Association between dysbiosis of the vaginal microbiota and bacterial infections
 
Apoorva¹, Somesh Gupta^1*, Seema Sood², Benu Dhawan², Garima Kacchawa³, A.K.Saxena⁴
Departments of ¹Dermatology and Venereology,²Microbiology, ³Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India, ⁴Dermatology and S.T.D Department, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
*Corresponding author
 
Introduction: A healthy vaginal flora is composed of facultative and strict anaerobes with Lactobacillus species being predominant. Decrease in the protective lactobacilli and concomitant increase in anaerobic bacteria leads to bacterial vaginosis (BV). Alterations in the composition of the vaginal flora is associated with adverse reproductive outcomes and acquisition and transmission of sexually transmitted infections (STIs) e.g. Neisseria gonorrhea, Chlamydia trachomatis, Mycoplasma species and human immunodeficiency virus (HIV).
 
Aim & Objectives: The study was conducted to assess the prevalence of bacterial infections of vaginal tract in women with abnormal flora and its correlation with severity of dysbiosis.
MATERIALS & METHODS: Thirty five sexually active non-pregnant women between 18-45 years of age who presented with self reported symptoms of vaginitis (vaginal discharge/ genital itching/ genital burning/ lower abdominal pain) were included in the study. Vaginal swab specimens were collected from the lateral wall of the vagina and abundance of various bacterial morphotypes was assessed by microscopic evaluation of Gram stained smears using the Nugent scoring method for diagnosis of BV. Samples with a score of ≥4 suggestive of dysbiosis were processed further for polymerase chain reaction (PCR) based detection of Neisseria gonorrhea, Chlamydia trachomatis, Mycoplasma genitalium, Mycoplasma hominis and Ureaplasma urealyticum.
 
Results: Nugent's score ≥4 was reported in 15 (42.86%) out of 35 women enrolled in the study. Among these women with dysbiosis, Chlamydia trachomatis was detected in 1 (6.67%), Mycoplasma hominis in 2 (13.33%) and Ureaplasma urealyticum in 1 (6.6.7%) out of 15 samples. None of these 15 samples were positive for Neisseria gonorrhea and Mycoplasma genitalium. Co-infection with other bacteria was found in BV positive women.
 
Conclusion: Vaginal dysbiosis may be associated with other bacterial infections and therefore regular screening for co-existing pathogens contributing to STIs should be encouraged.