and other adverse reproductive health outcomes.
  
  
  METHODS
  We characterized the VMB of women in Kenya, Rwanda, South Africa and Tanzania (KRST) using a 16S rDNA phylogenetic microarray. Cytokines were quantified in cervicovaginal lavages. Potential sociodemographic, behavioral, and clinical correlates were also evaluated.
  
  
  RESULTS
  Three hundred thirteen samples from 230 women were available for analysis. Five VMB clusters were identified: one cluster each dominated by Lactobacillus crispatus (KRST-I) and L. iners (KRST-II), and three clusters not dominated by a single species but containing multiple (facultative) anaerobes (KRST-III/IV/V). Women in clusters KRST-I and II had lower mean concentrations of interleukin (IL)-1α (p < 0.001) and Granulocyte Colony Stimulating Factor (G-CSF) (p = 0.01), but higher concentrations of interferon-γ-induced protein (IP-10) (p < 0.01) than women in clusters KRST-III/IV/V. A lower proportion of women in cluster KRST-I tested positive for bacterial sexually transmitted infections (STIs; ptrend = 0.07) and urinary tract infection (UTI; p = 0.06), and a higher proportion of women in clusters KRST-I and II had vaginal candidiasis (ptrend = 0.09), but these associations did not reach statistical significance. Women who reported unusual vaginal discharge were more likely to belong to clusters KRST-III/IV/V (p = 0.05).
  
  
  CONCLUSIONS
  Vaginal dysbiosis in African women was significantly associated with vaginal inflammation; the associations with increased prevalence of STIs and UTI, and decreased prevalence of vaginal candidiasis, should be confirmed in larger studies.
authors.affiliation: Institute of Infection and Global Health, University of Liverpool, Liverpool, UK. rgautam@upei.ca.
authors.forename: Raju
authors.initials: R
authors.lastname: Gautam
authors.affiliation: Amsterdam Institute for Global Health and Development and Academic Medical Center, Amsterdam, The Netherlands. h.borgdorff@aighd.org.
authors.forename: Hanneke
authors.initials: H
authors.lastname: Borgdorff
authors.affiliation: Institute of Tropical Medicine, Antwerp, Belgium. vjespers@itg.be.
authors.forename: Vicky
authors.initials: V
authors.lastname: Jespers
authors.affiliation: London School for Hygiene and Tropical Medicine, MRC Tropical Epidemiology Group, London, UK. Suzanna.Francis@lshtm.ac.uk.
authors.forename: Suzanna C
authors.initials: SC
authors.lastname: Francis
authors.affiliation: Ghent University, International Centre for Reproductive Health, Ghent, Belgium. riet7@icloud.com.
authors.forename: Rita
authors.initials: R
authors.lastname: Verhelst
authors.affiliation: International Centre for Reproductive Health Kenya, Mombasa, Kenya. mwauramaryw@gmail.com.
authors.forename: Mary
authors.initials: M
authors.lastname: Mwaura
authors.affiliation: Wits Reproductive Health and HIV Research Institute, Witwatersrand University, Johannesburg, South Africa. sdelany@whri.ac.za.
authors.forename: Sinead
authors.initials: S
authors.lastname: Delany-Moretlwe
authors.affiliation: Rinda Ubuzima, Kigali, Rwanda. ndayisaba@gmail.com.
authors.forename: Gilles
authors.initials: G
authors.lastname: Ndayisaba
authors.affiliation: Institute of Tropical Medicine, Antwerp, Belgium. jordan.kyongo@gmail.com.
authors.forename: Jordan K
authors.initials: JK
authors.lastname: Kyongo
authors.affiliation: Institute of Tropical Medicine, Antwerp, Belgium. lhardy@itg.be.
authors.forename: Liselotte
authors.initials: L
authors.lastname: Hardy
authors.affiliation: Institute of Tropical Medicine, Antwerp, Belgium. jmenten@itg.be.
authors.forename: Joris
authors.initials: J
authors.lastname: Menten
authors.affiliation: Institute of Tropical Medicine, Antwerp, Belgium. tcrucitti@itg.be.
authors.forename: Tania
authors.initials: T
authors.lastname: Crucitti
authors.affiliation: TNO Quality of Life, Zeist, The Netherlands. evgeni.tsivtsivadze@tno.nl.
authors.forename: Evgeni
authors.initials: E
authors.lastname: Tsivtsivadze
authors.affiliation: TNO Quality of Life, Zeist, The Netherlands. frank.schuren@tno.nl.
authors.forename: Frank
authors.initials: F
authors.lastname: Schuren
authors.affiliation: Institute of Infection and Global Health, University of Liverpool, Liverpool, UK. j.vandewijgert@liverpool.ac.uk.|Rinda Ubuzima, Kigali, Rwanda. j.vandewijgert@liverpool.ac.uk.|Department of Clinical Infection, Immunology and Microbiology, Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, West Derby Street, Liverpool, L69 7BE, UK. j.vandewijgert@liverpool.ac.uk.
authors.forename: Janneke H H M
authors.initials: JH
authors.lastname: van de Wijgert
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D007778:Lactobacillus / Q000235:genetics / Q000302:isolation & purification*; D064307:Microbiota; D010802:Phylogeny; D015995:Prevalence; D015231:Sexually Transmitted Diseases, Bacterial / Q000453:epidemiology / Q000382:microbiology*; D014621:Vagina / Q000382:microbiology*; D055815:Young Adult