Bridget M Whitney1, Sujatha Srinivasan2, Kenneth Tapia3, Eric Munene Muriuki4, Bhavna H Chohan5, Jacqueline M Wallis2, Congzhou Liu2, Brandon L Guthrie6, R Scott McClelland7, Noah G Hoffman8, David N Fredricks9, Alison C Roxby10. 1. Department of Epidemiology, University of Washington, Seattle, Washington, USA. 2. Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA. 3. Department of Global Health, University of Washington, Seattle, Washington, USA. 4. Institute of Infectious and Tropical Diseases (UNITID), University of Nairobi, Nairobi, Kenya. 5. Department of Global Health, University of Washington, and Kenya Medical Research Institute, Nairobi, Kenya. 6. Department of Global Health and Epidemiology, University of Washington, Seattle, Washington, USA. 7. Department of Medicine, Global Health, and Epidemiology, University of Washington, Seattle, Washington, USA. 8. Department of Medicine, University of Washington, Seattle, Washington, USA. 9. Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, and Department of Medicine, University of Washington, Seattle, Washington, USA. 10. Department of Medicine and Global Health, University of Washington, Seattle, Washington, USA.
Abstract
BACKGROUND: The vaginal microbiome plays a key role in women's reproductive health. Use of exogenous hormones, such as intramuscular depot medroxyprogesterone acetate (DMPA-IM), may alter the composition of vaginal bacterial community. METHODS: Vaginal swab samples were collected from postpartum Kenyan women initiating DMPA-IM or nonhormonal contraception (non-HC). Bacterial vaginosis was assessed by Nugent score (Nugent-BV) and bacterial community composition was evaluated using broad-range 16S ribosomal RNA gene polymerase chain reaction with high-throughput sequencing. Changes in Nugent score, alpha diversity (Shannon diversity index), and total bacterial load between contraceptive groups from enrollment to 3 months after initiation were estimated using multivariable linear mixed effects regression. RESULTS: Among 54 human immunodeficiency virus-negative women, 33 choosing DMPA-IM and 21 choosing non-HC, Nugent-BV was more common among DMPA-IM users at enrollment. At follow-up, Nugent score had decreased significantly among DMPA-IM users (change, -1.89; 95% confidence interval [CI], -3.53 to -.25; P = .02) while alpha diversity remained stable (0.03; -.24 to .30; P = .83). Conversely, Nugent score remained relatively stable among non-HC users (change, -0.73; 95% CI, -2.18 to .73; P = .33) while alpha diversity decreased (-0.34; -.67 to -.001; P = .05). The total bacterial load decreased slightly in DMPA-IM users and increased slightly among non-HC users, resulting in a significant difference in change between the contraceptive groups (difference, -0.64 log10 gene copies per swab sample; 95% CI, -1.19 to -.08; P = .02). While significant changes in Nugent score and alpha diversity were observed within contraceptive groups, changes between groups were not significantly different. CONCLUSIONS: Postpartum vaginal bacterial diversity did not change in DMPA-IM users despite a reduction in Nugent-BV, but it decreased significantly among women using non-HC. Choice of contraception may influence Lactobacillus recovery in postpartum women.
