# The vaginal microenvironment in asymptomatic versus symptomatic bacterial vaginosis

> **NIH NIH R21** · JOHNS HOPKINS UNIVERSITY · 2024 · $203,892

## Abstract

Bacterial vaginosis (BV), which is characterized by a dysbiotic vaginal microbiota low in Lactobacillus species,
affects nearly 30% of U.S. women; the majority (55%) are asymptomatic (aBV). Guidelines currently
recommend testing and treatment only for symptomatic BV (sBV). BV (a composite variable with aBV and
symptomatic BV [sBV]) has been associated with an increased risk of sexually transmitted infections (STIs)
and HIV acquisition. Although studies to distinguish the differential risk of incident STI or HIV between women
with aBV and sBV have not been published, preliminary data from our group suggests that aBV is strongly
associated with incident STI and a published pilot study of BV suppressive therapy in women with aBV
indicated a decrease in chlamydia cases. To date, enthusiasm for research on or clinical treatment of aBV has
been limited, primarily by lack of data on aBV risks and perceptions of low efficacy of currently available BV
treatments. However, while BV treatment is challenging, approximately 50% of women with sBV taking
currently available therapies do achieve lasting cure. Moreover, novel, more effective therapies for BV are on
the horizon: a recent high-profile randomized trial of Lactin V, a L. crispatus intravaginal live biotherapeutic
product, showed reduced BV recurrence13. As new, better treatments for sBV become available, it is critical to
determine whether women with aBV should also be treated, in order to prevent sequelae such as STI or HIV
acquisition. If the vaginal microenvironment is shown to be identical in women with sBV and aBV, this will be
an important initial step demonstrating that aBV is a condition that should not be ignored, and will galvanize
further studies to define aBV, STI and HIV risk, and advance treatment. In a large epidemiologic study of over
300 women, our specific aims are to assess whether women with aBV and sBV differ in two broad areas (1)
biobehavioral factors and (2) the vaginal microenvironment, including factors associated with HIV and STI
acquisition risk (vaginal microbiota, key metabolites and soluble mediators of inflammation). This is a
secondary analysis leveraging existing data from a previously funded study (NIAID R01-AI116799, PI:
Brotman) for which 16S rRNA gene amplicon, metabolomic, and immunologic profiles have already been
generated from cervicovaginal lavage samples collected in the NIH's Longitudinal Study of Vaginal Flora.
Information gained through this proposed study will provide foundational data to better define aBV, and to
determine whether future studies to define the risk of HIV and STI acquisition associated with aBV, or studies
of aBV treatment as a method to prevent HIV and STIs are needed. This resubmission application is in
response to a program announcement (PAR-20-291) which is designed for Exploratory and Developmental
Research Grant Program for NIAID K-award Recipients. It will provide career development for the PI to
transition to research independen...

## Key facts

- **NIH application ID:** 10782002
- **Project number:** 5R21AI168984-02
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Susan Anne Tuddenham
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $203,892
- **Award type:** 5
- **Project period:** 2023-03-01 → 2026-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10782002

## Citation

> US National Institutes of Health, RePORTER application 10782002, The vaginal microenvironment in asymptomatic versus symptomatic bacterial vaginosis (5R21AI168984-02). Retrieved via AI Analytics 2026-06-12 from https://api.ai-analytics.org/grant/nih/10782002. Licensed CC0.

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