A novel sequencing-based vaginal health assay combining self-sampling, HPV detection and genotyping, STI detection, and vaginal microbiome analysis

PLoS One. 2019 May 1;14(5):e0215945. doi: 10.1371/journal.pone.0215945. eCollection 2019.

Abstract

The composition of the vaginal microbiome, including both the presence of pathogens involved in sexually transmitted infections (STI) as well as commensal microbiota, has been shown to have important associations for a woman's reproductive and general health. Currently, healthcare providers cannot offer comprehensive vaginal microbiome screening, but are limited to the detection of individual pathogens, such as high-risk human papillomavirus (hrHPV), the predominant cause of cervical cancer. There is no single test on the market that combines HPV, STI, and microbiome screening. Here, we describe a novel inclusive vaginal health assay that combines self-sampling with sequencing-based HPV detection and genotyping, vaginal microbiome analysis, and STI-associated pathogen detection. The assay includes genotyping and detection of 14 hrHPV types, 5 low-risk HPV types (lrHPV), as well as the relative abundance of 31 bacterial taxa of clinical importance, including Lactobacillus, Sneathia, Gardnerella, and 3 pathogens involved in STI, with high sensitivity, specificity, and reproducibility. For each of these taxa, reference ranges were determined in a group of 50 self-reported healthy women. The HPV sequencing portion of the test was evaluated against the digene High-Risk HPV HC2 DNA test. For hrHPV genotyping, agreement was 95.3% with a kappa of 0.804 (601 samples); after removal of samples in which the digene hrHPV probe showed cross-reactivity with lrHPV types, the sensitivity and specificity of the hrHPV genotyping assay were 94.5% and 96.6%, respectively, with a kappa of 0.841. For lrHPV genotyping, agreement was 93.9% with a kappa of 0.788 (148 samples), while sensitivity and specificity were 100% and 92.9%, respectively. This novel assay could be used to complement conventional cervical cancer screening, because its self-sampling format can expand access among women who would otherwise not participate, and because of its additional information about the composition of the vaginal microbiome and the presence of pathogens.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Capsid Proteins / genetics
  • DNA, Viral / genetics
  • DNA, Viral / isolation & purification
  • Female
  • Gardnerella / genetics
  • Gardnerella / isolation & purification
  • Genotype
  • Humans
  • Lactobacillus / genetics
  • Lactobacillus / isolation & purification
  • Limit of Detection
  • Microbiota*
  • Middle Aged
  • Oncogene Proteins, Viral / genetics
  • Papillomaviridae / genetics*
  • Papillomaviridae / isolation & purification
  • Papillomavirus Infections / diagnosis*
  • Papillomavirus Infections / virology
  • RNA, Ribosomal, 16S / genetics
  • RNA, Ribosomal, 16S / metabolism
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Sexually Transmitted Diseases / diagnosis*
  • Sexually Transmitted Diseases / virology
  • Vagina / microbiology
  • Vagina / virology*
  • Young Adult

Substances

  • Capsid Proteins
  • DNA, Viral
  • HPV L1 protein, Human papillomavirus
  • Oncogene Proteins, Viral
  • RNA, Ribosomal, 16S

Grants and funding

The funder, uBiome, Inc. provided support in the form of salaries for all authors, and decided which initial targets to include in the study design, but did not have any additional role in data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of each author are articulated in the ‘author contributions’ section.