A case of misdiagnosis?

Women who get vaginal infections – almost everyone, at least once, according to federal figures – could be suffering because of a blanket approach to diagnosis and treatment that may perpetuate problems ranging from annoying to deadly, according to new research at the University of Idaho. Larry Forney, a UI biology professor and father of two grown daughters, said he’s angry at scientists and doctors who have assumed that women are all the same when it comes to the bacterial composition of their most intimate areas. Not true, according to Forney’s findings published in a recent issue of the ISME Journal, a publication of the International Society for Microbial Ecology. His research used genetic analysis to show that there are distinct differences in normal vaginal microbial make-up. Researchers speculate that failure to identify and accommodate those differences may allow doctors to overlook women prone to ailments ranging from common yeast infections to sexually transmitted diseases, including HIV.

“If men got yeast infections,” Forney said. “There wouldn’t be any.”

Using samples collected from 144 women in four U.S. states and Canada, Forney and his research team found that there are eight major kinds of vaginal microbial communities – and that they may vary significantly in their ability to resist harmful bacteria.

Even more important, the researchers found that resistance appears to be linked to race, with black women less likely than white women to bounce back from bacterial upsets that raise the pH of the vaginal environment, inviting infection. The vagina is typically a low-pH place, which inhibits the growth of invasive microbes and maintains a healthy balance.

“It’s kind of like nature’s system for protection when you think about all the nasty things that can happen to the vagina,” said Forney, 53.

But in women predisposed to allowing high-pH bacteria to flourish, that natural resilience may not be there, he said. Differences in the kinds of bacteria present might explain why other researchers have shown that black women are more likely than white women to develop a condition called bacterial vaginosis, which has been linked to problems that include preterm birth, pelvic inflammatory disease, endometriosis and infertility.

The condition also has been tied to HIV infection, which in 2004 was the leading cause of death for black women aged 25 to 34, and the third leading cause of death for black women aged 35 to 44, according to the federal Centers for Disease Control and Prevention.

“I think the medical care has not taken these individual differences into account,” said Forney.

His view was echoed by Dr. William J. Ledger, a professor in the Department of Obstetrics and Gynecology at the Weill Medical College of Cornell University in New York.

Ledger, who also specializes in infectious diseases, said Forney is among the first to define normal microbial communities using genetic components of bacteria instead of traditional cultures.

“I think the value is that if we learn about what is natural and the natural evolution of things, we’re going to have a better idea when things are not natural of what we need to do to get things back to normal,” Ledger said.

Eventually, doctors may be able to type women according to their microbial make-up and then treat them specifically for a particular problem. Ledger expressed doubt about the medical community’s accepted attitude toward bacterial vaginosis, which he said is too widely – and often wrongly – diagnosed.

But he added that Forney’s research will help doctors pinpoint ailments and treatment.

“Instead of using a shotgun and firing at everybody, maybe we’ll get to use a laser gun to treat a few women correctly,” Ledger said.

Forney embarked on his recent research after previously studying wastewater for Procter and Gamble. The company, one of the world’s leader producers of personal care products, sponsored the new study.

“They have a great interest in the bacteria found in the vagina,” Forney noted.

Until now, that hasn’t been typical terrain for the scientist, who also has examined the dry forests of western Mexico and mud volcanoes of the Mediterranean Sea. The common theme is the exploration of the microbial communities that populate each place, he said.

He’s hoping his work on vaginal bacteria will be supported with new funding through the Human Microbiome Project of the National Institutes of Health, which proposes to study human microbial communities.

It’s still too early for women to identify their own microbial make-up, but it’s never too soon for them to recognize their individual differences, Forney said.

“What’s right for one woman might not be right for someone else,” he said. “It could be misleading to make comparisons to even their sisters and their mothers.”

Instead, women should be aware of the normal conditions of their bodies and seek help if something’s not quite right.

“I wish people would talk more openly about reproductive health,” he said. “A yeast infection is not a dirty thing.”