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The Restoration of the Vaginal Microbiota After Treatment for Bacterial Vaginosis with Metronidazole or Probiotics

  • Host Microbe Interactions
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Abstract

Whether or not treatment with antibiotics or probiotics for bacterial vaginosis (BV) is associated with a change in the diversity of vaginal microbiota in women was investigated. One hundred fifteen women, consisting of 30 healthy subjects, 30 BV-positive control subjects, 30 subjects with BV treated with a 7-day metronidazole regimen, and 25 subjects with BV treated with a 10-day probiotics regimen, were analyzed to determine the efficacy and disparity of diversity and richness of vaginal microbiota using 454 pyrosequencing. Follow-up visits at days 5 and 30 showed a greater BV cure rate in the probiotics-treated subjects (88.0 and 96 %, respectively) compared to the metronidazole-treated subjects (83.3 and 70 %, respectively [p = 0.625 at day 5 and p = 0.013 at day 30]). Treatment with metronidazole reduced the taxa diversity and eradicated most of the BV-associated phylotypes, while probiotics only suppressed the overgrowth and re-established vaginal homeostasis gradually and steadily. Despite significant interindividual variation, the microbiota of the actively treated groups or participants constituted a unique profile. Along with the decrease in pathogenic bacteria, such as Gardnerella, Atopobium, Prevotella, Megasphaera, Coriobacteriaceae, Lachnospiraceae, Mycoplasma, and Sneathia, a Lactobacillus-dominated vaginal microbiota was recovered. Acting as vaginal sentinels and biomarkers, the relative abundance of Lactobacillus and pathogenic bacteria determined the consistency of the BV clinical and microbiologic cure rates, as well as recurrent BV. Both 7-day intravaginal metronidazole and 10-day intravaginal probiotics have good efficacy against BV, while probiotics maintained normal vaginal microbiota longer due to effective and steady vaginal microbiota restoration, which provide new insights into BV treatment.

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Acknowledgments

This work was supported by the National Basic Research Program of China (973 program) Grant 2013CB531404 and a Qiu-Shi Scholarship from Zhejiang University. We would like to thank all the participants recruited in this study.

Conflict of interest

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China

    Zongxin Ling, Weiguang Chen, Yueqiu Luo, Li Yuan, Lanjuan Li & Charlie Xiang

  2. Department of Intensive Care Unit, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China

    Xia Liu

  3. Department of Obstetrics and Gynecology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China

    Yaxian Xia

  4. J. Craig Venter Institute, Rockville, MD, 20850, USA

    Karen E Nelson & Charlie Xiang

  5. Insititue of Microecology, Dalian Medical University, Dalian, Liaoning, 116044, China

    Shaolei Huang, Shaoen Zhang & Jieli Yuan

  6. Chinese National Human Genome Center at Shanghai, Shanghai, 201203, China

    Yuezhu Wang

Authors
  1. Zongxin Ling
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  2. Xia Liu
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  3. Weiguang Chen
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  4. Yueqiu Luo
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  5. Li Yuan
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  6. Yaxian Xia
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  7. Karen E Nelson
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  9. Shaoen Zhang
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  10. Yuezhu Wang
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  11. Jieli Yuan
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  12. Lanjuan Li
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  13. Charlie Xiang
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Corresponding authors

Correspondence to Jieli Yuan, Lanjuan Li or Charlie Xiang.

Additional information

Zongxin Ling, Xia Liu, and Weiguang Chen contributed equally to this work.

Clinical Trial Registration: ChiCTR-TRC-11001484 (www.chictr.org)

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ESM 1

(DOC 139 kb)

Table S1

The clinical data for each participant in our study (XLS 48 kb)

Table S2

Comparison of phylotype coverage and diversity estimation of the 16S rRNA gene libraries at the 3 % dissimilarity from the pyrosequencing analysis (DOC 39 kb)

Table S3

All genera assigned using the RDP classifier with at least 50 % as bootstrap support (XLS 299 kb)

Table S4

The abundance of vaginal bacteria relative to total Bacteria gene copy number by species-specific qPCR for clinical cured participants in the 5-day follow-up after treatment (DOC 47 kb)

Table S5

List of the 112 8-bp barcodes used to tag each PCR product analyzed as part of the study (DOC 42 kb)

Table S6

Species-specific primer sets for detection of vaginal bacteria by qPCR (DOC 84 kb)

Fig. S1

Differences of phylum (A) and predominant genera (B) detected in vagina from CN, BV, and BV treated with metronidazole and Lactobacillus individuals (*p < 0.05, **p < 0.01) (JPEG 42 kb)

High resolution image (TIFF 608 kb)

Fig. S2

Interindividual variations in the proportion of major phyla (A) and genera (B) in 115 vaginal samples from four groups. Only the seven largest phyla and 23 largest genera are shown in the figure. These data illustrate the dramatic interindividual variation (JPEG 120 kb)

High resolution image (TIFF 3271 kb)

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Ling, Z., Liu, X., Chen, W. et al. The Restoration of the Vaginal Microbiota After Treatment for Bacterial Vaginosis with Metronidazole or Probiotics. Microb Ecol 65, 773–780 (2013). https://doi.org/10.1007/s00248-012-0154-3

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  • DOI: https://doi.org/10.1007/s00248-012-0154-3

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