Influence of cervicovaginal microbiota on Chlamydia trachomatis infection dynamics
Authors:Emily Hand1, Indriati Hood-Pishchany1,2, Toni Darville1,2 and Catherine M. O’Connell2
doi: 10.15698/mic2025.04.848
Volume 12, pp. 93 to 108, published 15/04/2025.
1 Department of Microbiology and Immunology, University of North Carolina at Chapel Hill. 2 Department of Pediatrics, University of North Carolina at Chapel Hill.
Keywords:
chlamydia, gonorrhea, lactobacilli, microbiome, 16S rRNA, immunity, multiomics.
Corresponding Author(s):
Conflict of interest statement:
The authors have declared that no conflicts of interest exist.
Please cite this article as:
Emily Hand, Indriati Hood-Pishchany, Toni Darville and Catherine M. O’Connell (2025). Influence of cervicovaginal microbiota on Chlamydia trachomatis infection dynamics. Microbial Cell 12: 93-108. doi: 10.15698/mic2025.04.848
© 2025 Hand et al. This is an open-access article released under the terms of the Creative Commons Attribution (CC BY) license, which allows the unrestricted use, distribution, and reproduction in any medium, provided the original author and source are acknowledged.
Abstract:
The cervicovaginal microbiome (CVM) is increasingly being considered as an important aspect of women’s health, particularly in relation to the risk and progression of sexually transmitted infections (STIs). CVM composition varies significantly between individuals and is shaped by factors including diet, age, environmental exposures, and lifestyle. Understanding these influences may shed light on how microbial imbalances contribute to infection susceptibility and the development of reproductive health disorders. Five distinct community state types (CSTs) classify common CVM compositions. Most CSTs (I, II, III, V) are characterized by a dominant Lactobacillus species and are associated with better or neutral reproductive health, including reduced coincident detection of STIs such as Chlamydia trachomatis. In contrast, CST IV is composed of diverse, predominantly anaerobic, microbial species and is associated with CVM dysbiosis, bacterial vaginosis, and a heightened risk of STI acquisition. This review examines the complex interplay between the CVM, C. trachomatis infection, and host immune responses, highlighting the role of metabolites such as short-chain and long-chain fatty acids, indole, and iron in modulating pathogen survival and host defenses. Additionally, the impacts of CVM composition on C. trachomatis persistence, ascension, and clearance are discussed, alongside co-infection dynamics with pathogens like Neisseria gonorrhoeae and Mycoplasma genitalium.