Semin Reprod Med 2014; 32(01): 028-034
DOI: 10.1055/s-0033-1361820
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Modulating the Vaginal Microbiome: The Need for a Bridge between Science and Practice

Gregor Reid
1   Lawson Health Research Institute
2   Department of Microbiology & Immunology, The University of Western Ontario
3   Department of Surgery, The University of Western Ontario, London, Canada
› Author Affiliations
Further Information

Publication History

Publication Date:
03 January 2014 (online)

Abstract

Infections of the urinary and reproductive tracts continue to afflict hundreds of millions of women and girls each year. For those fortunate enough to have access to medical care, the diagnostic and treatment measures used on them have changed little in 40 years and remain far from adequate. The development of alternatives, such as probiotics, has been hindered by lack of funding, but now face bureaucratic barriers that reflect an outdated regulatory system more concerned with policies than care for the patient. The technological advances emerging from human microbiome studies are making it possible to generate a completely new understanding of how microbes interact with the host, what influences them, and when the result is an aberration requiring intervention. But until bridges are built between scientific progress and practice, it is women and girls who will continue to receive suboptimal care for their often persistent and debilitating conditions.

 
  • References

  • 1 Hobday AJ, Haury L, Dayton PK. Function of the human hymen. Med Hypotheses 1997; 49 (2) 171-173
  • 2 Al-Achi A. An introduction to botanical medicines: history, science, uses, and dangers. Westport, CT: Praeger Publishers; 2008: 126
  • 3 van Leeuwenhoek A. Microscopical observations concerning blood, milk, bone, the brain, spittle, and cuticula, etc. Phil Trans 1674; 9: 121-128
  • 4 Reid G, Younes JA, Van der Mei HC, Gloor GB, Knight R, Busscher HJ. Microbiota restoration: natural and supplemented recovery of human microbial communities. Nat Rev Microbiol 2011; 9 (1) 27-38
  • 5 Hummelen R, Fernandes AD, Macklaim JM , et al. Deep sequencing of the vaginal microbiota of women with HIV. PLoS ONE 2010; 5 (8) e12078
  • 6 Zhou X, Westman R, Hickey R , et al. Vaginal microbiota of women with frequent vulvovaginal candidiasis. Infect Immun 2009; 77 (9) 4130-4135
  • 7 Siddiqui H, Nederbragt AJ, Lagesen K, Jeansson SL, Jakobsen KS. Assessing diversity of the female urine microbiota by high throughput sequencing of 16S rDNA amplicons. BMC Microbiol 2011; 11: 244
  • 8 Ravel J, Gajer P, Abdo Z , et al. Vaginal microbiome of reproductive-age women. Proc Natl Acad Sci U S A 2011; 108 (Suppl. 01) 4680-4687
  • 9 Brown JM, Hess KL, Brown S, Murphy C, Waldman AL, Hezareh M. Intravaginal practices and risk of bacterial vaginosis and candidiasis infection among a cohort of women in the United States. Obstet Gynecol 2013; 121 (4) 773-780
  • 10 Ferris DG, Nyirjesy P, Sobel JD, Soper D, Pavletic A, Litaker MS. Over-the-counter antifungal drug misuse associated with patient-diagnosed vulvovaginal candidiasis. Obstet Gynecol 2002; 99 (3) 419-425
  • 11 Shipitsyna E, Roos A, Datcu R , et al. Composition of the vaginal microbiota in women of reproductive age—sensitive and specific molecular diagnosis of bacterial vaginosis is possible?. PLoS ONE 2013; 8 (4) e60670
