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The cervico-vaginal microbiota in women notified for Chlamydia trachomatis infection: A case-control study at the STI outpatient clinic in Amsterdam, the Netherlands

  1. R van Houdt4
  1. 1Public Health Laboratory, Public health Service Amsterdam, Amsterdam, the Netherlands
  2. 2Sexually transmitted infections outpatient clinic, Public Health Service Amsterdam, Amsterdam, the Netherlands
  3. 3Department of Dermatology, Amsterdam Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
  4. 4Department of Medical Microbiology and Infection Prevention, VU University Medical Centre, Amsterdam, the Netherlands
  1. Corresponding author: Charlotte van der Veer, Public Health Laboratory, Amsterdam Public Health Service, Amsterdam, the Netherlands. Phone +31 205555069. Email: cvdveer{at}
  1. Alternate corresponding author: Dr. Sylvia Bruisten, Public Health Laboratory, Amsterdam Public Health Service, Amsterdam, the Netherlands. Phone +31 205555376. Email: sbruisten{at}


Background. Increasing evidence suggests that cervico-vaginal microbiota (CVM) play an important role in acquiring sexually transmitted infections (STI). Here we study the CVM in a population of women notified by a sex-partner for Chlamydia trachomatis infection.

Methods. We included 98 women who were contact-traced by C. trachomatis positive sex partners at the STI outpatient clinic in Amsterdam, the Netherlands, and analyzed their cervico-vaginal samples and clinical data. CVM were characterized by sequencing the V3/V4 region of the 16srRNA gene and by hierarchical clustering. Characteristics associating with C. trachomatis infection were examined using bivariable and multivariable logistic regression analysis.

Results. The CVM was characterized for 93 women, of whom 52 tested C. trachomatis positive and 41 C. trachomatis negative. We identified three major CVM clusters. Clustered CVM predominantly comprised either diverse anaerobic bacteria (n=39; 42%), Lactobacillus iners (n=32; 34%) or Lactobacillus crispatus (n=22; 24%). In multivariable analysis, we found that the CVM was significantly associated with C. trachomatis infection (OR=4.2 (95% confidence interval: 1.2-15.4) for women with diverse anaerobic CVM and OR=4.4 (CI: 1.3-15.6), for women with L. iners-dominated CVM, compared to women with L. crispatus-dominated CVM), as was younger age (OR=3.1 (CI: 1.1-8.7) for those ≤21 years old) and reporting a steady sex partner (OR=3.6 (CI: 1.4-9.4)).

Conclusion. Women who tested positive for Chlamydia trachomatis infection after having been contact-traced by a chlamydia positive partner were more likely to have CVM dominated by L. iners or by diverse anaerobic bacteria, than by L. crispatus.

  • Received March 9, 2016.
  • Accepted July 6, 2016.

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