Weight and Nutritional Correlates with Bacterial Vaginosis – A Pilot Study

Poster Title: Weight and Nutritional Correlates with Bacterial Vaginosis – A Pilot Study

Student: Karolina Wadolowska, MS Class of 2022

Faculty Mentor and Department: Candice J. McNeil, MD, MPH, Department of Medicine 

Research Team: Jamy Ard, MD, Iqra Munawar, MS, Department of Medicine

Funding Source: This study is not funded. Specimens were processed courtesy of the Schwebke Lab at University of Alabama Birmingham. 

ABSTRACT

Background: Bacterial vaginosis (BV), a condition characterized by the disruption of the normal vaginal microbiota, leads to increased vaginal discharge and malodor in approximately half of the women affected and is the most common cause of vaginal symptoms among women.  The prevalence of BV among women age 14-49 in the United States is estimated to be 21.2 million (29.2%).¹ This condition places a significant burden on the healthcare system, resulting in millions of health care visits annually in the United States alone.² Furthermore, BV has been linked to numerous other adverse health outcomes, including serving as an independent risk factor for the acquisition of HIV and other sexually transmitted infections (STI) as well as the development of pelvic inflammatory disease (PID) which is associated with serious long term sequelae including infertility and pelvic pain.³  BV has also been associated with increased risk of adverse events during pregnancy including premature rupture of membranes, intraamniotic infection, low birth weight and preterm birth.⁴ Studies have shown that certain alterations in the gut microbiome are associated with obesity and that changes in gut microflora occur with weight loss and certain dietary changes such as reduced carbohydrate intake and increased protein intake. ⁶ However, the impact of diet and weight on the vaginal microbiome and BV has not yet been explored. 

Hypothesis: Diet and weight will negatively influence the vaginal microbiome and increase the likelihood of BV.  

Methods: Female patients entering Wake Forest Baptist Health (WFBH) Weight Management Program (WMP) between 2016 to 2019 were invited to participate in a survey with questions addressing demographic information and various behavioral characteristics that may influence rates of BV. Participants also provided a one-time self-obtained vaginal swab that was analyzed for presence of BV using the Nugent gram stain. A chart review was simultaneously conducted to collect participants’ past medical history, weight, nutrition information, and laboratory values to include HbA1c, lipid profile, and C-reactive protein (CRP). Information was entered into RedCap and subsequently analyzed. 

Results: 31 participants were recruited into the study, with a participant median age of 45. A majority of participants self-identified as White Non-Hispanic/Latino (n=24, 82.8%) and Black or African American (n=5, 17.2%). 37.9% (n=11) of participants were post-menopausal, while 62.1% (n=18) were pre-menopausal at time of survey administration. A majority of participants indicated that they have never been diagnosed with vaginosis (n=18, 64.3%), followed by those (n=8, 28.6%) indicating that they have been diagnosed, while two (7.1%) participants were unsure. In contrast, 23 (82.1%) participants indicated that they had been previously diagnosed with vaginal yeast infection, while 5 (17.9%) participants indicated that they have not. Participants reported treatment for a vaginal yeast infection an average of six times in their life. The most commonly observed concurrent medical conditions in study participants included hypertension (58.1%), dyslipidemia (45.2%), diabetes (42.0%), and obstructive sleep apnea (29.0%). Of 20 specimens where Nugent gram stain was available, one was indicative, 15 negative, and four indeterminate samples for BV, respectively. 

Conclusions: The most common vaginal complaint on history was vaginal yeast infection. Most women had never experienced bacterial vaginosis and few had evidence of vaginal dysbiosis as represented by an abnormal Nugent score. Further studies are needed to explore the influence of the gut on the vaginal microbiome.   

Source of mentor’s funding or other support that funded this research: This study is not funded.