The Presence of Lactobacillus spp. and its Effect on the Occurrence of Other Microorganisms in the Reproductive Tract of Polish Women

Aneta Kiecka; Katarzyna Rak; Joanna Białecka; Anna Białecka; Marian Szczepanik

doi:10.33073/pjm-2024-024

.blurhash-client-img { display: none !important; }

The Presence of Lactobacillus spp. and its Effect on the Occurrence of Other Microorganisms in the Reproductive Tract of Polish Women

Polish Journal of Microbiology

Volume 73 (2024): Issue 3 (September 2024)

By: Aneta Kiecka , Katarzyna Rak , Joanna Białecka , Anna Białecka and Marian Szczepanik

Open Access

|Aug 2024

Figures & Tables

Microscope photos showing *Lactobacillus* categories of 0, 1, 2, and 3.
A) 0 – means none, B) 1 – a single bacterium (up to 10 in the field of view), C) 2 – few (11–50 in the field of view), D) 3 – many (> 50 in the field of view) cells of *Lactobacillus*.

Table I

Occurrence of individual microorganisms in women with and without symptoms qualified for the study and the microbiological methods used.

Microorganisms		Method	Total	Without symptoms (n = 752)	With symptoms (n = 287)	p-value*	OR^# (95% CI)	p-value**
Microorganisms		Method	n (%)	n (%)	n (%)	p-value*	OR^# (95% CI)	p-value**
Lactobacillus spp.^†	0	microscopic	46 (4.4%)	19 (2.5%)	27 (9.4%)	< 0.001	1 (REF.)	–
	1		132 (12.7%)	90 (12.0%)	42 (14.6%)		0.33 (0.17; 0.66)	0.002
	2		611 (58.8%)	451 (60.0%)	160 (55.7%)		0.25 (0.14; 0.46)	< 0.001
	3		250 (24.1%)	192 (25.5%)	58 (20.2%)		0.22 (0.11; 0.41)	< 0.001
Gardnerella vaginalis		culture, microscopic	51 (4.9%)	11 (1.5%)	40 (13.9%)	< 0.001	10.55 (5.40; 20.63)	< 0.001
Ureaplasma parvum		PCR	165 (15.9%)	81 (10.8%)	84 (29.3%)	< 0.001	3.42 (2.43; 4.82)	< 0.001
Ureaplasma urealyticum		PCR	80 (7.7%)	27 (3.6%)	53 (18.5%)	< 0.001	6.02 (3.71; 9.75)	< 0.001
Mycoplasma hominis		PCR	19 (1.8%)	0 (0%)	19 (6.6%)	< 0.001	109.30 (6.58; 1,816.53)	0.001
Mycoplasma genitalium		PCR	1 (0.1%)	0 (0%)	1 (0.3%)	0.276	7.88 (0.32; 193.98)	0.207
Chlamydia trachomatis		PCR	8 (0.8%)	1 (0.1%)	7 (2.4%)	< 0.001	13.40 (2.31; 77.74)	0.004
Enterobacterales		culture	55 (5.3%)	35 (4.7%)	20 (7.0%)	0.162	1.55 (0.88; 2.72)	0.127
Streptococcus group B		culture	81 (7.8%)	57 (7.6%)	24 (8.4%)	0.698	1.12 (0.69; 1.84)	0.641
Yeast		culture, microscopic	177 (17.0%)	100 (13.3%)	77 (26.8%)	< 0.001	2.39 (1.71; 3.34)	< 0.001
Neisseria gonorrhoeae		culture	0 (0.0%)	0 (0.0%)	0 (0.0%)	–	–	–
Trichomonas vaginalis		culture	0 (0.0%)	0 (0.0%)	0 (0.0%)	–	–	–

1* – all p-values are examined on Fisher’s test

1** – p-values measured by Wald method using Firth’s logistic regression

1# – OR of occurrence symptoms in women with or without detected microorganisms, reference category in all microorganism is “undetected”

1† – 0 means none, 1 single (up to 10 in the field of view), 2 few (11–50 in the field of view), 3 many (> 50 in the field of view) cells of Lactobacillus

Table II

Relationship between the occurrence microorganisms and symptoms.

