{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T12:24:43Z","timestamp":1777983883100,"version":"3.51.4"},"reference-count":67,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T00:00:00Z","timestamp":1770076800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T00:00:00Z","timestamp":1773100800000},"content-version":"vor","delay-in-days":35,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Gouvernement du Canada | Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["PJT 180322"],"award-info":[{"award-number":["PJT 180322"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006955","name":"U.S. Department of Health & Human Services | NIH | Office of Extramural Research, National Institutes of Health","doi-asserted-by":"publisher","award":["R21 AI157912"],"award-info":[{"award-number":["R21 AI157912"]}],"id":[{"id":"10.13039\/100006955","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001804","name":"Canada Research Chairs","doi-asserted-by":"publisher","award":["CRC-2020-00175"],"award-info":[{"award-number":["CRC-2020-00175"]}],"id":[{"id":"10.13039\/501100001804","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Commun Med"],"DOI":"10.1038\/s43856-026-01410-2","type":"journal-article","created":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T17:34:45Z","timestamp":1770140085000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Nugent score is an inappropriate diagnostic tool for neovaginal bacteria in transfeminine people"],"prefix":"10.1038","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-7374-2203","authenticated-orcid":false,"given":"Reeya","family":"Parmar","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bern","family":"Monari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emery","family":"Potter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge","family":"Rojas-Vargas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hannah","family":"Wilcox","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Zuanazzi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annabel","family":"Poon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9095-7030","authenticated-orcid":false,"given":"Ainslie C.","family":"Shouldice","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vonetta L.","family":"Edwards","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yonah","family":"Krakowsky","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0851-2233","authenticated-orcid":false,"given":"Jacques","family":"Ravel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica L.","family":"Prodger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,2,3]]},"reference":[{"key":"1410_CR1","doi-asserted-by":"publisher","unstructured":"James, S. E., Herman, J., Keisling, M., Mottet, L. & Anafi, M. 2015 U.S. Transgender Survey (USTS): Version 1. ICPSR - Interuniversity Consortium for Political and Social Research https:\/\/doi.org\/10.3886\/ICPSR37229.V1 (2019).","DOI":"10.3886\/ICPSR37229.V1"},{"key":"1410_CR2","unstructured":"Coleman, E. et al. Standards of care for the health of transgender and gender diverse people, version 8. Int. J. Transgend. Health. https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC9553112\/ (2022)."},{"key":"1410_CR3","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1016\/j.jsxm.2017.01.022","volume":"14","author":"NA Papadopulos","year":"2017","unstructured":"Papadopulos, N. A. et al. Quality of life and patient satisfaction following male-to-female sex reassignment surgery. J. Sex. Med. 14, 721\u2013730 (2017).","journal-title":"J. Sex. Med."},{"key":"1410_CR4","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1097\/PRS.0000000000008198","volume":"148","author":"MS Jun","year":"2021","unstructured":"Jun, M. S., Gonzalez, E., Zhao, L. C. & Bluebond-Langner, R. Penile inversion vaginoplasty with robotically assisted peritoneal flaps. Plast. Reconstr. Surg. 148, 439\u2013442 (2021).","journal-title":"Plast. Reconstr. Surg."