Studies on the vaginal microbiome have started only recently, following the researches for characterizing the human microbiome. Describing the real composition of microbial community in the vagina using microbiome studies is crucial for women's health, since abnormal vaginal microbiota is associated with increased risk for acquisition of sexually transmitted infections, infertility and poor gestational outcomes. Previous studies showed that hot's immune response is strongly associated to altered vaginal flora and its complications although the mechanisms involved in this association are still poorly understood. Considering that the treatment of the most frequent type of abnormal vaginal flora, bacterial vaginosis (BV), is associated with high rates of therapeutic failure it has been suggested that individual differences in the immune response to BV may be related with its treatment outcomes. The largest study on vaginal microbiome demonstrated that the vaginal microbiota can be classified into 5 communities according to the abundance of the bacterial species. The BV cases are placed in the bacterial community with the lowest abundance of lactobacilli and such community and can be further divided into 3 sub-communities. Thus, it can be suggested that in addition to host's immune response, differences in the bacterial composition of BV may influence its treatment outcome. Considering that no other study has been performed aiming to determine the vaginal microbiome of Brazilian women and that BV present high rates of therapeutic failure, the aims of this study are: to characterize the vaginal microbiome of Brazilian women in reproductive age from the five regions of the country and to evaluate if the sub-communities of BV, total bacterial count and the proteomic profile are associated with the persistence of BV after conventional treatment. The microbiome of at least 500 women will be determined with pyrosequencing. Vaginal flora will be classified in normal, intermediate and BV, according to Nugent et al. (1991) criteria and the BV cases observed will be evaluated for the presence of the bacterial sub-communities. In addition, BV cases will be assessed before and after treatment for the bacterial count using flux cytometry and proteomic profiles using mass spectrometry MALDI-TOF-TOF. Thus, these results will allow the first-time description of the vaginal microbiome in Brazilian women and the association between BV treatment and bacterial and proteomic profiles, which may contribute to future strategies for improving women's reproductive health.
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