# Dysbiosis, Recurrent Bacterial Vaginosis and the Vaginal Microbiome

> **NIH NIH K23** · JOHNS HOPKINS UNIVERSITY · 2020 · $197,017

## Abstract

Project Summary/Abstract:
Disrupted or “dysbiotic” vaginal microbiota, as epitomized by the clinical syndrome of bacterial vaginosis (BV),
can result in severe recurrent symptoms despite antibiotic therapy, as well as serious reproductive
consequences including preterm labor and the acquisition and transmission of sexually transmitted infections.
New molecular techniques are enabling a more sophisticated understanding of the complex structure of
vaginal microbial communities, while studies from the nascent field of metabolomics suggest that the functional
output of these microbiota may be a key factor in the pathogenesis of dysbiosis. Hormonal contraception (HC)
has been shown in epidemiologic studies to decrease the risk of incident and recurrent BV in some, but not all
women. Preliminary data suggests that HC stabilizes and shifts the microbiota away from the low-lactobacilli,
mixed anaerobe-predominant communities characteristic of BV. As such, it may hold promise as a way to
ameliorate dysbiosis and treat recurrent BV in selected patients. However, despite over 50 years of
widespread use, our understanding of the impact of HC on the structure of vaginal communities in
asymptomatic women is incomplete, and the impact of HC on the function of vaginal communities in these
women is not known. Additionally, the impact of HC on the structure and function of the vaginal microbiota in
women with recurrent BV is unknown. This proposal seeks to elucidate these questions through 3 aims: 1) To
evaluate the impact of HC on the structure of the vaginal microbiota in asymptomatic women as measured by
absolute bacterial counts of Lactobacillus species, (in particular L. iners), and other selected anaerobes in
vaginal microbial communities, 2) To determine the impact of HC on the function of the vaginal microbiota in
asymptomatic women as measured by the production of lactic acid isomers and biogenic amines, and 3) To
evaluate the impact of HC on the structure and function of the vaginal microbiota in a small pilot cohort of
women with recurrent BV. Aims 1 and 2 will be nested within an existing cohort study, the Hormonal
Contraception Longitudinal Study. For aim 3, the PI will recruit a small pilot cohort for an observational study of
women with recurrent BV starting on HC. Through formal didactics and structured mentorship from a team
which comprises experts in genitourinary infections, metagenomics, and advanced analytics, the PI will
develop a unique analytic skill set, including knowledge of the R statistical package, longitudinal data analysis,
multi-level modeling, principle component analysis and hierarchical clustering analysis, as well as experience
in patient recruitment and clinical research. This will enable her to achieve the long-term goal of becoming an
independent clinical investigator who will utilize the powerful new tools of metagenomics and metabolomics to
design and lead interventions to improve clinical outcomes in women.

## Key facts

- **NIH application ID:** 9965814
- **Project number:** 5K23AI125715-05
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Susan Anne Tuddenham
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $197,017
- **Award type:** 5
- **Project period:** 2016-07-01 → 2022-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9965814

## Citation

> US National Institutes of Health, RePORTER application 9965814, Dysbiosis, Recurrent Bacterial Vaginosis and the Vaginal Microbiome (5K23AI125715-05). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/9965814. Licensed CC0.

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