Defining the relationship between vaginal and urinary microbiomes

• Published in: American journal of obstetrics and gynecology 2020-02, Vol.222 (2), p.154.e1-154.e10
• Main Authors: Komesu, Yuko M., Dinwiddie, Darrell L., Richter, Holly E., Lukacz, Emily S., Sung, Vivian W., Siddiqui, Nazema Y., Zyczynski, Halina M., Ridgeway, Beri, Rogers, Rebecca G., Arya, Lily A., Mazloomdoost, Donna, Levy, Josh, Carper, Benjamin, Gantz, Marie G.
• Format: Article
• Language: English
• Subjects: Adult; Burkholderiales; Case-Control Studies; Clostridiales; Discriminant Analysis; Escherichia; Female; Flavobacterium; Gardnerella; Humans; Lactobacillus; Linear Models; Microbiota - genetics; Middle Aged; mixed urinary incontinence; Prevotella; RNA, Ribosomal, 16S - analysis; Streptococcus; Ureaplasma; Urinary Incontinence; urinary microbiome; Urinary Tract - microbiology; Urine - microbiology; urologic conditions; Vagina - microbiology; vaginal microbiome
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2019.08.011

Although the vaginal and urinary microbiomes have been increasingly well-characterized in health and disease, few have described the relationship between these neighboring environments. Elucidating this relationship has implications for understanding how manipulation of the vaginal microbiome may affect the urinary microbiome and treatment of common urinary conditions. To describe the relationship between urinary and vaginal microbiomes using 16S rRNA gene sequencing. We hypothesized that the composition of the urinary and vaginal microbiomes would be significantly associated, with similarities in predominant taxa. This multicenter study collected vaginal swabs and catheterized urine samples from 186 women with mixed urinary incontinence enrolled in a parent study and 84 similarly aged controls. Investigators decided a priori that if vaginal and/or urinary microbiomes differed between continent and incontinent women, the groups would be analyzed separately; if similar, samples from continent and incontinent women would be pooled and analyzed together. A central laboratory sequenced variable regions 1–3 (v1–3) and characterized bacteria to the genus level. Operational taxonomic unit abundance was described for paired vaginal and urine samples. Pearson’s correlation characterized the relationship between individual operational taxonomic units of paired samples. Canonical correlation analysis evaluated the association between clinical variables (including mixed urinary incontinence and control status) and vaginal and urinary operational taxonomic units, using the Canonical correlation analysis function in the Vegan package (R version 3.5). Linear discriminant analysis effect size was used to find taxa that discriminated between vaginal and urinary samples. Urinary and vaginal samples were collected from 212 women (mean age 53±11 years) and results from 197 paired samples were available for analysis. As operational taxonomic units in mixed urinary incontinence and control samples were related in canonical correlation analysis and since taxa did not discriminate between mixed urinary incontinence or controls in either vagina or urine, mixed urinary incontinence and control samples were pooled for further analysis. Canonical correlation analysis of vaginal and urinary samples indicated that that 60 of the 100 most abundant operational taxonomic units in the samples largely overlapped. Lactobacillus was the most abundant genus in both urine and vagina (contributi