Vaginal Microbiome and Its Relationship to Behavior, Sexual Health, and Sexually Transmitted Diseases

Lewis, Felicia M. T.; Bernstein, Kyle T.; Aral, Sevgi O.

doi:10.1097/aog.0000000000001932

Cited by 248Reproductive tract infections researchGut microbiota and healthProbiotics and Fermented Foods

Vaginal Microbiome and Its Relationship to Behavior, Sexual Health, and Sexually Transmitted Diseases

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Lewis, Felicia M. T., Bernstein, Kyle T., Aral, Sevgi O.·2017·Obstetrics & Gynecology

DOI 10.1097/aog.0000000000001932PMC PMC6743080

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Abstract

The vaginal microbiota has great significance in maintaining vaginal health and protecting the host from disease. Recent advances in molecular techniques and informatics allow researchers to explore microbial composition in detail and to compare the structure of vaginal microbial communities with behavior and health outcomes, particularly acquisition and transmission of sexually transmitted diseases (STDs) and poor birth outcomes. Vaginal flora have been found to cluster into a limited number of communities, although community structure is dynamic. Certain community types are more associated with poor reproductive outcomes and STDs; communities dominated by Lactobacillus species, particularly Lactobacillus crispatus , are most associated with vaginal health. Modifiable and nonmodifiable factors are strongly associated with community composition, including behavior, race or ethnicity, and hygiene. In this review, we describe the state of the science on the vaginal microbiome and its relationship to behavior, sexual health, and STDs, including determinants of the microbiome that go beyond an individual level.

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A dysbiotic vaginal microbiome, characterized by increased microbial diversity and reduced Lactobacillus spp., is associated with vaginal inflammation, increased incidence of sexually transmitted infections, and bacterial vaginosis.
“a dysbiotic vaginal microbiome (VMB), characterized by increased microbial diversity and a reduction in Lactobacillus spp. has been associated with vaginal inflammation, an increased incidence of sexually transmitted infections (STI) and clinical conditions such as bacterial vaginosis (BV) [4, 6–8].”
From Feasibility, safety and tolerability of estrogen and/or probiotics for improving vaginal health in Canadian African, Caribbean, and Black women: A pilot phase 1 clinical trial (2025) · cites this paper as [8]
The sections on vaginal bacterial communities and consequences of dysbiosis describe Lactobacillus-poor, diverse microbiota, a link to bacterial vaginosis, and increased risk of acquiring STIs. The paper does not establish the claimed general association with vaginal inflammation; its discussion of cervicovaginal inflammation is tentative and concerns a possible pathway linking hormonal contraception to HIV risk. Page numbers are unavailable in our copy. (LLM, conf=0.86)
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[98]Schwebke JR, Desmond R. A randomized trial of metronidazole in asymptomatic BV to prevent acquisition of STDs. Am J Obstet Gynecol 2007; 196: 517.e1– 6. 17547876 PMC1993882

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Authors: Lewis, F. M. T., Bernstein, K. T., & Aral, S. O.
Affiliations: Centers for Disease Control and Prevention (US)
ORCID: Lewis, Felicia M. T.
Bernstein, Kyle T.
Aral, Sevgi O.
Venue: Obstetrics & Gynecology
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2017-04
Volume: 129
Issue: 4
Pages: 643-654
ISSN: 0029-7844 (ISSN-L)
1873-233X
DOI: 10.1097/aog.0000000000001932
PMC: PMC6743080
OpenAlex: W2593687742
Cited by: 248
References: 121
Citations by year: 2026: 12 · 2025: 34 · 2024: 38 · 2023: 38 · 2022: 37 · 2021: 42 · 2020: 21 · 2019: 20 · 2018: 3 · 2017: 3
FWCI: 1.80
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Obstetrics and Gynecology (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health (CC999999)
Topics: Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
Life Sciences › Agricultural and Biological Sciences › Food Science › Probiotics and Fermented Foods
Keywords: vaginal microbiota, sexually transmitted infections, Lactobacillus crispatus, Lactobacillus, vaginal health, sexual behavior, birth outcomes, race and ethnicity, vaginal hygiene, microbial community structure
MeSH terms: Female, Humans, Sexual Behavior, Sexually Transmitted Diseases, Vagina, Reproductive Health, Microbiota

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Vaginal Microbiome and Its Relationship to Behavior, Sexual Health, and Sexually Transmitted Diseases

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