  • 12 Gardner HL, Dukes CD. Haemophilus vaginalis vaginitis: a newly defined specific infection previously classified non-specific vaginitis. Am J Obstet Gynecol 1955; 69 (5) 962-976
  • 13 Holmes KK, Spiegel C, Amsel AR, Eschenbach DA, Chen KC, Totten P. Nonspecific vaginosis. Scand J Infect Dis Suppl 1981; 26: 110-114
  • 14 Greaves WL, Chungafung J, Morris B, Haile A, Townsend JL. Clindamycin versus metronidazole in the treatment of bacterial vaginosis. Obstet Gynecol 1988; 72 (5) 799-802
  • 15 Koren O, Knights D, Gonzalez A , et al. A guide to enterotypes across the human body: meta-analysis of microbial community structures in human microbiome datasets. PLoS Comput Biol 2013; 9 (1) e1002863
  • 16 Fernandes AD, Macklaim JM, Linn TG, Reid G, Gloor GB. ANOVA-like differential expression (ALDEx) analysis for mixed population RNA-Seq. PLoS ONE 2013; 8 (7) e67019
  • 17 Oduyebo OO, Anorlu RI, Ogunsola FT. The effects of antimicrobial therapy on bacterial vaginosis in non-pregnant women. Cochrane Database Syst Rev 2009; (3) CD006055
  • 18 Sobel J, Peipert JF, McGregor JA , et al. Efficacy of clindamycin vaginal ovule (3-day treatment) vs. clindamycin vaginal cream (7-day treatment) in bacterial vaginosis. Infect Dis Obstet Gynecol 2001; 9 (1) 9-15
  • 19 Ferris DG, Litaker MS, Woodward L, Mathis D, Hendrich J. Treatment of bacterial vaginosis: a comparison of oral metronidazole, metronidazole vaginal gel, and clindamycin vaginal cream. J Fam Pract 1995; 41 (5) 443-449
  • 20 Ugwumadu AH, Hay P. Bacterial vaginosis: sequelae and management. Curr Opin Infect Dis 1999; 12 (1) 53-59
  • 21 O'Dowd TC, Parker S, Kelly A. Women's experiences of general practitioner management of their vaginal symptoms. Br J Gen Pract 1996; 46 (408) 415-418
  • 22 Johnson SR, Griffiths H, Humberstone FJ. Attitudes and experience of women to common vaginal infections. J Low Genit Tract Dis 2010; 14 (4) 287-294
  • 23 Payne SC, Cromer PR, Stanek MK, Palmer AA. Evidence of African-American women's frustrations with chronic recurrent bacterial vaginosis. J Am Acad Nurse Pract 2010; 22 (2) 101-108
  • 24 Reid G, Zorzitto ML, Bruce AW, Jewett MAS, Chan RCY, Costerton JW. The pathogenesis of urinary tract infection in the elderly: the role of bacterial adherence to uroepithelial cells. Curr Microbiol 1984; 11 (2) 67-72
  • 25 Kirjavainen P, Pautler S, Baroja ML , et al. Aberrant vaginal microbiota and IL-12 skewed cytokine production by antigen-presenting cells are characteristic of women prone to urinary tract infections. Clin Vaccine Immunol 2008; 16 (1) 29-36
  • 26 Davis CP, Cohen MS, Anderson MD, Gruber MB, Warren MM. Urothelial hyperplasia and neoplasia. II. Detection of nitrosamines and interferon in chronic urinary tract infections in rats. J Urol 1985; 134 (5) 1002-1006
  • 27 Nordenstam GR, Brandberg CA, Odén AS, Svanborg Edén CM, Svanborg A. Bacteriuria and mortality in an elderly population. N Engl J Med 1986; 314 (18) 1152-1156
  • 28 Williams DH, Schaeffer AJ. Current concepts in urinary tract infections. Minerva Urol Nefrol 2004; 56 (1) 15-31
  • 29 Wagenlehner FM, Hoyme U, Kaase M, Fünfstück R, Naber KG, Schmiemann G. Uncomplicated urinary tract infections. Dtsch Arztebl Int 2011; 108 (24) 415-423
  • 30 Raz R. Fosfomycin: an old—new antibiotic. Clin Microbiol Infect 2012; 18 (1) 4-7
  • 31 Madani Y, Mann B. Nitrofurantoin-induced lung disease and prophylaxis of urinary tract infections. Prim Care Respir J 2012; 21 (3) 337-341
