From the Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA.
Vaccine and Infectious Diseases Division, Fred Hutchinson Research Center, Seattle, WA.
Sex Transm Dis. 2020 Apr;47(4):269-274. doi: 10.1097/OLQ.0000000000001143.
Up to 30% of women with vaginal symptoms are not assigned a diagnosis after standard diagnostic assessment.
We compared premenopausal women with idiopathic vaginitis (IV) or vulvodynia (VVD) to healthy controls. Microbiota were characterized using rRNA sequencing. Cytokines/chemokines (IL-10, IL-1α, IL-1β, IL-6, IL-8, IL-2, IL-18, IL-4, IL-9, and IL-13) were measured in vaginal lavage fluid using the Meso Scale Discovery platform or ELISA (IL-1ra). Immunoglobulins were measured in vaginal lavage fluid using a bead-based immunoassay (Millipore). Cases and controls were compared using Kruskal-Wallis, analysis of variance, and linear regression or (for microbiome composition) the Bray-Curtis dissimilarity statistic.
We compared 20 women with IV, 30 with VVD, and 52 controls. Most (80%) had greater than 90% 16S rRNA gene sequences from Lactobacillus crispatus, L. jensenii, L. gasseri, or L. iners. In analyses adjusted for age and hormonal contraception (HC), Gardnerella vaginalis was less prevalent and abundant in women with VVD (2/30, 7%) versus controls (16/52, 31%) or IV (5/20, 25%) (P = 0.030). Bray-Curtis dissimilarity was not significantly different between IV and controls or VVD. Fungal sequences were only detected in 5 participants: 2 control, 1 IV, 2 VVD. In univariate analysis, cytokines were not associated with diagnosis. Median vaginal concentration of IgE (but not other immunoglobulins) was lower in women with VVD (P = 0.006).
Minimal differences in vaginal microbiota and inflammatory markers between women with IV, VVD or controls suggest no striking association between vaginal bacteria, fungi or inflammation and diagnosis in these women.
经过标准诊断评估后，仍有 30%左右的阴道症状女性无法确诊。
我们比较了患有特发性阴道炎（IV）或外阴痛（VVD）的绝经前妇女与健康对照组。使用 rRNA 测序对微生物群进行了特征分析。使用 Meso Scale Discovery 平台或 ELISA（IL-1ra）测量阴道灌洗液中的细胞因子/趋化因子（IL-10、IL-1α、IL-1β、IL-6、IL-8、IL-2、IL-18、IL-4、IL-9 和 IL-13）。使用基于珠的免疫测定法（Millipore）测量阴道灌洗液中的免疫球蛋白。使用 Kruskal-Wallis、方差分析和线性回归或（对于微生物组组成）Bray-Curtis 不相似性统计量比较病例和对照组。
我们比较了 20 名 IV 患者、30 名 VVD 患者和 52 名对照组。大多数（80%）阴道中有超过 90%的乳杆菌 crispatus、L. jensenii、L. gasseri 或 L. iners 的 16S rRNA 基因序列。在调整年龄和激素避孕（HC）的分析中，阴道加德纳菌在 VVD 患者（2/30，7%）中比对照组（16/52，31%）或 IV 患者（5/20，25%）更为常见且丰富（P=0.030）。IV 和对照组或 VVD 之间的 Bray-Curtis 不相似性没有显著差异。仅在 5 名参与者中检测到真菌序列：2 名对照组，1 名 IV，2 名 VVD。在单变量分析中，细胞因子与诊断无关。VVD 患者的阴道 IgE 浓度中位数较低（P=0.006）。
IV、VVD 或对照组女性之间的阴道微生物群和炎症标志物差异极小，表明这些女性的阴道细菌、真菌或炎症与诊断之间没有明显关联。
