A fruitful alliance: the synergy between Atopobium vaginae and Gardnerella vaginalis in bacterial vaginosis-associated biofilm

Liselotte Hardy, Vicky Jespers, Said Abdellati, Irith De Baetselier, Lambert Mwambarangwe, Viateur Musengamana, Janneke van de Wijgert, Mario Vaneechoutte, Tania Crucitti, Liselotte Hardy, Vicky Jespers, Said Abdellati, Irith De Baetselier, Lambert Mwambarangwe, Viateur Musengamana, Janneke van de Wijgert, Mario Vaneechoutte, Tania Crucitti

Abstract

Objectives: Bacterial vaginosis (BV) is characterised by a change in the microbial composition of the vagina. The BV-associated organisms outnumber the health-associated Lactobacillus species and form a polymicrobial biofilm on the vaginal epithelium, possibly explaining the difficulties with antibiotic treatment. A better understanding of vaginal biofilm with emphasis on Atopobium vaginae and Gardnerella vaginalis may contribute to a better diagnosis and treatment of BV.

Methods: To this purpose, we evaluated the association between the presence of both bacteria by fluorescence in situ hybridisation (FISH) and BV by Nugent scoring in 463 vaginal slides of 120 participants participating in a clinical trial in Rwanda.

Results: A bacterial biofilm was detected in half of the samples using a universal bacterial probe. The biofilm contained A. vaginae in 54.1% and G. vaginalis in 82.0% of the samples. A. vaginae was accompanied by G. vaginalis in 99.5% of samples. The odds of having a Nugent score above 4 were increased for samples with dispersed G. vaginalis and/or A. vaginae present (OR 4.5; CI 2 to 10.3). The probability of having a high Nugent score was even higher when a combination of adherent G. vaginalis and dispersed A. vaginae was visualised (OR 75.6; CI 13.3 to 429.5) and highest when both bacteria were part of the biofilm (OR 119; CI 39.9 to 360.8).

Conclusions: Our study, although not comprehensive at studying the polymicrobial biofilm in BV, provided a strong indication towards the importance of A. vaginae and the symbiosis of A. vaginae and G. vaginalis in this biofilm.

Trial registration number: NCT01796613.

Keywords: ANTIBIOTIC SENSITIVITY; BACTERIAL VAGINOSIS; DIAGNOSIS; GENITAL TRACT INFECT; MICROBIOLOGY.

Conflict of interest statement

Competing interests: None declared.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Figures

Figure 1
Figure 1
Superimposed confocal laser scanning images with 400× magnification of Atopobium vaginae+Gardnerella vaginalis biofilm in six vaginal samples (A–F): vaginal epithelial cells DAPI in blue, A. vaginae-specific peptide nucleic acid (PNA)-probe AtoITM1 with Alexa Fluor 488 in green and G. vaginalis-specific PNA-probe Gard162 with Alexa Fluor 647 in red. For clarity, we omitted the BacUni-1 plane, such that the bacteria that did not hybridise with Gard162 and AtoITM1 are visible in DAPI blue only.

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