Dr Ravel, associate professor at the University of Maryland’s Institute of Genome Sciences, said his team had isolated six vaginal microbial “state types”, one of which 98% of all women would fit into.
“It’s useful to understand what a healthy vaginal microbiota is. Even more important is helping and understanding how susceptible to infection a microbiota is. Whilst still healthy it can have different degrees of susceptibility.”
Getting to causality
The picture is complicated because community states change regularly, within group types, and even for individual women, especially when the development of the disease state of vaginosis is considered.
“The major problem with a lot of the research that has been so far is that … it has looked at women who present to them with bacterial vaginosis. When we study bacterial vaginosis once it has already occurred we miss the window to understand real true causality associated with bacterial vaginosis. We need to perform prospective, longitudinal studies.
“The advantage of that is we can get to causality.”
Such studies were underway from his team, he said.