Screening the vaginal microbiome as a predictive tool in reproductive health

Abstract

The vagina is an organ of utmost importance in reproductive and sexual health. Its health is largely determined by the status of the niche microbial community that lives within it: the vaginal microbiome. A vaginal microbiome dominated by vaginal Lactobacillus species is typically considered an indicator of good health, while deviations from this dogma are considered unstable and a marker for poor health, typically leading to a diagnosis of bacterial vaginosis. A dysbiotic vaginal microbiome has also been associated with other conditions such as infertility, preterm birth, genitourinary syndrome of menopause, etc. Until recently, data on the constitution of the vaginal microbiome has been limited and the true impact of this microbial community on human health was underappreciated. In recent years, as the impact of the gut microbiome on human health has been unravelled and shown promising clinical applications, the vaginal microbiome has now piqued the interest of researchers and clinicians. Compared to other sites of the reproductive tract, the vaginal microbiome can be easily sampled and thus screened, making it a desirable testing target. This raises questions as to the predictive capacity of vaginal microbiome data. Identifying screenable biomarkers within the human vaginal microbiome would be pertinent to human reproductive and sexual health, creating new avenues of intervention for assisted reproduction, disease prevention and management, reduction of infant mortality, etc. This calls for an in-depth analysis of the feasibility of using the vaginal microbiome as a predictive tool in healthcare by analysing past and current trends from bench to bedside and examining where and how it could be applied, which is the focus of this review.