  • 32 Ferry SA, Holm SE, Stenlund H, Lundholm R, Monsen TJ. Clinical and bacteriological outcome of different doses and duration of pivmecillinam compared with placebo therapy of uncomplicated lower urinary tract infection in women: the LUTIW project. Scand J Prim Health Care 2007; 25 (1) 49-57
  • 33 Kim TK, Thomas SM, Ho M , et al. Heterogeneity of vaginal microbial communities within individuals. J Clin Microbiol 2009; 47 (4) 1181-1189
  • 34 Hickey RJ, Zhou X, Pierson JD, Ravel J, Forney LJ. Understanding vaginal microbiome complexity from an ecological perspective. Transl Res 2012; 160 (4) 267-282
  • 35 Menard JP, Mazouni C, Fenollar F, Raoult D, Boubli L, Bretelle F. Diagnostic accuracy of quantitative real-time PCR assay versus clinical and Gram stain identification of bacterial vaginosis. Eur J Clin Microbiol Infect Dis 2010; 29 (12) 1547-1552
  • 36 Macklaim JM, Cohen CR, Donders G , et al. Exploring a road map to counter misconceptions about the cervicovaginal microbiome and disease. Reprod Sci 2012; 19 (11) 1154-1162
  • 37 Hall-Stoodley L, Stoodley P. Evolving concepts in biofilm infections. Cell Microbiol 2009; 11 (7) 1034-1043
  • 38 Conrad D, Haynes M, Salamon P, Rainey PB, Youle M, Rohwer F. Cystic fibrosis therapy: a community ecology perspective. Am J Respir Cell Mol Biol 2013; 48 (2) 150-156
  • 39 Qin Z, Yang L, Qu D, Molin S, Tolker-Nielsen T. Pseudomonas aeruginosa extracellular products inhibit staphylococcal growth, and disrupt established biofilms produced by Staphylococcus epidermidis . Microbiology 2009; 155 (Pt 7) 2148-2156
  • 40 McMillan A, Dell M, Zellar MP , et al. Disruption of urogenital biofilms by lactobacilli. Colloids Surf B Biointerfaces 2011; 86 (1) 58-64
  • 41 Absolom DR. The role of bacterial hydrophobicity in infection: bacterial adhesion and phagocytic ingestion. Can J Microbiol 1988; 34 (3) 287-298
  • 42 Verstraelen H, Swidsinski A. The biofilm in bacterial vaginosis: implications for epidemiology, diagnosis and treatment. Curr Opin Infect Dis 2013; 26 (1) 86-89
  • 43 Macklaim JM, Fernandes AD, Reid G, Gloor GB. Comparative meta-RNA-seq of the vaginal microbiota and differential expression by Lactobacillus iners in health and dysbiosis. Microbiome 2013; 1: 12
  • 44 Nicholson JK, Holmes E, Kinross JM, Darzi AW, Takats Z, Lindon JC. Metabolic phenotyping in clinical and surgical environments. Nature 2012; 491 (7424) 384-392
  • 45 Luong ML, Libman M, Dahhou M , et al. Vaginal douching, bacterial vaginosis, and spontaneous preterm birth. J Obstet Gynaecol Can 2010; 32 (4) 313-320
  • 46 Enos M, Burton JP, Dols J , et al. Probiotics for the first 1000 days of life in the developing world. . Benef. Microbes 2013; 4 (1) 3-16
  • 47 Reid G, Charbonneau D, Erb J , et al. Oral use of Lactobacillus rhamnosus GR-1 and L. fermentum RC-14 significantly alters vaginal flora: randomized, placebo-controlled trial in 64 healthy women. FEMS Immunol Med Microbiol 2003; 35 (2) 131-134
  • 48 Beerepoot MA, ter Riet G, Nys S , et al. Lactobacilli vs antibiotics to prevent urinary tract infections: a randomized, double-blind, noninferiority trial in postmenopausal women. Arch Intern Med 2012; 172 (9) 704-712
  • 49 Morelli L, Zonenenschain D, Del Piano M, Cognein P. Utilization of the intestinal tract as a delivery system for urogenital probiotics. J Clin Gastroenterol 2004; 38 (6, Suppl): S107-S110