Neovaginal Human Papillomavirus Prevalence in Transfeminine Individuals: A Systematic Review.

OBJECTIVE: To assess the prevalence of high-risk human papillomavirus (hrHPV) and human papillomavirus (HPV)-associated abnormalities in the neovaginas of postvaginoplasty transfeminine patients to inform potential HPV-screening guidelines for this patient population. DATA SOURCES: MEDLINE, ClinicalTrials.gov , the Cochrane Library, Scopus, and Google Scholar were searched through September 30, 2022. METHODS OF STUDY SELECTION: The population included transfeminine individuals who had undergone vaginoplasty with an outcome of subsequent positive HPV diagnosis or HPV-related lesions. Randomized clinical trials, cohort studies, cross-sectional studies, and case reports available in English were included in the analysis. Identified articles were doubly screened, and accepted articles were doubly extracted. TABULATION, INTEGRATION, AND RESULTS: Of 59 abstracts identified, 30 were screened for eligibility, of which 15 met the criteria for review. Included studies were assessed for vaginoplasty procedure type, time elapsed between vaginoplasty and HPV testing, HPV type, location and manner of sample collection, method of HPV diagnosis, and classification and location of HPV-associated neovaginal lesions. Studies were assigned a grade of evidence of very low, low, moderate, or high based on study design, precision, directness, and risk of bias. Prevalence of neovaginal hrHPV ranged from 8.3% to 20% in identified studies, and per-study prevalence of HPV-related neovaginal abnormalities ranged from 0% to 8.3% in patients. CONCLUSION: The current body of research demonstrates that, after vaginoplasty, transfeminine individuals may develop neovaginal HPV infection with associated cytologic abnormalities or grossly apparent lesions. In some included studies, neovaginal HPV-associated lesions were highly advanced before they were identified. A small number of studies assessed neovaginal HPV prevalence in transfeminine individuals, with hrHPV prevalence ranging from 8.3% to 20%. However, broader conclusions about neovaginal HPV prevalence are limited by a lack of high-grade evidence in the existing literature. More rigorous prevalence research is needed to inform preventative care guidelines for transfeminine individuals at risk of developing HPV-related neovaginal complications. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42022379977.

Non-Lactobacillus-Dominant and Polymicrobial Vaginal Microbiomes Are More Common in Younger South African Women and Predictive of Increased Risk of Human Immunodeficiency Virus Acquisition.

BACKGROUND: Adolescent girls and young women aged 15‒24 years in sub-Saharan Africa are at disproportionate risk of human immunodeficiency virus (HIV) infection. Given the known association between vaginal microbial dysbiosis and HIV susceptibility, we performed an age-stratified analysis of the vaginal microbiome in South African women and compared this to their risk of HIV acquisition. METHODS: Vaginal microbiome data were generated by mass spectrometry-based proteomic analysis of cervicovaginal lavages collected from participants (n = 688) in the Centre for the AIDS Programme of Research in South Africa (CAPRISA) 004 trial. Participants were grouped by age (18-19 years, n = 93; 20-24 years, n = 326; 25-41 years, n = 269). RESULTS: Four microbiome types were identified based on predominant taxa, including Lactobacillus crispatus (CST-LC, 12.2%), Lactobacillus iners (CST-LI, 43.6%), Gardnerella vaginalis (CST-GV, 26.6%), or polymicrobial (CST-PM, 15.1%). Women aged 18-19 and 20-24 years had increased CST-PM and a non-Lactobacillus-dominant microbiome compared to those 25-41 years (odds ratio [OR], 3.14 [95% confidence interval {CI}, 1.12-7.87], P = .017; OR, 2.81 [95% CI, 1.07-7.09], P = .038, respectively; and OR, 1.65 [95% CI, 1.02-2.65], P = .028; OR, 1.40 [95% CI, 1.01-1.95], P = .030, respectively). The HIV incidence rate of women with CST-PM microbiome was 7.19-fold higher compared to women with CST-LC (hazard ratio [HR], 7.19 [95% CI, 2.11-24.5], P = .00162), which was also consistent in women aged 20-24 years (HR, 4.90 [95% CI, 1.10-21.9], P = .0375). CONCLUSIONS: Younger women were more likely to have a higher-risk polymicrobial microbiome suggesting that vaginal microbiota are contributing to increased HIV-1 susceptibility in this group. CLINICAL TRIALS REGISTRATION: NCT00441298.

The neovaginal microbiome of transgender women post-gender reassignment surgery.

BACKGROUND: Gender reassignment surgery is a procedure some transgender women (TW) undergo for gender-affirming purposes. This often includes the construction of a neovagina using existing penile and scrotal tissue and/or a sigmoid colon graft. There are limited data regarding the composition and function of the neovaginal microbiome representing a major gap in knowledge in neovaginal health. RESULTS: Metaproteomics was performed on secretions collected from the neovaginas (n = 5) and rectums (n = 7) of TW surgically reassigned via penile inversion/scrotal graft with (n = 1) or without (n = 4) a sigmoid colon graft extension and compared with secretions from cis vaginas (n = 32). We identified 541 unique bacterial proteins from 38 taxa. The most abundant taxa in the neovaginas were Porphyromonas (30.2%), Peptostreptococcus (9.2%), Prevotella (9.0%), Mobiluncus (8.0%), and Jonquetella (7.2%), while cis vaginas were primarily Lactobacillus and Gardnerella. Rectal samples were mainly composed of Prevotella and Roseburia. Neovaginas (median Shannon's H index = 1.33) had higher alpha diversity compared to cis vaginas (Shannon's H = 0.35) (p = 7.2E-3, Mann-Whitney U test) and were more similar to the non-Lactobacillus dominant/polymicrobial cis vaginas based on beta diversity (perMANOVA, p = 0.001, r2 = 0.342). In comparison to cis vaginas, toll-like receptor response, amino acid, and short-chain fatty acid metabolic pathways were increased (p < 0.01), while keratinization and cornification proteins were decreased (p < 0.001) in the neovaginal proteome. CONCLUSIONS: Penile skin-lined neovaginas have diverse, polymicrobial communities that show similarities in composition to uncircumcised penises and host responses to cis vaginas with bacterial vaginosis (BV) including increased immune activation pathways and decreased epithelial barrier function. Developing a better understanding of microbiome-associated inflammation in the neovaginal environment will be important for improving our knowledge of neovaginal health. Video Abstract.