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The significance of Lactobacillus crispatus and L. vaginalis for vaginal health and the negative effect of recent sex: a cross-sectional descriptive study across groups of African women

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Abstract
Background: Women in sub-Saharan Africa are vulnerable to acquiring HIV infection and reproductive tract infections. Bacterial vaginosis (BV), a disruption of the vaginal microbiota, has been shown to be strongly associated with HIV infection. Risk factors related to potentially protective or harmful microbiota species are not known. Methods: We present cross-sectional quantitative polymerase chain reaction data of the Lactobacillus genus, five Lactobacillus species, and three BV-related bacteria (Gardnerella vaginalis, Atopobium vaginae, and Prevotella bivia) together with Escherichia coli and Candida albicans in 426 African women across different groups at risk for HIV. We selected a reference group of adult HIV-negative women at average risk for HIV acquisition and compared species variations in subgroups of adolescents, HIV-negative pregnant women, women engaging in traditional vaginal practices, sex workers and a group of HIV-positive women on combination antiretroviral therapy. We explored the associations between presence and quantity of the bacteria with BV by Nugent score, in relation to several factors of known or theoretical importance. Results: The presence of species across Kenyan, South African and Rwandan women was remarkably similar and few differences were seen between the two groups of reference women in Kenya and South Africa. The Rwandan sex workers and HIV-positive women had the highest Gardnerella vaginalis presence (p = 0.006). Pregnant women had a higher Lactobacillus genus mean log (7.01 genome equivalents (geq)/ml) compared to the reference women (6.08 geq/ml). L. vaginalis (43%) was second to L. iners (81.9%) highly present in women with a normal Nugent score. Recent sexual exposure negatively affected the presence of Lactobacillus crispatus (<0.001), L. vaginalis (p = 0.001), and Lactobacillus genus (p < 0.001). Having more than one sexual partner in the last three months was associated with an increased prevalence of Gardnerella vaginalis (p = 0.044) and L. iners (p = 0.001). Conclusions: Although the composition of species across the studied African countries was similar, the presence of protective species i.e. Lactobacillus crispatus and L. vaginalis in women with a normal Nugent score appeared lower compared to non-African studies. Furthermore, Lactobacillus species were negatively affected by sexual behavioural. Strategies to support protective Lactobacillus species are urgently needed.
Keywords
Vaginal microbiota, HIV prevention, Sexual health, Sub-Saharan Africa, quantitative PCR, Sexually transmitted infections, reproductive health, Lactobacillus, Bacterial vaginosis, REAL-TIME PCR, BACTERIAL VAGINOSIS, GARDNERELLA-VAGINALIS, REPRODUCTIVE HEALTH, MYCOPLASMA-HOMINIS, HIV ACQUISITION, JAPANESE WOMEN, RISK-FACTORS, LACTIC-ACID, MICROBIOTA

