Study Redefines What a Healthy Vagina Is

WEDNESDAY, May 2 (HealthDay News) — Bacteria that live normally
in the vagina differ from woman to woman and can even change dramatically
in short periods of time in the same woman, a new analysis reveals.

The findings are likely to alter the one-size-fits-all diagnosis and
treatment of vaginal infections that currently prevails among
obstetricians and gynecologists.

“This certainly changes the diagnosis, treatment and prevention of
vaginosis (bacterial infection in the vagina),” said Stephen Dewhurst,
chairman of microbiology and immunology at the University of Rochester
Medical Center in New York. “Among other things, this makes vaginosis much
harder to diagnose. If [vaginal bacteria] change over time, how sure are
you that this really is vaginosis?”

Dewhurst was not involved with the study, which appears in the May 2
issue of the journal Science Translational Medicine.

“In the practice of medicine, all women have been considered pretty
much the same when it comes to vaginal microbiota, with the same
treatment,” said study senior author Jacques Ravel, an associate professor
of microbiology and immunology at the University of Maryland School of
Medicine in Baltimore. Antibiotics typically are prescribed to treat
vaginosis.

“In some people [treatments] work really well, and in some they fail,”
said Ravel, who also is associate director of the university’s Institute
for Genome Sciences. “Now we know it’s because not all women are made
equal.”

Prior research by the same group had identified five basic microbial
communities in the vagina. The researchers also found that these
communities tended to vary according to ethnicity.

The balance of microbial communities is vital in protecting women from
infections, including sexually transmitted diseases.

But bacterial vaginosis — when one type of bacteria thrives and
dominates other types, which raises the risk of infection — is extremely
common.

Ravel and his co-authors collected vaginal bacterial samples from 32
healthy, reproductive-age women twice a week for four months, and then
analyzed the samples using genomic techniques.

Again the researchers found five basic bacterial communities, and also
noted that some changed rapidly in the same woman while others stayed
stable.

In some cases, the collection of bacteria seen in a particular woman
would have indicated the presence of bacterial vaginosis, although these
women were healthy and not experiencing any symptoms.

“This changes what we consider to be a normal bacterial community in
the vagina,” Dewhurst said.

Changes in bacterial communities tended to correspond with estrogen
levels at different points in the menstrual cycle, the particular
composition of bacteria in a woman’s vagina and sexual activity.

It’s also likely that what a woman eats or the environment in which she
lives will affect microbial composition, Ravel added.

The authors postulated that microbiota that fluctuated regularly may
make a woman more vulnerable to infection.

“Bacterial vaginosis is linked to transmission of HIV and other
sexually transmitted diseases, so this is a potentially significant risk
factor for acquiring sexually transmitted diseases,” Dewhurst said.

And if it turns out that there is a “new normal” of vaginal microbiota
depending on the woman, this could curb the overuse of antibiotics, the
authors said.

Vaginal bacteria also can affect pregnancy and fertility. The
composition of vaginal microbiota and of a man’s sperm could mean that a
woman is fertile with one man and infertile with another, an accompanying
editorial suggested.

“We need to rethink the way we approach women’s health and treatment
and diagnosis,” Ravel said.

More information

The U.S. Centers for Disease Control and Prevention has more on bacterial vaginosis.

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