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Vaginal Microbiome and Its Relationship to Behavior, Sexual Health, and Sexually Transmitted Diseases

Lewis, Felicia M. T. MD; Bernstein, Kyle T. PhD, MsC; Aral, Sevgi O. PhD, MS

doi: 10.1097/AOG.0000000000001932
Contents: Infectious Disease: Clinical Expert Series
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The vaginal microbiota has great significance in maintaining vaginal health and protecting the host from disease. Recent advances in molecular techniques and informatics allow researchers to explore microbial composition in detail and to compare the structure of vaginal microbial communities with behavior and health outcomes, particularly acquisition and transmission of sexually transmitted diseases (STDs) and poor birth outcomes. Vaginal flora have been found to cluster into a limited number of communities, although community structure is dynamic. Certain community types are more associated with poor reproductive outcomes and STDs; communities dominated by Lactobacillus species, particularly Lactobacillus crispatus, are most associated with vaginal health. Modifiable and nonmodifiable factors are strongly associated with community composition, including behavior, race or ethnicity, and hygiene. In this review, we describe the state of the science on the vaginal microbiome and its relationship to behavior, sexual health, and STDs, including determinants of the microbiome that go beyond an individual level.

Structure and function of the vaginal microbiome is complex, influenced by many factors, and may be key to acquisition and transmission of sexually transmitted diseases.

Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, and the Philadelphia Department of Public Health, Philadelphia, Pennsylvania.

Corresponding author: Felicia M. T. Lewis, MD, Medical Epidemiologist, Philadelphia Department of Public Health/Centers for Disease Control and Prevention, 500 S Broad Street, Philadelphia, PA 19146; email:

Financial Disclosure The authors did not report any potential conflicts of interest.

The conclusions, findings, and opinions expressed by authors do not necessarily reflect the official position of the U.S. Department of Health and Human Services or the Centers for Disease Control and Prevention.

Continuing medical education for this article is available at

Each author has indicated that he or she has met the journal’s requirements for authorship.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.