Interplay between the temporal dynamics of the vaginal microbiota and human papillomavirus detection

Rebecca M. Brotman, Michelle D. Shardell, Pawel Gajer, J. Kathleen Tracy, Jonathan M. Zenilman, Jacques Ravel, Patti E. Gravitt

Research output: Contribution to journalArticlepeer-review

125 Scopus citations


Background. We sought to describe the temporal relationship between vaginal microbiota and human papillomavirus (HPV) detection. Methods. Thirty-two reproductive-age women self-collected midvaginal swabs twice weekly for 16 weeks (937 samples). Vaginal bacterial communities were characterized by pyrosequencing of barcoded 16S rRNA genes and clustered into 6 community state types (CSTs). Each swab was tested for 37 HPV types. The effects of CSTs on the rate of transition between HPV-negative and HPV-positive states were assessed using continuous-time Markov models. Results. Participants had an average of 29 samples, with HPV point prevalence between 58%-77%. CST was associated with changes in HPV status (P <.001). Lactobacillus gasseri-dominated CSTs had the fastest HPV remission rate, and a low Lactobacillus community with high proportions of the genera Atopobium (CST IV-B) had the slowest rate compared to L. crispatus-dominated CSTs (adjusted transition rate ratio [aTRR], 4.43, 95% confidence interval [CI], 1.11-17.7; aTRR, 0.33, 95% CI, .12-1.19, respectively). The rate ratio of incident HPV for low Lactobacillus CST IV - A was 1.86 (95% CI, .52-6.74). Conclusions. Vaginal microbiota dominated by L. gasseri was associated with increased clearance of detectable HPV. Frequent longitudinal sampling is necessary for evaluation of the association between HPV detection and dynamic microbiota.

Original languageEnglish (US)
Pages (from-to)1723-1733
Number of pages11
JournalJournal of Infectious Diseases
Issue number11
StatePublished - Dec 1 2014


  • 16S rRNA gene analysis
  • Human papillomavirus (HPV)
  • Transition model
  • Vaginal microbiota

ASJC Scopus subject areas

  • Medicine(all)


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