},{"key":"1410_CR5","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1016\/j.urology.2022.05.001","volume":"166","author":"CDG Castanon","year":"2022","unstructured":"Castanon, C. D. G. et al. Laparoscopy assisted peritoneal pull-through vaginoplasty in transgender women. Urology 166, 301\u2013302 (2022).","journal-title":"Urology"},{"key":"1410_CR6","doi-asserted-by":"publisher","first-page":"4907208","DOI":"10.1155\/2018\/4907208","volume":"2018","author":"CJ Salgado","year":"2018","unstructured":"Salgado, C. J., Nugent, A., Kuhn, J., Janette, M. & Bahna, H. Primary sigmoid vaginoplasty in transwomen: technique and outcomes. Biomed. Res. Int. 2018, 4907208 (2018).","journal-title":"Biomed. Res. Int."},{"key":"1410_CR7","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1080\/26895269.2021.1926391","volume":"23","author":"B Tristani-Firouzi","year":"2022","unstructured":"Tristani-Firouzi, B. et al. Preferences for and barriers to gender affirming surgeries in transgender and non-binary individuals. Int. J. Transgend. Health 23, 458\u2013471 (2022).","journal-title":"Int. J. Transgend. Health"},{"key":"1410_CR8","doi-asserted-by":"crossref","unstructured":"Rojas-Vargas, J. et al. The neovaginal microbiota, symptoms, and local immune correlates in transfeminine individuals with penile inversion vaginoplasty. Cell Rep. 44, 116546 (2025).","DOI":"10.1016\/j.celrep.2025.116546"},{"key":"1410_CR9","doi-asserted-by":"crossref","unstructured":"Monari, B. et al. The vaginal microbiota, symptoms, and local immune correlates in transmasculine individuals using sustained testosterone therapy. Cell Rep. 44, 116632 (2025).","DOI":"10.1016\/j.celrep.2025.116632"},{"key":"1410_CR10","doi-asserted-by":"publisher","first-page":"1344","DOI":"10.1093\/jsxmed\/qdad109","volume":"20","author":"J Hallarn","year":"2023","unstructured":"Hallarn, J. et al. Gynecological concerns and vaginal practices and exposures among transfeminine individuals who have undergone vaginoplasty. J. Sex. Med. 20, 1344\u20131352 (2023).","journal-title":"J. Sex. Med."},{"key":"1410_CR11","doi-asserted-by":"publisher","first-page":"106","DOI":"10.3389\/fcimb.2020.00106","volume":"10","author":"DE O\u2019Hanlon","year":"2020","unstructured":"O\u2019Hanlon, D. E., Gajer, P., Brotman, R. M. & Ravel, J. Asymptomatic bacterial vaginosis is associated with depletion of mature superficial cells shed from the vaginal epithelium. Front. Cell Infect. Microbiol. 10, 106 (2020).","journal-title":"Front. Cell Infect. Microbiol."},{"key":"1410_CR12","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1146\/annurev-micro-092611-150157","volume":"66","author":"B Ma","year":"2012","unstructured":"Ma, B., Forney, L. J. & Ravel, J. Vaginal microbiome: rethinking health and disease. Annu. Rev. Microbiol. 66, 371\u2013389 (2012).","journal-title":"Annu. Rev. Microbiol."},{"key":"1410_CR13","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1016\/0002-9378(88)90078-6","volume":"158","author":"DA Eschenbach","year":"1988","unstructured":"Eschenbach, D. A. et al. Diagnosis and clinical manifestations of bacterial vaginosis. Am. J. Obstet. Gynecol. 158, 819\u2013828 (1988).","journal-title":"Am. J. Obstet. Gynecol."},{"key":"1410_CR14","doi-asserted-by":"publisher","first-page":"1863","DOI":"10.1086\/315127","volume":"180","author":"HL Martin","year":"1999","unstructured":"Martin, H. L. et al. Vaginal lactobacilli, microbial flora, and risk of human immunodeficiency virus type 1 and sexually transmitted disease acquisition. J. Infect. Dis. 180, 1863\u20131868 (1999).","journal-title":"J. Infect. Dis."},{"key":"1410_CR15","doi-asserted-by":"publisher","first-page":"e102467","DOI":"10.1371\/journal.pone.0102467","volume":"9","author":"P Mirmonsef","year":"2014","unstructured":"Mirmonsef, P. et al. Free glycogen in vaginal fluids is associated with Lactobacillus colonization and low vaginal pH. PLoS ONE 9, e102467 (2014).","journal-title":"PLoS ONE"},{"key":"1410_CR16","doi-asserted-by":"publisher","first-page":"580","DOI":"10.1136\/sextrans-2014-051601","volume":"90","author":"L Masson","year":"2014","unstructured":"Masson, L. et al. Defining genital tract cytokine signatures of sexually transmitted infections and bacterial vaginosis in women at high risk of HIV infection: a cross-sectional study. Sex. Transm. Infect. 