Plummer Erica L, Vodstrcil Lenka A, Danielewski Jennifer A, Murray Gerald L, Fairley Christopher K, Garland Suzanne M, Hocking Jane S, Tabrizi Sepehr N, Bradshaw Catriona S
Department of Molecular Microbiology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Melbourne, Victoria, Australia.
PLoS One. 2018 Jan 2;13(1):e0190199. doi: 10.1371/journal.pone.0190199. eCollection 2018.
Recurrence following recommended treatment for bacterial vaginosis is unacceptably high. While the pathogenesis of recurrence is not well understood, recent evidence indicates re-infection from sexual partners is likely to play a role. The aim of this study was to assess the acceptability and tolerability of topical and oral antimicrobial therapy in male partners of women with bacterial vaginosis (BV), and to investigate the impact of dual-partner treatment on the vaginal and penile microbiota.
Women with symptomatic BV (Nugent Score of 4-10 and ≥3 Amsel criteria) and their regular male sexual partner were recruited from Melbourne Sexual Health Centre, Melbourne, Australia. Women received oral metronidazole 400mg twice daily (or intra-vaginal 2% clindamycin cream, if contraindicated) for 7-days. Male partners received oral metronidazole 400mg twice daily and 2% clindamycin cream topically to the penile skin twice daily for 7-days. Couples provided self-collected genital specimens and completed questionnaires at enrolment and then weekly for 4-weeks. Genital microbiota composition was determined by 16S rRNA gene sequencing. Changes in genital microbiota composition were assessed by Bray-Curtis index. Bacterial diversity was measured by the Shannon Diversity Index.
Twenty-two couples were recruited. Sixteen couples (76%) completed all study procedures. Adherence was high; most participants took >90% of prescribed medication. Medication, and particularly topical clindamycin in males, was well tolerated. Dual-partner treatment had an immediate and sustained effect on the composition of vaginal microbiota (median Bray-Curtis score day 0 versus day 8 = 0.03 [IQR 0-0.15], day 0 vs day 28 = 0.03 [0.02-0.11]). We observed a reduction in bacterial diversity of the vaginal microbiota and a decrease in the prevalence and abundance of BV-associated bacteria following treatment. Treatment had an immediate effect on the composition of the cutaneous penile microbiota (median Bray-Curtis score day 0 vs day 8 = 0.09 [0.04-0.17]), however this was not as pronounced at day 28 (median Bray-Curtis score day 0 vs day 28 = 0.38 [0.11-0.59]). A decrease in the prevalence and abundance of BV-associated bacteria in the cutaneous penile microbiota was observed immediately following treatment at day 8.
Combined oral and topical treatment of male partners of women with BV is acceptable and well tolerated. The combined acceptability and microbiological data presented in this paper supports the need for larger studies with longer follow up to characterize the sustained effect of dual partner treatment on the genital microbiota of couples and assess the impact on BV recurrence.
细菌性阴道病经推荐治疗后的复发率高得令人难以接受。虽然复发的发病机制尚不完全清楚，但最近的证据表明，性伴侣的再次感染可能起了作用。本研究的目的是评估局部和口服抗菌治疗在细菌性阴道病（BV）女性患者男性伴侣中的可接受性和耐受性，并研究双性伴侣治疗对阴道和阴茎微生物群的影响。
从澳大利亚墨尔本性健康中心招募有症状的BV女性患者（ Nugent评分为4 - 10分且符合≥3项阿姆塞尔标准）及其固定男性性伴侣。女性患者每天口服两次400mg甲硝唑（若有禁忌则使用阴道内2%克林霉素乳膏），共7天。男性伴侣每天口服两次400mg甲硝唑，并每天两次在阴茎皮肤局部涂抹2%克林霉素乳膏，共7天。夫妇双方在入组时自行采集生殖器标本并完成问卷，然后连续4周每周进行一次。通过16S rRNA基因测序确定生殖器微生物群组成。通过Bray - Curtis指数评估生殖器微生物群组成的变化。用香农多样性指数测量细菌多样性。
招募了22对夫妇。16对夫妇（76%）完成了所有研究程序。依从性很高；大多数参与者服用了>90%的规定药物。药物，尤其是男性使用的局部克林霉素，耐受性良好。双性伴侣治疗对阴道微生物群的组成有立即且持续的影响（第0天与第8天的中位数Bray - Curtis评分为0.03 [四分位距0 - 0.15]，第0天与第28天为0.03 [0.02 - 0.11]）。我们观察到治疗后阴道微生物群的细菌多样性降低，以及与BV相关细菌的患病率和丰度下降。治疗对阴茎皮肤微生物群的组成有立即影响（第0天与第8天的中位数Bray - Curtis评分为0.09 [0.04 - 0.17]），但在第28天不太明显（第0天与第28天的中位数Bray - Curtis评分为0.38 [0.11 - 0.59]）。在治疗后第8天立即观察到阴茎皮肤微生物群中与BV相关细菌的患病率和丰度下降。
BV女性患者男性伴侣联合口服和局部治疗是可接受的且耐受性良好。本文提供的联合可接受性和微生物学数据支持需要进行更大规模、更长随访时间的研究，以表征双性伴侣治疗对夫妇生殖器微生物群的持续影响，并评估对BV复发的影响。
