The Cervicovaginal Microbiota in Women Notified for Chlamydia trachomatis Infection: A Case-Control Study at the Sexually Transmitted Infection Outpatient Clinic in Amsterdam, The Netherlands

Clin Infect Dis. 2017 Jan 1;64(1):24-31. doi: 10.1093/cid/ciw586. Epub 2016 Aug 27.


Background: Increasing evidence suggests that the cervicovaginal microbiota (CVM) plays an important role in acquiring sexually transmitted infections (STIs). 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 cervicovaginal samples and clinical data. CVMs were characterized by sequencing the V3/V4 region of the 16S ribosomal RNA 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 3 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 CVM was significantly associated with C. trachomatis infection (odds ratio [OR], 4.2 [95% confidence interval {CI}, 1.2-15.4] for women with diverse anaerobic CVM and OR, 4.4 [95% CI, 1.3-15.6], for women with L. iners-dominated CVM, compared with women with L. crispatus-dominated CVM), as was younger age (OR, 3.1 [95% CI, 1.1-8.7] for those ≤21 years old) and reporting a steady sex partner (OR, 3.6 [95% CI, 1.4-9.4]).

Conclusions: 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.

Keywords: Chlamydia trachomatis; cervicovaginal microbiota; contact tracing.

MeSH terms

  • Adult
  • Case-Control Studies
  • Cervix Uteri / microbiology*
  • Chlamydia Infections / epidemiology*
  • Chlamydia Infections / microbiology*
  • Chlamydia trachomatis* / classification
  • Chlamydia trachomatis* / genetics
  • Disease Notification
  • Female
  • High-Throughput Nucleotide Sequencing
  • Humans
  • Microbiota*
  • Netherlands / epidemiology
  • Phylogeny
  • Public Health Surveillance
  • RNA, Ribosomal, 16S / genetics
  • Risk Factors
  • Sexual Behavior
  • Sexually Transmitted Diseases
  • Vagina / microbiology*
  • Young Adult


  • RNA, Ribosomal, 16S