TY - JOUR
T1 - Longitudinal Changes in Vaginal Microbiota Composition Assessed by Gram Stain Among Never Sexually Active Pre- and Postmenarcheal Adolescents in Rakai, Uganda
AU - Thoma, Marie E.
AU - Gray, Ronald H.
AU - Kiwanuka, Noah
AU - Aluma, Simon
AU - Wang, Mei Cheng
AU - Sewankambo, Nelson
AU - Wawer, Maria J.
N1 - Funding Information:
This work was supported in part by the National Institutes of Health (NIH), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH grant R01AI47608 (to M.J.W.); the NIH, National Institute for Allergy and Infectious Diseases (NIAID), NIH grant T32AI050056 (to J.M.Z.), the Intramural Program of the Eunice Kennedy Shriver NICHD (to M.E.T.), and the Cooperative Agreement number R36PS001104 (to M.E.T.) from the Center for Disease Control and Prevention (CDC) . Its contents are solely the responsibility of the authors and do not represent the official views of the CDC.
PY - 2011/2
Y1 - 2011/2
N2 - Study Objective: To describe changes in vaginal microbiota and pH over time among never sexually active adolescents at different menarcheal stages. Design: A cohort of 49 sexually inexperienced Ugandan adolescents provided weekly self-collected vaginal swabs and behavioral/health information for up to two years. Menarcheal stage was classified as: not experiencing menarche during follow-up (premenarcheal, n = 9), achieving menarche during follow-up (perimenarcheal, n = 20), and being postmenarcheal (n = 20) at enrollment. Vaginal microbiota were characterized as morphotypes of large gram-positive rods, small gram-negative or variable rods, and curved gram-negative rods based on Nugent Gram-stain criteria. Baseline measures were compared using nonparametric tests. Mean changes (β) in morphotypes and pH over time were estimated using longitudinal mixed-effects models. Results: The baseline median (IQR: interquartile range) Nugent score was 8 (7-8) in premenarcheal, 4.5 (1-8) in perimenarcheal, and 1 (0-3) in postmenarcheal girls (P = 0.001). For each respective menarcheal stage, the median (IQR) counts of gram-positive rods were 0 (0-0), 10 (0-30), and 30 (18-30) (P = 0.002) and gram-negative or variable rods were 30 (30-30), 16 (0.5-30), and 0.5 (0-2.5) (P = 0.002) at enrollment. Counts of gram-positive rods increased (β = 0.259, 95% CI: 0.156, 0.362) and gram-negative or variable rods decreased (β = -0.201, 95% CI:-0.298,-0.103) significantly over time in premenarcheal girls, but not in other groups. Vaginal pH declined significantly in peri- and postmenarcheal girls only. Conclusion: Vaginal microbiota composition varied by menarcheal stage at enrollment. Over time, significant changes in vaginal morphotypes occurred in premenarcheal girls, suggesting this may be an important period of transition.
AB - Study Objective: To describe changes in vaginal microbiota and pH over time among never sexually active adolescents at different menarcheal stages. Design: A cohort of 49 sexually inexperienced Ugandan adolescents provided weekly self-collected vaginal swabs and behavioral/health information for up to two years. Menarcheal stage was classified as: not experiencing menarche during follow-up (premenarcheal, n = 9), achieving menarche during follow-up (perimenarcheal, n = 20), and being postmenarcheal (n = 20) at enrollment. Vaginal microbiota were characterized as morphotypes of large gram-positive rods, small gram-negative or variable rods, and curved gram-negative rods based on Nugent Gram-stain criteria. Baseline measures were compared using nonparametric tests. Mean changes (β) in morphotypes and pH over time were estimated using longitudinal mixed-effects models. Results: The baseline median (IQR: interquartile range) Nugent score was 8 (7-8) in premenarcheal, 4.5 (1-8) in perimenarcheal, and 1 (0-3) in postmenarcheal girls (P = 0.001). For each respective menarcheal stage, the median (IQR) counts of gram-positive rods were 0 (0-0), 10 (0-30), and 30 (18-30) (P = 0.002) and gram-negative or variable rods were 30 (30-30), 16 (0.5-30), and 0.5 (0-2.5) (P = 0.002) at enrollment. Counts of gram-positive rods increased (β = 0.259, 95% CI: 0.156, 0.362) and gram-negative or variable rods decreased (β = -0.201, 95% CI:-0.298,-0.103) significantly over time in premenarcheal girls, but not in other groups. Vaginal pH declined significantly in peri- and postmenarcheal girls only. Conclusion: Vaginal microbiota composition varied by menarcheal stage at enrollment. Over time, significant changes in vaginal morphotypes occurred in premenarcheal girls, suggesting this may be an important period of transition.
KW - Bacterial vaginosis
KW - Gram stain
KW - Lactobacilli
KW - Menarche
KW - Nugent score
KW - PH
KW - Vaginal microbiota
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U2 - 10.1016/j.jpag.2010.07.002
DO - 10.1016/j.jpag.2010.07.002
M3 - Article
C2 - 20709584
AN - SCOPUS:78751702618
SN - 1083-3188
VL - 24
SP - 42
EP - 47
JO - Journal of pediatric and adolescent gynecology
JF - Journal of pediatric and adolescent gynecology
IS - 1
ER -