90, 580\u2013587 (2014).","journal-title":"Sex. Transm. Infect."},{"key":"1410_CR17","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1136\/sextrans-2015-052072","volume":"92","author":"L Masson","year":"2016","unstructured":"Masson, L. et al. Inflammatory cytokine biomarkers to identify women with asymptomatic sexually transmitted infections and bacterial vaginosis who are at high risk of HIV infection. Sex. Transm. Infect. 92, 186\u2013193 (2016).","journal-title":"Sex. Transm. Infect."},{"key":"1410_CR18","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1111\/1471-0528.15854","volume":"127","author":"J Norenhag","year":"2020","unstructured":"Norenhag, J. et al. The vaginal microbiota, human papillomavirus and cervical dysplasia: a systematic review and network meta-analysis. BJOG 127, 171\u2013180 (2020).","journal-title":"BJOG"},{"key":"1410_CR19","doi-asserted-by":"publisher","first-page":"1907","DOI":"10.1086\/657320","volume":"202","author":"RM Brotman","year":"2010","unstructured":"Brotman, R. M. et al. Bacterial vaginosis assessed by Gram stain and diminished colonization resistance to incident gonococcal, chlamydial, and trichomonal genital infection. J. Infect. Dis. 202, 1907\u20131915 (2010).","journal-title":"J. Infect. Dis."},{"key":"1410_CR20","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1093\/molehr\/gag003","volume":"9","author":"S Cauci","year":"2003","unstructured":"Cauci, S. et al. Interrelationships of interleukin-8 with interleukin-1beta and neutrophils in vaginal fluid of healthy and bacterial vaginosis positive women. Mol. Hum. Reprod. 9, 53\u201358 (2003).","journal-title":"Mol. Hum. Reprod."},{"key":"1410_CR21","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1086\/367658","volume":"36","author":"HC Wiesenfeld","year":"2003","unstructured":"Wiesenfeld, H. C., Hillier, S. L., Krohn, M. A., Landers, D. V. & Sweet, R. L. Bacterial vaginosis is a strong predictor of Neisseria gonorrhoeae and Chlamydia trachomatis infection. Clin. Infect. Dis. 36, 663\u2013668 (2003).","journal-title":"Clin. Infect. Dis."},{"key":"1410_CR22","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1177\/000992280003900307","volume":"39","author":"SE Peters","year":"2000","unstructured":"Peters, S. E. et al. Behaviors associated with Neisseria gonorrhoeae and Chlamydia trachomatis: cervical infection among young women attending adolescent clinics. Clin. Pediatr. 39, 173\u2013177 (2000).","journal-title":"Clin. Pediatr."},{"key":"1410_CR23","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1086\/375819","volume":"37","author":"TL Cherpes","year":"2003","unstructured":"Cherpes, T. L., Meyn, L. A., Krohn, M. A., Lurie, J. G. & Hillier, S. L. Association between acquisition of herpes simplex virus type 2 in women and bacterial vaginosis. Clin. Infect. Dis. 37, 319\u2013325 (2003).","journal-title":"Clin. Infect. Dis."},{"key":"1410_CR24","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1128\/jcm.29.2.297-301.1991","volume":"29","author":"RP Nugent","year":"1991","unstructured":"Nugent, R. P., Krohn, M. A. & Hillier, S. L. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J. Clin. Microbiol. 29, 297\u2013301 (1991).","journal-title":"J. Clin. Microbiol."