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J Infect Dis. 2015 Sep 1;212(5):793-802. doi: 10.1093/infdis/jiv079. Epub 2015 Feb 12.

Rapid and Profound Shifts in the Vaginal Microbiota Following Antibiotic Treatment for Bacterial Vaginosis.

Author information

1
Vaccine and Infectious Disease Division.
2
Department of Medicine.
3
Vaccine and Infectious Disease Division Clinical Research Division, Fred Hutchinson Cancer Research Center Department of Medicine Department of Microbiology, University of Washington, Seattle.
4
Vaccine and Infectious Disease Division Clinical Research Division, Fred Hutchinson Cancer Research Center Department of Medicine.

Abstract

BACKGROUND:

Bacterial vaginosis (BV) is a common polymicrobial disease associated with numerous negative reproductive health outcomes, including an increased risk of human immunodeficiency virus acquisition. BV is treatable with antibiotics, but relapse is common. A more detailed understanding of bacterial dynamics during antibiotic therapy for BV could identify conditions that favor establishment, maintenance, and eradication of BV-associated bacterial species, thereby improving treatment outcomes.

METHODS:

We used mathematical models to analyze daily quantitative measurements of 11 key bacterial species during metronidazole treatment for 15 cases of BV.

RESULTS:

We identified complete reorganization of vaginal bacterial composition within a day of initiating therapy. Although baseline bacterial levels predicted a longer time to clearance, all anaerobic species were eliminated rapidly within a median of 3 days. However, reemergence of BV-associated species was common following treatment cessation. Gardnerella vaginalis, a facultative anaerobe, was cleared more slowly than anaerobic BV-associated species, and levels of G. vaginalis often rebounded during treatment. We observed gradual Lactobacillus species growth, indicating that untargeted microbes fill the transient vacuum formed during treatment.

CONCLUSIONS:

Under antibiotic pressure, the human microbiome can undergo rapid shifts on a scale of hours. When treatment is stopped, BV-associated bacteria quickly reemerge, suggesting a possible role for intermittent prophylactic treatment.

KEYWORDS:

Gardnerella vaginalis; Lactobacillus; bacterial vaginosis; mathematical modeling; metronidazole; qPCR; vaginal microbiota

PMID:
25676470
PMCID:
PMC4539900
DOI:
10.1093/infdis/jiv079
[Indexed for MEDLINE]
Free PMC Article

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