title: A fruitful alliance: the synergy betweenAtopobium vaginaeandGardnerella vaginalisin bacterial vaginosis-associated biofilm.
abstract: OBJECTIVE
  Bacterial vaginosis (BV) is characterised by a change in the microbial composition of the vagina. The BV-associated organisms outnumber the health-associatedLactobacillusspecies and form a polymicrobial biofilm on the vaginal epithelium, possibly explaining the difficulties with antibiotic treatment. A better understanding of vaginal biofilm with emphasis onAtopobium vaginaeandGardnerella vaginalismay contribute to a better diagnosis and treatment of BV.
  
  
  METHODS
  To this purpose, we evaluated the association between the presence of both bacteria by fluorescence in situ hybridisation (FISH) and BV by Nugent scoring in 463 vaginal slides of 120 participants participating in a clinical trial in Rwanda.
  
  
  RESULTS
  A bacterial biofilm was detected in half of the samples using a universal bacterial probe. The biofilm containedA. vaginaein 54.1% andG. vaginalisin 82.0% of the samples.A. vaginaewas accompanied byG. vaginalisin 99.5% of samples. The odds of having a Nugent score above 4 were increased for samples with dispersedG. vaginalisand/orA. vaginaepresent (OR 4.5; CI 2 to 10.3). The probability of having a high Nugent score was even higher when a combination of adherentG. vaginalisand dispersedA. vaginaewas visualised (OR 75.6; CI 13.3 to 429.5) and highest when both bacteria were part of the biofilm (OR 119; CI 39.9 to 360.8).
  
  
  CONCLUSIONS
  Our study, although not comprehensive at studying the polymicrobial biofilm in BV, provided a strong indication towards the importance ofA. vaginaeand the symbiosis ofA. vaginaeandG. vaginalisin this biofilm.
  
  
  BACKGROUND
  NCT01796613.
authors.affiliation: HIV and Sexual Health Group, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.|Laboratory Bacteriology Research, Faculty of Medicine & Health Sciences, University of Ghent, Ghent, Belgium.|STI Reference Laboratory, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Liselotte
authors.initials: L
authors.lastname: Hardy
authors.affiliation: HIV and Sexual Health Group, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Vicky
authors.initials: V
authors.lastname: Jespers
authors.affiliation: STI Reference Laboratory, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Said
authors.initials: S
authors.lastname: Abdellati
authors.affiliation: STI Reference Laboratory, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Irith
authors.identifier: http://orcid.org/0000-0002-1804-252X
authors.initials: I
authors.lastname: De Baetselier
authors.affiliation: Rinda Ubuzima, Kigali, Rwanda.
authors.forename: Lambert
authors.initials: L
authors.lastname: Mwambarangwe
authors.affiliation: Rinda Ubuzima, Kigali, Rwanda.
authors.forename: Viateur
authors.initials: V
authors.lastname: Musengamana
authors.affiliation: Rinda Ubuzima, Kigali, Rwanda.|Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.
authors.forename: Janneke
authors.initials: J
authors.lastname: van de Wijgert
authors.affiliation: Laboratory Bacteriology Research, Faculty of Medicine & Health Sciences, University of Ghent, Ghent, Belgium.
authors.forename: Mario
authors.initials: M
authors.lastname: Vaneechoutte
authors.affiliation: STI Reference Laboratory, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Tania
authors.initials: T
authors.lastname: Crucitti
keywords: ANTIBIOTIC SENSITIVITY; BACTERIAL VAGINOSIS; DIAGNOSIS; GENITAL TRACT INFECT; MICROBIOLOGY