BACKGROUND: The vaginal microbiome plays a key role in women's reproductive health. Use of exogenous hormones, such as intramuscular depot medroxyprogesterone acetate (DMPA-IM), may alter the composition of vaginal bacterial community. METHODS: Vaginal swab samples were collected from postpartum Kenyan women initiating DMPA-IM or nonhormonal contraception (non-HC). Bacterial vaginosis was assessed by Nugent score (Nugent-BV) and bacterial community composition was evaluated using broad-range 16S ribosomal RNA gene polymerase chain reaction with high-throughput sequencing. Changes in Nugent score, alpha diversity (Shannon diversity index), and total bacterial load between contraceptive groups from enrollment to 3 months after initiation were estimated using multivariable linear mixed effects regression. RESULTS: Among 54 human immunodeficiency virus-negative women, 33 choosing DMPA-IM and 21 choosing non-HC, Nugent-BV was more common among DMPA-IM users at enrollment. At follow-up, Nugent score had decreased significantly among DMPA-IM users (change, -1.89; 95% confidence interval [CI], -3.53 to -.25; P = .02) while alpha diversity remained stable (0.03; -.24 to .30; P = .83). Conversely, Nugent score remained relatively stable among non-HC users (change, -0.73; 95% CI, -2.18 to .73; P = .33) while alpha diversity decreased (-0.34; -.67 to -.001; P = .05). The total bacterial load decreased slightly in DMPA-IM users and increased slightly among non-HC users, resulting in a significant difference in change between the contraceptive groups (difference, -0.64 log10 gene copies per swab sample; 95% CI, -1.19 to -.08; P = .02). While significant changes in Nugent score and alpha diversity were observed within contraceptive groups, changes between groups were not significantly different. CONCLUSIONS: Postpartum vaginal bacterial diversity did not change in DMPA-IM users despite a reduction in Nugent-BV, but it decreased significantly among women using non-HC. Choice of contraception may influence Lactobacillus recovery in postpartum women.
Authors: Alison C Roxby; David N Fredricks; Katherine Odem-Davis; Kristjana Ásbjörnsdóttir; Linnet Masese; Tina L Fiedler; Stephen De Rosa; Walter Jaoko; James N Kiarie; Julie Overbaugh; R Scott McClelland Journal: J Acquir Immune Defic Syndr Date: 2016-04-01 Impact factor: 3.731
Authors: Jennifer E Balkus; Sujatha Srinivasan; Omu Anzala; Joshua Kimani; Chloe Andac; Jane Schwebke; David N Fredricks; R Scott McClelland Journal: J Infect Dis Date: 2017-03-01 Impact factor: 5.226
Authors: Elizabeth H Byrne; Melis N Anahtar; Kathleen E Cohen; Amber Moodley; Nikita Padavattan; Nasreen Ismail; Brittany A Bowman; Gregory S Olson; Amanda Mabhula; Alasdair Leslie; Thumbi Ndung'u; Bruce D Walker; Musie S Ghebremichael; Krista L Dong; Douglas S Kwon Journal: Lancet Infect Dis Date: 2015-12-24 Impact factor: 25.071
Authors: H L Martin; B A Richardson; P M Nyange; L Lavreys; S L Hillier; B Chohan; K Mandaliya; J O Ndinya-Achola; J Bwayo; J Kreiss Journal: J Infect Dis Date: 1999-12 Impact factor: 5.226
Authors: J M Baeten; P M Nyange; B A Richardson; L Lavreys; B Chohan; H L Martin; K Mandaliya; J O Ndinya-Achola; J J Bwayo; J K Kreiss Journal: Am J Obstet Gynecol Date: 2001-08 Impact factor: 8.661
Authors: Sujatha Srinivasan; Noah G Hoffman; Martin T Morgan; Frederick A Matsen; Tina L Fiedler; Robert W Hall; Frederick J Ross; Connor O McCoy; Roger Bumgarner; Jeanne M Marrazzo; David N Fredricks Journal: PLoS One Date: 2012-06-18 Impact factor: 3.240
Authors: Enis Afgan; Dannon Baker; Bérénice Batut; Marius van den Beek; Dave Bouvier; Martin Cech; John Chilton; Dave Clements; Nate Coraor; Björn A Grüning; Aysam Guerler; Jennifer Hillman-Jackson; Saskia Hiltemann; Vahid Jalili; Helena Rasche; Nicola Soranzo; Jeremy Goecks; James Taylor; Anton Nekrutenko; Daniel Blankenberg Journal: Nucleic Acids Res Date: 2018-07-02 Impact factor: 16.971
Authors: Bridget M Whitney; Brandon L Guthrie; Sujatha Srinivasan; Kenneth Tapia; Eric Munene Muriuki; Bhavna H Chohan; Jacqueline M Wallis; Congzhou Liu; R Scott McClelland; David N Fredricks; Alison C Roxby Journal: PLoS One Date: 2020-03-05 Impact factor: 3.240