Microorganisms		Model 1		Model 2		Model 3
Microorganisms		OR^# (95% CI)	p-value**	OR^# (95% CI)	p-value**	OR^# (95% CI)	p-value**
Lactobacillus spp.^†	1	0.31 (0.15; 0.61)	< 0.001	0.42 (0.20; 0.87)	0.019	0.33 (0.16; 0.69)	0.003
	2	0.23 (0.12; 0.43)	< 0.001	0.38 (0.19; 0.76)	0.006	0.27 (0.13; 0.54)	< 0.001
	3	0.20 (0.10; 0.38)	< 0.001	0.38 (0.18; 0.81)	0.012	0.23 (0.10; 0.50)	< 0.001
Gardnerella vaginalis		10.47 (5.36; 20.47)	< 0.001	7.83 (3.93; 15.61)	< 0.001	10.03 (4.92; 20.47)	< 0.001
Ureaplasma parvum		3.40 (2.42; 4.79)	< 0.001	3.18 (2.25; 4.50)	< 0.001	2.93 (2.06; 4.16)	< 0.001
Ureaplasma urealyticum		5.98 (3.69; 9.69)	< 0.001	5.69 (3.49; 9.28)	< 0.001	5.56 (3.40; 9.09)	< 0.001
Mycoplasma hominis		111.18 (6.71; 1,842.58)	0.001	98.35 (5.93; 1,631.18)	0.001	94.56 (5.72; 1,563.34)	0.001
Chlamydia trachomatis		13.21 (2.28; 76.60)	0.004	13.56 (2.31; 79.70)	0.004	10.12 (1.69; 60.80)	0.011
Yeast		2.38 (1.70; 3.32)	< 0.001	2.24 (1.59; 3.14)	< 0.001	1.93 (1.36; 2.74)	< 0.001

1 Model 1 adjusted to age, Model 2 adjusted to age and pH, Model 3 adjusted to age, pH and leucocytes

1# – OR of occurrence symptoms in women with microorganisms (except of Lactobacillus) compared with those without microorganisms, in the case Lactobacillus OR refers to prevalence of symptoms in women with detected

1† – Lactobacillus at the level 1 single (up to 10 in the field of view), 2 few (11–50 in the field of view), 3 many (> 50 in the field of view) respectively, compared with 0 (lack)

1** – p-values testing by Wald method and Firth’s logistic regression

Table III

Relationship between the presence of Lactobacillus spp. and other microorganisms.

