Changes in the vaginal microbiota following antibiotic treatment for Mycoplasma genitalium, Chlamydia trachomatis and bacterial vaginosis

PLoS One. 2020 Jul 28;15(7):e0236036. doi: 10.1371/journal.pone.0236036. eCollection 2020.

Abstract

The human vagina harbor a rich microbiota. The optimal state is dominated by lactobacilli that help to maintain health and prevent various diseases. However, the microbiota may rapidly change to a polymicrobial state that has been linked to a number of diseases. In the present study, the temporal changes of the vaginal microbiota in patients treated for sexually transmitted diseases or bacterial vaginosis (BV) and in untreated controls were studied for 26 days. The patients included 52 women treated with azithromycin, tetracyclines or moxifloxacin for present or suspected infection with Chlamydia trachomatis or Mycoplasma genitalium. Women with concurrent BV were also treated with metronidazole. The controls were 10 healthy women of matching age. The microbiota was analyzed by 16S rRNA gene deep sequencing, specific qPCRs and microscopy. There was generally good correlation between Nugent score and community state type (CST) and qPCR confirmed the sequencing results. By sequencing, more than 600 different taxa were found, but only 33 constituted more than 1 ‰ of the sequences. In both patients and controls the microbiota could be divided into three different community state types, CST-I, CST-III and CST-IV. Without metronidazole, the microbiota remained relatively stable regarding CST although changes were seen during menstrual periods. Administration of metronidazole changed the microbiota from CST-IV to CST-III in approximately 50% of the treated patients. In contrast, the CST was generally unaffected by azithromycin or tetracyclines. In 30% of the BV patients, Gardnerella vaginalis was not eradicated by metronidazole. The majority of women colonized with Ureaplasma parvum remained positive after azithromycin while U. urealyticum was eradicated.

MeSH terms

  • Adolescent
  • Adult
  • Anti-Bacterial Agents / pharmacology*
  • Chlamydia Infections / drug therapy
  • Chlamydia Infections / microbiology*
  • Chlamydia trachomatis / drug effects
  • Chlamydia trachomatis / isolation & purification
  • Female
  • Gardnerella vaginalis / drug effects
  • Gardnerella vaginalis / isolation & purification
  • Gram-Positive Bacterial Infections / drug therapy
  • Gram-Positive Bacterial Infections / microbiology*
  • Humans
  • Microbiota / drug effects*
  • Middle Aged
  • Mycoplasma Infections / drug therapy
  • Mycoplasma Infections / microbiology*
  • Mycoplasma genitalium / drug effects
  • Mycoplasma genitalium / isolation & purification
  • Vagina / drug effects
  • Vagina / microbiology*
  • Vaginosis, Bacterial / drug therapy
  • Vaginosis, Bacterial / microbiology*
  • Young Adult

Substances

  • Anti-Bacterial Agents

Grants and funding

The authors received no specific funding for this work.