The Continuum of Microbial Ecosystems along the Female Reproductive Tract: Implications for Health and Fertility
Abstract
:1. Introduction
2. The Vaginal Microbiome: An Influencer of Microbial Niches along the Female Reproductive Tract
3. Intrinsic Host & Extrinsic Environmental Factors That Contribute to Vaginal Dysbiosis
4. Bacterial Vaginosis
4.1. Bacterial Vaginosis and the Urinary Tract
4.2. Bacterial Vaginosis, Diseases of the Reproductive Tract, and Adverse Pregnancy Outcomes
4.3. Bacterial Vaginosis and the Pathogenesis of Tubal Infertility
5. The Microbiomes of the Fallopian Tubes, Endometrium, and Cervix
Pathogenesis of Dysbiotic Disorders along the Upper Reproductive Tract
6. Immunological Responses, Redox Potential & Metabolic Function
7. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Disruption | Mechanism | Result | Reference |
---|---|---|---|
Biological | |||
Menstruation | Temporary dip in estrogen during the secretory phase | Estrogen promotes proliferation of Lactobacillus spp. Responsible for maintaining a low vaginal pH. A decrease in estrogen levels results in a decrease in Lactobacilli and a temporary rise in vaginal pH which increases susceptibility to opportunistic pathogens. | Bardos et al., 2020 [36] |
Menopause | Decrease in overall estrogen levels | Chronic low estrogen levels decrease accumulation of glycogen in the vaginal epithelium thereby reducing colonization of lactobacilli dependent on epithelial glycogen levels. | Achilles et al., 2018 [37] |
Pregnancy | Inflammatory responses are moderated | Towards the end of pregnancy, the lower reproductive tissues increase microbial diversity and decrease Lactobaccilus spp. | Bardos et al., 2020 [36] |
Lifestyle | |||
Hygiene products | Changes to pH levels | Vaginal douching has been linked to increased susceptibility to bacterial vaginosis. | Brotman et al., 2008 [38] |
Tampons | Changes to lactic acid production and pH | Decreased vaginal microbiome stability is associated with tampon use. | Carter et al., 2018 [39] |
Antibiotic use | Killing of commensal bacteria | Depletion of commensal bacteria due to antibiotic treatment was found to cause increased secretions of IL-33 in vaginal epithelium, suppressing antiviral immunity. | Oh et al., 2016 [40] |
IUD-use | Changes in commensal microbial populations | Copper IUD use was associated with an increase in Gardnerella vaginalis and Atopobium vaginae possibly leading to increased bacterial vaginosis risk. LNG-releasing IUD use was associated with a decrease in Lactobacillus spp. Furthermore, an increase in Candida spp. | Achilles et al., 2018 [37] |
Sexual activity | Changes in commensal microbial populations, shift in CST type | The number of sex partners and age when sexual activity started is associated with CST grouping and microbiome stability. Women with new sexual partners are at an increased risk for bacterial vaginosis. | Chen et al., 2017 [8] |
Causative Pathogenesis | |||
Leaky gut | Hematogenous spread of GI commensals into peritoneal cavity | Increased risk of placental infection, pre-term birth, and miscarriage | Bardos et al., 2020 [36] |
Periodontal disease | Microbial transmission from oral cavity | Increased risk of intra-uterine infection and pre-eclampsia | Parihar et al., 2015 [41] |
Resultant Pathogenesis | |||
HPV infection | Opportunistic infection | Subjects with HPV infections have less Lactobacillus spp. Furthermore, more microbial diversity | Nicolò et al., 2021 [42] |
Cervical cancer | Variable gene expression of L. iners-dependent community functionality and composition | L. Iners decreased amongst women with HPV infection, suggesting a protective effect. Alternatively, L. iners is associated with CIN 2+ and ICC | Piyathilake et al., 2016 [43] |
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Nakama, C.; Thompson, B.; Szybala, C.; McBeth, A.; Dobner, P.; Zwickey, H. The Continuum of Microbial Ecosystems along the Female Reproductive Tract: Implications for Health and Fertility. Pathogens 2022, 11, 1244. https://doi.org/10.3390/pathogens11111244
Nakama C, Thompson B, Szybala C, McBeth A, Dobner P, Zwickey H. The Continuum of Microbial Ecosystems along the Female Reproductive Tract: Implications for Health and Fertility. Pathogens. 2022; 11(11):1244. https://doi.org/10.3390/pathogens11111244
Chicago/Turabian StyleNakama, Claudia, Brice Thompson, Cory Szybala, Andrea McBeth, Piper Dobner, and Heather Zwickey. 2022. "The Continuum of Microbial Ecosystems along the Female Reproductive Tract: Implications for Health and Fertility" Pathogens 11, no. 11: 1244. https://doi.org/10.3390/pathogens11111244