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Lactobacillus iners-dominated vaginal microbiota is associated with increased susceptibility to Chlamydia trachomatis infection in Dutch women: a case–control study
  1. Robin van Houdt1,2,
  2. Bing Ma3,
  3. Sylvia M Bruisten2,
  4. Arjen G C L Speksnijder4,
  5. Jacques Ravel3,
  6. Henry J C de Vries2,5
  1. 1 Department of Medical Microbiology and Infection Control, VU Medical Center, Amsterdam, The Netherlands
  2. 2 Department of Infectious Diseases, Public Health Service, Amsterdam, The Netherlands
  3. 3 Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
  4. 4 Naturalis Biodiversity Center, Leiden, The Netherlands
  5. 5 Department of Dermatology, Academic Medical Center, Amsterdam, The Netherlands
  1. Correspondence to Dr Robin van Houdt, Department of Medical Microbiology and Infection Control, VU University Medical Center, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands; r.vanhoudt{at}


Introduction This prospective study aimed to study the composition and structure of the vaginal microbiota prior to Chlamydia trachomatis infection.

Methods A nested case–control study was performed in 122 women, half of which acquired C. trachomatis within a year after their first visit. At the first visit, the composition and structure of vaginal microbial communities were analysed using 16S rRNA sequencing in the context of the sociodemographic and sexual risk behaviour information using logistic regression.

Results Five vaginal community state types (CSTs) were identified. Four CSTs were dominated by Lactobacillus spp., of which L. crispatus (37%) and L. iners (33%) were the most common. One CST was characterised by the absence of Lactobacillus spp. (25%) and the presence of an array of strict and facultative anaerobes. Multivariate logistic regression analysis revealed that women with a L. iners-dominated CST had an increased risk of C. trachomatis infection (p=0.04; OR: 2.6, 95% CI 1.0 to 6.6).

Conclusions The distribution of CSTs dominated by Lactobacillus spp. agreed with previous studies. However, the frequency of dysbiosis among Caucasian women was relatively high (24%). Having vaginal microbiota dominated by L. iners was associated with an increased risk for C. trachomatis infection. Therefore, we hypothesise that specific signatures of vaginal microbiota are indicative of increased host predisposition to acquiring STIs.

  • vaginal microbiology
  • molecular epidemiology
  • chlamydia infection
  • sexual health
  • women

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  • Handling editor Jackie A Cassell

  • Contributors RvH, AGCLS and HJCdV conceived and designed the study and obtained funding. RvH and SMB performed laboratory analyses of the samples. RvH, AGCLS and HJCdV participated in data collection. RvH and BM performed data management, and genomic and statistical analyses. RvH wrote the manuscript. JR facilitated and contributed to the genomic analyses. All authors contributed to data interpretation, reviewed successive drafts and approved the final version of the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The Ethics Committee of the Free University of Amsterdam.

  • Provenance and peer review Not commissioned; externally peer reviewed.