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Daubert E, Weber KM, French AL, Seidman D, Michel K, Gustafson D, Murphy K, Muzny CA, Alcaide M, Sheth A, Adimora AA, Spear GT. Obesity is associated with lower bacterial vaginosis prevalence in menopausal but not pre-menopausal women in a retrospective analysis of the Women's Interagency HIV Study. PLoS One 2021; 16:e0248136. [PMID: 33684141 PMCID: PMC7939367 DOI: 10.1371/journal.pone.0248136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/21/2021] [Indexed: 01/16/2023] Open
Abstract
The vaginal microbiota is known to impact women's health, but the biological factors that influence the composition of the microbiota are not fully understood. We previously observed that levels of glycogen in the lumen of the vagina were higher in women that had a high body mass index (BMI). Vaginal glycogen is thought to impact the composition of the vaginal microbiota. We therefore sought to determine if BMI was associated having or not having bacterial vaginosis (BV), as determined by the Amsel criteria. We also hypothesized that increased blood glucose levels could lead to the previously-observed higher vaginal glycogen levels and therefore investigated if hemoglobin A1c levels were associated with BV. We analyzed data from the Women's Interagency HIV Study using multiple multivariable (GEE) logistic regression models to assess the relationship between BMI, BV and blood glucose. Women with a BMI >30 kg/m2 (obese) had a lower rate (multivariable adjusted OR 0.87 (0.79-0.97), p = 0.009) of BV compared to the reference group (BMI 18.5-24.9 kg/m2). There was a significantly lower rate of BV in post-menopausal obese women compared to the post-menopausal reference group, but not in pre-menopausal women. HIV- post-menopausal obese women had a significantly lower rate of BV, but this was not seen in HIV+ post-menopausal obese women. Pre-menopausal women with a higher hemoglobin A1c (≥6.5%) had a significantly lower rate (multivariable adjusted OR 0.66 (0.49-0.91), p = 0.010) of BV compared to pre-menopausal women with normal hemoglobin A1c levels (<5.7%), but there was no difference in post-menopausal women. This study shows an inverse association of BMI with BV in post-menopausal women and hemoglobin A1c with BV in pre-menopausal women. Further studies are needed to confirm these relationships in other cohorts across different reproductive stages and to identify underlying mechanisms for these observed associations.
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Affiliation(s)
- Elizabeth Daubert
- Cook County Health/Hektoen Institute of Medicine, Chicago, IL, United States of America
| | - Kathleen M. Weber
- Cook County Health/Hektoen Institute of Medicine, Chicago, IL, United States of America
| | - Audrey L. French
- Department of Medicine, Stroger Hospital of Cook County, Chicago, IL, United States of America
| | - Dominika Seidman
- School of Medicine, University of California, San Francisco, CA, United States of America
| | - Katherine Michel
- Department of Infectious Diseases, School of Medicine, Georgetown University, Washington, D.C., United States of America
| | - Deborah Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences Medical Center, Brooklyn, New York, United States of America
| | - Kerry Murphy
- Department of Medicine, Montefiore at AECOM, Bronx, NY, United States of America
| | - Christina A. Muzny
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Maria Alcaide
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Anandi Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Adaora A. Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Gregory T. Spear
- Hektoen Institute of Medicine, Chicago, IL, United States of America
- * E-mail:
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Kancheva Landolt N, Chaithongwongwatthana S, Nilgate S, Teeratakulpisarn N, Ubolyam S, Apornpong T, Ananworanich J, Phanuphak N. Use of copper intrauterine device is not associated with higher bacterial vaginosis prevalence in Thai HIV-positive women. AIDS Care 2018; 30:1351-1355. [PMID: 29548268 DOI: 10.1080/09540121.2018.1450479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The study assessed and compared bacterial vaginosis (BV) prevalence in Thai women in reproductive age in four study groups - group 1, HIV-positive with copper intrauterine device (Cu-IUD); group 2, HIV-positive without Cu-IUD; group 3, HIV-negative with Cu-IUD; and group 4, HIV-negative without Cu-IUD. We conducted a cross-sectional study. BV prevalence was assessed by Nugent score and Amsel criteria. Descriptive statistics was used to present baseline characteristics; kwallis rank test - to compare variables between the four groups; logistic regression - to assess factors, related to BV prevalence. The analysis included 137 women in the four study groups with a median age of 39 years. Median BV prevalence by Nugent score was 45%, intermediate vaginal flora - 7% and normal vaginal flora - 48%. There was no statistically significant difference in the BV prevalence between the four study groups, p = 0.711. Threefold lower BV prevalence was found, assessed by Amsel criteria compared to Nugent score. Women with body mass index (BMI) < 20 had higher probability to have BV or intermediate vaginal flora, OR = 3.11, 95% CI (1.2-8.6), p = 0.025. The study found a high BV prevalence in the four study groups, related neither to HIV status, nor to Cu-IUD use. BV prevalence was associated only with low BMI. Thus, Cu-IUD could be a good contraceptive choice for HIV-positive women. Research in defining normal vaginal microbiota and improve diagnostic methods for BV should continue.