Microorganisms	Presence	n (%)	Lactobacillus spp.^†				p-value*
Microorganisms	Presence	n (%)	0	1	2	3	p-value*
Gardnerella vaginalis	No	988 (95.1%)	30 (65.2%)	108 (81.8%)	600 (98.2%)	250 (100%)	< 0.001
Gardnerella vaginalis	Yes	51 (4.9%)	16 (34.8%)	24 (18.2%)	11 (1.8%)	0 (0%)	–
Ureaplasma parvum	No	874 (84.1%)	36 (78.3%)	109 (82.6%)	520 (85.1%)	209 (83.6%)	0.542
Ureaplasma parvum	Yes	165 (15.9%)	10 (21.7%)	23 (17.4%)	91 (14.9%)	41 (16.4%)	–
Ureaplasma urealyticum	No	959 (92.3%)	40 (87.0%)	119 (90.2%)	566 (92.6%)	234 (93.6%)	0.299
Ureaplasma urealyticum	Yes	80 (7.7%)	6 (13.0%)	13 (9.8%)	45 (7.4%)	16 (6.4%)	–
Mycoplasma hominis	No	1020 (98.2%)	42 (91.3%)	129 (97.7%)	601 (98.4%)	248 (99.2%)	0.0153
Mycoplasma hominis	Yes	19 (1.8%)	4 (8.7%)	3 (2.3%)	10 (1.6%)	2 (0.8%)	–
Mycoplasma genitalium	No	1038 (99.9%)	45 (97.8%)	132 (100%)	611 (100%)	250 (100%)	0.0443
Mycoplasma genitalium	Yes	1 (0.1%)	1 (2.2%)	0 (0%)	0 (0%)	0 (0%)	–
Chlamydia trachomatis	No	1031 (99.2%)	46 (100%)	131 (99.2%)	606 (99.2%)	248 (99.2%)	1.000
Chlamydia trachomatis	Yes	8 (0.8%)	0 (0%)	1 (0.8%)	5 (0.8%)	2 (0.8%)	–
Enterobacterales	No	984 (94.7%)	36 (78.3%)	112 (84.8%)	590 (96.6%)	246 (98.4%)	< 0.001
Enterobacterales	Yes	55 (5.3%)	10 (21.7%)	20 (15.2%)	21 (3.4%)	4 (1.6%)	–
Streptococcus group B	No	958 (92.2%)	34 (73.9%)	108 (81.8%)	571 (93.5%)	245 (98.0%)	< 0.001
Streptococcus group B	Yes	81 (7.8%)	12 (26.1%)	24 (18.2%)	40 (6.5%)	5 (2.0%)	–
Yeast	No	862 (83.0%)	39 (84.8%)	111 (84.1%)	506 (82.8%)	206 (82.4%)	0.976
Yeast	Yes	177 (17.0%)	7 (15.2%)	21 (15.9%)	105 (17.2%)	44 (17.6%)	–
Neisseria gonorhoeae	No	1039 (100%)	46 (100%)	132 (100%)	611 (100%)	250 (100%)	–
Neisseria gonorhoeae	Yes	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	–
Trichomonas vaginalis	No	1039 (100%)	46 (100%)	132 (100%)	611 (100%)	250 (100%)	–
Trichomonas vaginalis	Yes	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	–

1* – all p-values are testing on Fisher’s exact test

1† – 0 means none, 1 single (up to 10 in the field of view), 2 few (11–50 in the field of view), 3 many (> 50 in the field of view)

Table IV

The association between presence of Lactobacillus and other microorganisms – multivariable logistic regression models.

Microorganisms	Lactobacillus as ordered variable^†		Lactobacillus as dichotomous variable^††
	Per 1 category level increase		Not present	Present	Not present	Present
	Model 1	Model 2	Model 1		Model 2
Yeast	1.04 (0.83; 1.30)	1.32 (1.02; 1.71)	1 (REF.)	0.97 (0.43; 2.18)	1 (REF.)	1.69 (0.70; 4.07)
Enterobacterales	0.35 (0.25; 0.48)	0.54 (0.37; 0.81)	1 (REF.)	0.19 (0.09; 0.40)	1 (REF.)	0.78 (0.31; 1.97)
Streptococcus group B	0.40 (0.30; 0.52)	0.63 (0.45; 0.89)	1 (REF.)	0.23 (0.11; 0.47)	1 (REF.)	0.99 (0.42; 2.29)
Gardnerella_vaginalis	0.14 (0.09; 0.21)	0.20 (0.12; 0.32)	1 (REF.)	0.05 (0.02; 0.11)	1 (REF.)	0.21 (0.09; 0.51)
Chlamydia_trachomatis	1.12 (0.45; 2.79)	1.39 (0.52; 3.75)	1 (REF.)	0.67 (0.04; 11.0)	1 (REF.)	1.19 (0.06; 24.33)
Mycoplasma_hominis	0.47 (0.28; 0.78)	0.61 (0.32; 1.16)	1 (REF.)	0.16 (0.05; 0.49)	1 (REF.)	0.32 (0.08; 1.32)
Ureaplasma_parvum	0.91 (0.72; 1.13)	1.16 (0.89; 1.50)	1 (REF.)	0.58 (0.28; 1.19)	1 (REF.)	1.02 (0.46; 2.26)
Ureaplasma_urealyticum	0.75 (0.56; 1.01)	0.88 (0.62; 1.25)	1 (REF.)	0.45 (0.19; 1.07)	1 (REF.)	0.70 (0.26; 1.90)

