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Clin Microbiol Infect. 2019 Jan;25(1):35-47. doi: 10.1016/j.cmi.2018.04.019. Epub 2018 May 3.

The vaginal microbiota and its association with human papillomavirus, Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium infections: a systematic review and meta-analysis.

Author information

1
Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), UVSQ, INSERM, Institut Pasteur, Université Paris-Saclay, Paris, France. Electronic address: Jeanne.tamarelle@uvsq.fr.
2
Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), UVSQ, INSERM, Institut Pasteur, Université Paris-Saclay, Paris, France.
3
USC EA 3671 Mycoplasmal and Chlamydial Infections in Humans, University of Bordeaux, Bordeaux, France; French National Reference Centre for Bacterial STIs, CHU Bordeaux, Bordeaux, France.
4
Institute for Genome Sciences and Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, USA.
5
Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), UVSQ, INSERM, Institut Pasteur, Université Paris-Saclay, Paris, France; AP-HP, Raymond-Poincaré Hospital, Garches, France.

Abstract

BACKGROUND:

The vaginal microbiota may modulate susceptibility to human papillomavirus (HPV), Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium infections. Persistent infection with a carcinogenic HPV is a prerequisite for cervical cancer, and C. trachomatis, N. gonorrheae and M. genitalium genital infections are all associated with pelvic inflammatory disease and subsequent infertility issues.

OBJECTIVES:

To evaluate the association between these infections and the vaginal microbiota.

DATA SOURCES:

The search was conducted on Medline and the Web of Science for articles published between 2000 and 2016.

STUDY ELIGIBILITY CRITERIA:

Inclusion criteria included a measure of association for vaginal microbiota and one of the considered STIs, female population, cohort, cross-sectional and interventional designs, and the use of PCR methods for pathogen detection.

METHODS:

The vaginal microbiota was dichotomized into high-Lactobacillus vaginal microbiota (HL-VMB) and low-Lactobacillus vaginal microbiota (LL-VMB), using either Nugent score, Amsel's criteria, presence of clue cells or gene sequencing. A random effects model assuming heterogeneity among the studies was used for each STI considered.

RESULTS:

The search yielded 1054 articles, of which 39 met the inclusion criteria. Measures of association with LL-VMB ranged from 0.6 (95% CI 0.3-1.2) to 2.8 (95% CI 0.3-28.0), 0.7 (95% CI 0.4-1.2) to 5.2 (95% CI 1.9-14.8), 0.8 (95% CI 0.5-1.4) to 3.8 (95% CI 0.4-36.2) and 0.4 (95% CI 0.1-1.5) to 6.1 (95% CI 2.0-18.5) for HPV, C. trachomatis, N. gonorrhoeae and M. genitalium infections, respectively.

CONCLUSIONS:

Although no clear trend for N. gonorrhoeae and M. genitalium infections could be detected, our results support a protective role of HL-VMB for HPV and C. trachomatis. Overall, these findings advocate for the use of high-resolution characterization methods for the vaginal microbiota and the need for longitudinal studies to lay the foundation for its integration in prevention and treatment strategies.

KEYWORDS:

Chlamydia trachomatis; Human papillomavirus; Meta-analysis; Mycoplasma genitalium; Neisseria gonorrhoeae; Sexually transmitted infection; Vaginal microbiota

PMID:
29729331
DOI:
10.1016/j.cmi.2018.04.019

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