02 Mar Vaginal microbiota in African women

What sociodemographic, behavioural, and clinical profiles are linked to disruptions of vaginal bacteria in African women?

Not enough is known about the sociodemographic, behavioural, and clinical correlates of the bacterial environment of the vagina. The vaginal microbiome (VMB) can be characterized using molecular methods. In this study, the VMB of women in Kenya, Rwanda, South Africa, and Tanzania (KRST) was characterised using a 16S rDNA phylogenetic microarray. We quantified cytokines (markers of inflammation) in cervicovaginal lavages.

Five VMB clusters were identified in 313 samples from 230 women. Lactobacillus crispatus (KRST-I) dominated one cluster while L. iners (KRST-II) dominated another. Three clusters were not dominated by a single species but contained multiple (facultative) anaerobes (KRST-III/IV/V). We considered these latter clusters to reflect a disturbed microbial balance, which is also called ‘dysbiosis’. VMB clustering was not associated with sociodemographic or behavioral characteristics. Dysbiosis in African women was significantly associated with vaginal inflammation, reflected by an increase in pro-inflammatory cytokines. Furthermore, women who reported unusual vaginal discharge were more likely to belong to the cluster KRST-III/IV/V (p=0.05). A lower proportion of women in cluster KRST-I tested positive for bacterial sexually transmitted infections (STIs; p for trend=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 (p for trend=0.09). These latter associations did not reach statistical significance and should be confirmed in larger studies.

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