1* – model 1 adjusted to age

1** – model 2 adjusted to age and pH

1† – Lactobacillus was coded as 0, 1, 2, 3, where 0 means none, 1 single (up to 10 in the field of view), few (11–50 in the field of view), 3 many (> 50 in the field of view) cells of Lactobacillus

1†† – result for presence of Lactobacillus (1 + 2 + 3) compared to 0

Distribution of pH between *Lactobacillus* categories.

Table V

The pH values in women with and without the occurrence of microorganisms.

Microorganisms	Not prevalent		Prevalent		p*	pH > 4.5	p**
Microorganisms	n	Q2 (Q1–Q3)	n	Q2 (Q1–Q3)	p*	OR (95% CI)**	p**
Lactobacillus spp.	46	5.5 (5.0; 5.5)	993	4.5 (4.0; 4.5)	< 0.001	0.01 (0.00; 0.05)	< 0.001
Gardnerella vaginalis	988	4.5 (4.0; 4.5)	51	5.0 (5.0; 5.5)	< 0.001	12.18 (6.31; 23.48)	< 0.001
Ureaplasma parvum	874	4.5 (4.0; 4.5)	165	4.5 (4.5; 5.0)	< 0.001	1.74 (1.21; 2.50)	0.003
Ureaplasma urealyticum	959	4.5 (4.0; 4.5)	80	4.5 (4.4; 5.0)	0.009	2.36 (1.47; 3.78)	< 0.001
Mycoplasma hominis	1020	4.5 (4.0; 4.5)	19	4.5 (4.5; 5.0)	0.014	2.88 (1.18; 7.01)	0.020
Mycoplasma genitalium	1038	4.5 (4.0; 4.5)	1	5.0 (5.0; 5.0)	0.203	11.50 (0.46; 284.64)	0.136
Chlamydia trachomatis	1031	4.5 (4.0; 4.5)	8	4.5 (4.4; 4.6)	0.698	1.27 (0.29; 5.52)	0.748
Enterobacterales	984	4.5 (4.0; 4.5)	55	5.0 (4.5; 5.0)	< 0.001	6.10 (3.47; 10.74)	< 0.001
Streptococcus group B	958	4.5 (4.0; 4.5)	81	5.0 (4.5; 5.0)	< 0.001	5.06 (3.17; 8.06)	< 0.001
Yeast	862	4.5 (4.0; 4.5)	177	4.5 (4.5; 5.0)	0.001	1.66 (1.16; 2.37)	0.005

1* – based on Mann-Whitney U test

1** – based on logistic regression, Firth’s method, crude models, OR of prevalence pH > 4.5 in women specific microorganisms compared with those without them; Q2 (Q1–Q3) denotes median (interquartile range)

References

Authors

Metrics

Articles in this issue

DOI: https://doi.org/10.33073/pjm-2024-024 | Journal eISSN: 2544-4646 | Journal ISSN: 1733-1331

Journal RSS Feed

Language: English

Page range: 265 - 273

Submitted on: Feb 5, 2024

Accepted on: May 24, 2024

Published on: Aug 25, 2024

Published by: Polish Society of Microbiologists

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

female reproductive tract microbiota,

Related subjects:

Microbiology and virology

© 2024 Aneta Kiecka, Katarzyna Rak, Joanna Białecka, Anna Białecka, Marian Szczepanik, published by Polish Society of Microbiologists
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Volume 73 (2024): Issue 3 (September 2024)

The Presence of Lactobacillus spp. and its Effect on the Occurrence of Other Microorganisms in the Reproductive Tract of Polish Women

Figures & Tables

Fig. 1.

Table I

Table II

Table III

Table IV

Fig. 2.

Table V

Paradigm

My account