# “Inflammation, Vaginal Microbiota, and STI/HIV Risk”

> **NIH NIH R01** · JOHNS HOPKINS UNIVERSITY · 2020 · $472,668

## Abstract

Young people (15-24 years old [yo]) acquire half of the 20 million new sexually transmitted infections (STI)
annually in the U.S. and 1 in 4 sexually active adolescent girls has an STI. Complex biological, socio-
behavioral, and cultural factors place sexually active adolescent girls at higher risk of acquiring STIs compared
with boys and adult women. Some STIs can increase HIV acquisition by breaching the protective mucosal
epithelial barrier, promoting inflammation, and recruiting HIV target cells into the genital tract. This synergy
between STIs, inflammation, and HIV contributes to the 380,000 new HIV infections among adolescent girls
and young women (10-24yo) each year worldwide. In communities where STI and HIV prevalence are high,
sexually active girls using hormonal contraception (HC), but without barrier protection, are at risk of STI/HIV
acquisition. Several observational studies have suggested that depot medroxyprogesterone acetate (DMPA)
may increase the risk of HIV acquisition by up to 3.0-fold. Yet, the biological aspects of STI co-infections,
inflammation, exogenous hormones, and HIV acquisition in adolescent girls and young women are
understudied. Given that most HIV infections occur at mucosal surfaces, there is a critical need to better
understand mucosal immune function and biologic factors like hormonal status and vaginal microbiota that can
alter susceptibility to STI/HIV among adolescent girls and young women. In the absence of such knowledge,
the development of effective biomedical technologies to prevent STIs and HIV within this vulnerable key
population will likely remain difficult. Our central hypothesis is that the hypoestrogenemia induced by DMPA
decreases the vagina's natural host defense mechanisms against STI/HIV by altering the microbiota (e.g.
decreasing lactobacilli), decreasing mucus pathogen trapping properties, and increasing inflammation. To test
our hypothesis, we propose the following two specific aims: (1) To identify the association between the vaginal
microbiota, inflammation, and STIs. The vaginal microbiota of 225 menarcheal, sexually-active, healthy U.S.
adolescent girls and young women (13-24yo) will be characterized by 16s rRNA sequencing using self-
collected vaginal swabs in a cross-sectional design; and (2) To determine the impact of DMPA use on vaginal
microbiota, inflammation, and female genital tract anatomy and physiology. A subset of adolescent girls and
young women who initiate DMPA (n=40) or those not using any HC (n=40) will be followed prospectively.
Changes from baseline in the vaginal microbiota, inflammation, and cervicovaginal mucus properties will be
assessed at 3 and 12 weeks. Our approach is innovative because it seeks to address key issues in an
understudied population using cutting edge methods. The proposed research is significant because it is
expected to vertically advance the field by providing key insight into the important role of vaginal microbiota
and exogenous hormones,...

## Key facts

- **NIH application ID:** 9908138
- **Project number:** 5R01HD092013-04
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Jenell S Coleman
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $472,668
- **Award type:** 5
- **Project period:** 2017-04-03 → 2023-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9908138

## Citation

> US National Institutes of Health, RePORTER application 9908138, “Inflammation, Vaginal Microbiota, and STI/HIV Risk” (5R01HD092013-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9908138. Licensed CC0.

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