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Affiliation(s)
- Nadia Kancheva Landolt
- a The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT) , Bangkok , Thailand
| | | | - Sumanee Nilgate
- b Faculty of Medicine , Chulalongkorn University , Bangkok , Thailand
| | | | - Sasiwimol Ubolyam
- a The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT) , Bangkok , Thailand
| | - Tanakorn Apornpong
- a The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT) , Bangkok , Thailand
| | - Jintanat Ananworanich
- a The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT) , Bangkok , Thailand.,d SEARCH , Bangkok , Thailand.,e Faculty of Medicine , The University of Amsterdam , Amsterdam , The Netherlands
| | - Nittaya Phanuphak
- c The Thai Red Cross AIDS Research Centre , Bangkok , Thailand.,d SEARCH , Bangkok , Thailand
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- a The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT) , Bangkok , Thailand
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Ventolini G, Khandelwal N, Hutton K, Lugo J, Gygax SE, Schlabritz-Loutsevitch N. Obesity and recurrent vulvovaginal bacterial infections in women of reproductive age. Postgrad Med J 2017; 93:297. [PMID: 28057837 PMCID: PMC5520277 DOI: 10.1136/postgradmedj-2016-134638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Gary Ventolini
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, Texas, USA
| | - Nuvneet Khandelwal
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, Texas, USA
| | - Kathryn Hutton
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, Texas, USA
| | - Jonathan Lugo
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, Texas, USA
| | - Scott E Gygax
- Genesis Biotechnology Group, Femeris Women's Health Research Center, Hamilton, New Jersey, USA
| | - Natalia Schlabritz-Loutsevitch
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, Texas, USA
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Srinivasan U, Misra D, Marazita ML, Foxman B. Vaginal and oral microbes, host genotype and preterm birth. Med Hypotheses 2009; 73:963-75. [PMID: 19942083 PMCID: PMC4026093 DOI: 10.1016/j.mehy.2009.06.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Revised: 06/03/2009] [Accepted: 06/06/2009] [Indexed: 01/08/2023]
Abstract
Preterm birth (PTB) is a leading cause of infant mortality and morbidity in the US and across the globe. Infection and associated inflammation are important initiators for PTB pathways; an estimated 40% of PTBs are attributed to amniochorionic-decidual or systemic inflammation. Historically, intrauterine infections have been implicated in PTB; recent evidence suggests that infections remote from the fetal site may also be causative. There is strong epidemiological evidence that bacterial vaginosis and periodontitis--two syndromes characterized by perturbations in the normal vaginal and oral bacterial microflora, respectively--are linked to infection-associated PTB. Oral and vaginal environments are similar in their bacterial microbiology; identical bacterial species have been independently isolated in periodontitis and bacterial vaginosis. Periodontitis and bacterial vaginosis also share many behavioral and sociodemographic risk factors suggesting a possible common pathophysiology. Genetic polymorphisms in host inflammatory responses to infection are shared between bacterial vaginosis, periodontitis and PTB, suggesting common mechanisms through which host genotype modify the effect of abnormal bacterial colonization on preterm birth. We review the state of knowledge regarding the risk of PTB attributable to perturbations in bacterial flora in oral and vaginal sites and the role of host genetics in modifying the risk of infection-related PTB. We posit that bacterial species that are common in perturbed vaginal and oral sites are associated with PTB through their interaction with the host immune system.
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Affiliation(s)
- Usha Srinivasan
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
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