Department of Epidemiology, University of Washington, Seattle, Washington, USA.
Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
Clin Infect Dis. 2021 Jun 15;72(12):e1093-e1102. doi: 10.1093/cid/ciaa1876.
The vaginal microbiome plays a key role in women's reproductive health. Use of exogenous hormones, such as intramuscular depot medroxyprogesterone acetate (DMPA-IM), may alter the composition of vaginal bacterial community.
Vaginal swab samples were collected from postpartum Kenyan women initiating DMPA-IM or nonhormonal contraception (non-HC). Bacterial vaginosis was assessed by Nugent score (Nugent-BV) and bacterial community composition was evaluated using broad-range 16S ribosomal RNA gene polymerase chain reaction with high-throughput sequencing. Changes in Nugent score, alpha diversity (Shannon diversity index), and total bacterial load between contraceptive groups from enrollment to 3 months after initiation were estimated using multivariable linear mixed effects regression.
Among 54 human immunodeficiency virus-negative women, 33 choosing DMPA-IM and 21 choosing non-HC, Nugent-BV was more common among DMPA-IM users at enrollment. At follow-up, Nugent score had decreased significantly among DMPA-IM users (change, -1.89; 95% confidence interval [CI], -3.53 to -.25; P = .02) while alpha diversity remained stable (0.03; -.24 to .30; P = .83). Conversely, Nugent score remained relatively stable among non-HC users (change, -0.73; 95% CI, -2.18 to .73; P = .33) while alpha diversity decreased (-0.34; -.67 to -.001; P = .05). The total bacterial load decreased slightly in DMPA-IM users and increased slightly among non-HC users, resulting in a significant difference in change between the contraceptive groups (difference, -0.64 log10 gene copies per swab sample; 95% CI, -1.19 to -.08; P = .02). While significant changes in Nugent score and alpha diversity were observed within contraceptive groups, changes between groups were not significantly different.
Postpartum vaginal bacterial diversity did not change in DMPA-IM users despite a reduction in Nugent-BV, but it decreased significantly among women using non-HC. Choice of contraception may influence Lactobacillus recovery in postpartum women.
阴道微生物群在女性生殖健康中起着关键作用。使用外源性激素，如肌肉内注射 depot 醋酸甲羟孕酮（DMPA-IM），可能会改变阴道细菌群落的组成。
从肯尼亚产后开始使用 DMPA-IM 或非激素避孕（非 HC）的女性中采集阴道拭子样本。通过 Nugent 评分（Nugent-BV）评估细菌性阴道病，使用广谱 16S 核糖体 RNA 基因聚合酶链反应结合高通量测序评估细菌群落组成。使用多变量线性混合效应回归估计从入组到开始后 3 个月时避孕组之间 Nugent 评分、alpha 多样性（香农多样性指数）和总细菌负荷的变化。
在 54 名人类免疫缺陷病毒阴性的女性中，33 名选择 DMPA-IM，21 名选择非 HC，入组时 DMPA-IM 使用者的 Nugent-BV 更为常见。随访时，DMPA-IM 使用者的 Nugent 评分显著下降（变化，-1.89；95%置信区间 [CI]，-3.53 至 -.25；P=0.02），而 alpha 多样性保持稳定（0.03；-0.24 至 0.30；P=0.83）。相反，非 HC 使用者的 Nugent 评分相对稳定（变化，-0.73；95%CI，-2.18 至.73；P=0.33），而 alpha 多样性下降（-0.34；-0.67 至 -.001；P=0.05）。DMPA-IM 使用者的总细菌负荷略有下降，而非 HC 使用者略有增加，导致避孕组之间的变化存在显著差异（差异，-0.64 log10 个每个拭子样本的基因拷贝；95%CI，-1.19 至 -.08；P=0.02）。尽管在 DMPA-IM 使用者中 Nugent-BV 降低，但阴道细菌多样性在避孕组内发生了显著变化，但在使用非 HC 的女性中显著降低。避孕方法的选择可能会影响产后妇女 Lactobacillus 的恢复。
