title: Alterations in the Genital Microbiota in Women With Spinal Cord Injury.
abstract: OBJECTIVE
  To evaluate the vaginal and cervical microbiota in women with spinal cord injury compared with mobile women.
  
  
  METHODS
  Fifty-two women with spinal cord injury (study group) and 57 mobile women (control group) were evaluated in a case-control study. All answered a structured questionnaire and were submitted to the following microbiological tests: microscopic examination of vaginal secretions for Trichomonas vaginalis and yeasts, Nugent score by Gram stain, bacterial culture, yeast culture, and endocervical sampling for Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma species.
  
  
  RESULTS
  Candida species detected by direct microscopic examination of vaginal fluid was more common in women with spinal cord injuries than in control women: 17.3% (9/52) compared with 3.5% (2/57), respectively (P=.017). However, the frequency of yeast-positive cultures was similar in both groups (21.2% [10/52] compared with 15.8% [14/57]). Women with spinal cord injury were more likely to have positive vaginal cultures for Escherichia coli (15.4% [8/52] compared with 0% [0/57], P=.002) and Corynebacterium species (25.0% [13/52] compared with 8.8% [5/57], P=.037) and less likely for Lactobacillus species (63.5% [33/52] compared with 94.7% [54/57], P<.001). Women with spinal cord injury were more likely to have intermediate flora by Gram stain (Nugent score 4-6) than did the women in the control group (13.5% [7/52] compared with 1.8% [1/57], P=.033). The frequency of Mycoplasma species detection was similar in both groups (36.9% [18/52] compared with 34.6% [21/57]). No woman in either group was positive for T vaginalis, C trachomatis, or N gonorrhoeae.
  
  
  CONCLUSIONS
  Women with spinal cord injury have an alteration in their vaginal microbiota away from a Lactobacillus species-dominated flora and a higher concentration of vaginal Candida species than do mobile women.
authors.affiliation: Discipline of Gynecology, Department of Obstetrics and Gynecology, College of Medicine, University of São Paulo, São Paulo, Brazil; and the Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York.
authors.forename: Cristhiane V G
authors.initials: CV
authors.lastname: Pires
authors.forename: Iara M
authors.initials: IM
authors.lastname: Linhares
authors.forename: Felipe
authors.initials: F
authors.lastname: Serzedello
authors.forename: Eiko I
authors.initials: EI
authors.lastname: Fukazawa
authors.forename: Edmund C
authors.initials: EC
authors.lastname: Baracat
authors.forename: Steven S
authors.initials: SS
authors.lastname: Witkin
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002584:Cervix Uteri / Q000382:microbiology*; D005260:Female; D006801:Humans; D064307:Microbiota; D008875:Middle Aged; D013119:Spinal Cord Injuries / Q000382:microbiology*; D014621:Vagina / Q000382:microbiology*; D014626:Vaginal Smears; D055815:Young Adult