BACKGROUND: Large datasets for investigating vaginal flora change at frequent, repeated intervals are limited and graphical methods for exploring such data are inadequate. We report 2-year weekly vaginal flora changes based on Gram stain using lasagna plots. METHODS: Weekly vaginal flora patterns were evaluated among 211 sexually experienced women with ≥18 months of follow-up in Rakai, Uganda. Vaginal flora swabs were self-collected weekly and categorized by Nugent Gram stain criteria (0-3, normal; 4-6, intermediate; 7-10, bacterial vaginosis [BV]). Vaginal flora patterns were analyzed as the percentage of weekly observations with BV (longitudinal prevalence) and illustrated by lasagna plots. Characteristics of women were compared across tertiles of longitudinal prevalence of BV. RESULTS: Ninety-five percent of women had at least 1 episode of BV over 2 years, with one-third of women spending more than half (52%-100%) of their time with BV. Vaginal pH >4.5 increased with increasing tertiles of longitudinal prevalence of BV (P < 0.001). Weekly fluctuation in vaginal flora states, as measured by a change in flora states from the before current visit, was highest in the middle (41.9%) compared with the lower (30.1%) and upper tertiles (27.8%, P < 0.001). HIV status and reported vaginal symptoms did not differ significantly across BV tertiles. CONCLUSIONS: Women exhibited different patterns of vaginal flora changes over time, which could not be described by baseline behaviors. Lasagna plots aided in describing the natural history of BV within and across women and may be applied to future BV natural history studies.
BACKGROUND: Large datasets for investigating vaginal flora change at frequent, repeated intervals are limited and graphical methods for exploring such data are inadequate. We report 2-year weekly vaginal flora changes based on Gram stain using lasagna plots. METHODS: Weekly vaginal flora patterns were evaluated among 211 sexually experienced women with ≥18 months of follow-up in Rakai, Uganda. Vaginal flora swabs were self-collected weekly and categorized by Nugent Gram stain criteria (0-3, normal; 4-6, intermediate; 7-10, bacterial vaginosis [BV]). Vaginal flora patterns were analyzed as the percentage of weekly observations with BV (longitudinal prevalence) and illustrated by lasagna plots. Characteristics of women were compared across tertiles of longitudinal prevalence of BV. RESULTS: Ninety-five percent of women had at least 1 episode of BV over 2 years, with one-third of women spending more than half (52%-100%) of their time with BV. Vaginal pH >4.5 increased with increasing tertiles of longitudinal prevalence of BV (P < 0.001). Weekly fluctuation in vaginal flora states, as measured by a change in flora states from the before current visit, was highest in the middle (41.9%) compared with the lower (30.1%) and upper tertiles (27.8%, P < 0.001). HIV status and reported vaginal symptoms did not differ significantly across BV tertiles. CONCLUSIONS:Women exhibited different patterns of vaginal flora changes over time, which could not be described by baseline behaviors. Lasagna plots aided in describing the natural history of BV within and across women and may be applied to future BV natural history studies.
Authors: Rebecca M Brotman; Emily J Erbelding; Roxanne M Jamshidi; Mark A Klebanoff; Jonathan M Zenilman; Khalil G Ghanem Journal: J Pediatr Adolesc Gynecol Date: 2007-08 Impact factor: 1.814
Authors: D J Jamieson; A Duerr; R S Klein; P Paramsothy; W Brown; S Cu-Uvin; A Rompalo; J Sobel Journal: Obstet Gynecol Date: 2001-10 Impact factor: 7.661
Authors: D Heather Watts; Gayle Springer; Howard Minkoff; Sharon L Hillier; Lisa Jacobson; Michael Moxley; Jessica Justman; Helen Cejtin; Casey O'Connell; Ruth M Greenblatt Journal: J Acquir Immune Defic Syndr Date: 2006-10-01 Impact factor: 3.731
Authors: Jeanne M Marrazzo; David H Martin; D Heather Watts; Joann Schulte; Jack D Sobel; Sharon L Hillier; Carolyn Deal; David N Fredricks Journal: Sex Transm Dis Date: 2010-12 Impact factor: 2.830
Authors: Mark A Klebanoff; Jane R Schwebke; Jun Zhang; Tonja R Nansel; Kai-Fun Yu; William W Andrews Journal: Obstet Gynecol Date: 2004-08 Impact factor: 7.661
Authors: Lance B Price; Cindy M Liu; Kristine E Johnson; Maliha Aziz; Matthew K Lau; Jolene Bowers; Jacques Ravel; Paul S Keim; David Serwadda; Maria J Wawer; Ronald H Gray Journal: PLoS One Date: 2010-01-06 Impact factor: 3.240
Authors: Cindy M Liu; Bruce A Hungate; Aaron A R Tobian; Jacques Ravel; Jessica L Prodger; David Serwadda; Godfrey Kigozi; Ronald M Galiwango; Fred Nalugoda; Paul Keim; Maria J Wawer; Lance B Price; Ronald H Gray Journal: MBio Date: 2015-06-16 Impact factor: 7.867
Authors: Muriel Aldunate; Daniela Srbinovski; Anna C Hearps; Catherine F Latham; Paul A Ramsland; Raffi Gugasyan; Richard A Cone; Gilda Tachedjian Journal: Front Physiol Date: 2015-06-02 Impact factor: 4.566
Authors: Catriona S Bradshaw; Jennifer Walker; Christopher K Fairley; Marcus Y Chen; Sepehr N Tabrizi; Basil Donovan; John M Kaldor; Kathryn McNamee; Eve Urban; Sandra Walker; Marian Currie; Hudson Birden; Francis Bowden; Suzanne Garland; Marie Pirotta; Lyle Gurrin; Jane S Hocking Journal: PLoS One Date: 2013-03-05 Impact factor: 3.240
Authors: Sujatha Srinivasan; Martin T Morgan; Congzhou Liu; Frederick A Matsen; Noah G Hoffman; Tina L Fiedler; Kathy J Agnew; Jeanne M Marrazzo; David N Fredricks Journal: PLoS One Date: 2013-10-24 Impact factor: 3.240