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Chicago
Jespers, Vicky, Janneke van de Wijgert, Piet Cools, Rita Verhelst, Hans Verstraelen, Sinead Delany-Moretlwe, Mary Mwaura, et al. 2015. “The Significance of Lactobacillus Crispatus and L. Vaginalis for Vaginal Health and the Negative Effect of Recent Sex: a Cross-sectional Descriptive Study Across Groups of African Women.” Bmc Infectious Diseases 15.
APA
Jespers, V., van de Wijgert, J., Cools, P., Verhelst, R., Verstraelen, H., Delany-Moretlwe, S., Mwaura, M., et al. (2015). The significance of Lactobacillus crispatus and L. vaginalis for vaginal health and the negative effect of recent sex: a cross-sectional descriptive study across groups of African women. BMC INFECTIOUS DISEASES, 15.
Vancouver
1.
Jespers V, van de Wijgert J, Cools P, Verhelst R, Verstraelen H, Delany-Moretlwe S, et al. The significance of Lactobacillus crispatus and L. vaginalis for vaginal health and the negative effect of recent sex: a cross-sectional descriptive study across groups of African women. BMC INFECTIOUS DISEASES. 2015;15.
MLA
Jespers, Vicky, Janneke van de Wijgert, Piet Cools, et al. “The Significance of Lactobacillus Crispatus and L. Vaginalis for Vaginal Health and the Negative Effect of Recent Sex: a Cross-sectional Descriptive Study Across Groups of African Women.” BMC INFECTIOUS DISEASES 15 (2015): n. pag. Print.
@article{7018117,
  abstract     = {Background: Women in sub-Saharan Africa are vulnerable to acquiring HIV infection and reproductive tract infections. Bacterial vaginosis (BV), a disruption of the vaginal microbiota, has been shown to be strongly associated with HIV infection. Risk factors related to potentially protective or harmful microbiota species are not known. 
Methods: We present cross-sectional quantitative polymerase chain reaction data of the Lactobacillus genus, five Lactobacillus species, and three BV-related bacteria (Gardnerella vaginalis, Atopobium vaginae, and Prevotella bivia) together with Escherichia coli and Candida albicans in 426 African women across different groups at risk for HIV. We selected a reference group of adult HIV-negative women at average risk for HIV acquisition and compared species variations in subgroups of adolescents, HIV-negative pregnant women, women engaging in traditional vaginal practices, sex workers and a group of HIV-positive women on combination antiretroviral therapy. We explored the associations between presence and quantity of the bacteria with BV by Nugent score, in relation to several factors of known or theoretical importance. 
Results: The presence of species across Kenyan, South African and Rwandan women was remarkably similar and few differences were seen between the two groups of reference women in Kenya and South Africa. The Rwandan sex workers and HIV-positive women had the highest Gardnerella vaginalis presence (p = 0.006). Pregnant women had a higher Lactobacillus genus mean log (7.01 genome equivalents (geq)/ml) compared to the reference women (6.08 geq/ml). L. vaginalis (43\%) was second to L. iners (81.9\%) highly present in women with a normal Nugent score. Recent sexual exposure negatively affected the presence of Lactobacillus crispatus ({\textlangle}0.001), L. vaginalis (p = 0.001), and Lactobacillus genus (p {\textlangle} 0.001). Having more than one sexual partner in the last three months was associated with an increased prevalence of Gardnerella vaginalis (p = 0.044) and L. iners (p = 0.001). 
Conclusions: Although the composition of species across the studied African countries was similar, the presence of protective species i.e. Lactobacillus crispatus and L. vaginalis in women with a normal Nugent score appeared lower compared to non-African studies. Furthermore, Lactobacillus species were negatively affected by sexual behavioural. Strategies to support protective Lactobacillus species are urgently needed.},
  articleno    = {115},
  author       = {Jespers, Vicky and van de Wijgert, Janneke and Cools, Piet and Verhelst, Rita and Verstraelen, Hans and Delany-Moretlwe, Sinead and Mwaura, Mary and Ndayisaba, Gilles F and Mandaliya, Kishor and Menten, Joris and Hardy, Liselotte and Crucitti, Tania},
  issn         = {1471-2334},
  journal      = {BMC INFECTIOUS DISEASES},
  keyword      = {Vaginal microbiota,HIV prevention,Sexual health,Sub-Saharan Africa,quantitative PCR,Sexually transmitted infections,reproductive health,Lactobacillus,Bacterial vaginosis,REAL-TIME PCR,BACTERIAL VAGINOSIS,GARDNERELLA-VAGINALIS,REPRODUCTIVE HEALTH,MYCOPLASMA-HOMINIS,HIV ACQUISITION,JAPANESE WOMEN,RISK-FACTORS,LACTIC-ACID,MICROBIOTA},
  language     = {eng},
  pages        = {14},
  title        = {The significance of Lactobacillus crispatus and L. vaginalis for vaginal health and the negative effect of recent sex: a cross-sectional descriptive study across groups of African women},
  url          = {http://dx.doi.org/10.1186/s12879-015-0825-z},
  volume       = {15},
  year         = {2015},
}

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