},{"key":"1410_CR25","doi-asserted-by":"publisher","first-page":"4680","DOI":"10.1073\/pnas.1002611107","volume":"108","author":"J Ravel","year":"2011","unstructured":"Ravel, J. et al. Vaginal microbiome of reproductive-age women. Proc. Natl. Acad. Sci. USA 108, 4680\u20134687 (2011).","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"1410_CR26","doi-asserted-by":"publisher","DOI":"10.1172\/jci.insight.147363","volume":"6","author":"JL Prodger","year":"2021","unstructured":"Prodger, J. L. et al. Penile bacteria associated with HIV seroconversion, inflammation, and immune cells. JCI Insight 6, e147363 (2021).","journal-title":"JCI Insight"},{"key":"1410_CR27","doi-asserted-by":"publisher","DOI":"10.1186\/s40168-020-00804-1","volume":"8","author":"KD Birse","year":"2020","unstructured":"Birse, K. D. et al. The neovaginal microbiome of transgender women post-gender reassignment surgery. Microbiome 8, 61 (2020).","journal-title":"Microbiome"},{"key":"1410_CR28","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.urology.2022.02.021","volume":"167","author":"RM Mora","year":"2022","unstructured":"Mora, R. M., Mehta, P., Ziltzer, R. & Samplaski, M. K. Systematic review: the neovaginal microbiome. Urology 167, 3\u201312 (2022).","journal-title":"Urology"},{"key":"1410_CR29","doi-asserted-by":"publisher","first-page":"E1213","DOI":"10.9778\/cmajo.20210061","volume":"9","author":"AI Scheim","year":"2021","unstructured":"Scheim, A. I., Coleman, T., Lachowsky, N. & Bauer, G. R. Health care access among transgender and nonbinary people in Canada, 2019: a cross-sectional survey. CMAJ Open 9, E1213\u2013E1222 (2021).","journal-title":"CMAJ Open"},{"key":"1410_CR30","doi-asserted-by":"publisher","first-page":"e00029","DOI":"10.1128\/msystems.00029-19","volume":"4","author":"JB Holm","year":"2019","unstructured":"Holm, J. B. et al. Ultrahigh-throughput multiplexing and sequencing of >500-base-pair amplicon regions on the Illumina HiSeq 2500 platform. mSystems 4, e00029\u201319 (2019).","journal-title":"mSystems"},{"key":"1410_CR31","doi-asserted-by":"publisher","unstructured":"Ravel, J. et al. Twice-daily application of HIV microbicides alters the vaginal microbiota. mBio https:\/\/doi.org\/10.1128\/mbio.00370-12 (2012).","DOI":"10.1128\/mbio.00370-12"},{"key":"1410_CR32","doi-asserted-by":"publisher","first-page":"132ra52","DOI":"10.1126\/scitranslmed.3003605","volume":"4","author":"P Gajer","year":"2012","unstructured":"Gajer, P. et al. Temporal dynamics of the human vaginal microbiota. Sci. Transl. Med. 4, 132ra52 (2012).","journal-title":"Sci. Transl. Med."},{"key":"1410_CR33","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1111\/aji.12264","volume":"71","author":"C Mitchell","year":"2014","unstructured":"Mitchell, C. & Marrazzo, J. Bacterial vaginosis and the cervicovaginal immune response. Am. J. Reprod. Immunol. 71, 555\u2013563 (2014).","journal-title":"Am. J. Reprod. Immunol."},{"key":"1410_CR34","doi-asserted-by":"crossref","unstructured":"Chen, X., Lu, Y., Chen, T. & Li, R. The female vaginal microbiome in health and bacterial vaginosis. Front. Cell. Infect. Microbiol. 11, 631972 (2021).","DOI":"10.3389\/fcimb.2021.631972"},{"key":"1410_CR35","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1038\/mi.2015.51","volume":"9","author":"KB Arnold","year":"2016","unstructured":"Arnold, K. B. et al. Increased levels of inflammatory cytokines in the female reproductive tract are associated with altered expression of proteases, mucosal barrier proteins, and an influx of HIV-susceptible target cells. Mucosal Immunol. 9, 194\u2013205 (2016).","journal-title":"Mucosal Immunol."},{"key":"1410_CR36","doi-asserted-by":"publisher","first-page":"e1006025","DOI":"10.1371\/journal.ppat.1006025","volume":"12","author":"JL Prodger","year":"2016","unstructured":"Prodger, J. L. et al. Chemokine levels in the penile coronal sulcus correlate with HIV-1 acquisition and are reduced by male circumcision in Rakai, Uganda. PLoS Pathog. 12, e1006025 (2016).","journal-title":"PLoS Pathog."},{"key":"1410_CR37","doi-asserted-by":"publisher","first-page":"103017","DOI":"10.1016\/j.autrev.2021.103017","volume":"21","author":"H Nakase","year":"2022","unstructured":"Nakase, H., Sato, N., Mizuno, N. & Ikawa, Y. The influence of cytokines on the complex pathology of ulcerative colitis. Autoimmun. Rev. 21, 103017 (2022).","journal-title":"Autoimmun. Rev."},{"key":"1410_CR38","doi-asserted-by":"publisher","first-page":"3176","DOI":"10.3390\/plants13223176","volume":"13","author":"W Li","year":"2024","unstructured":"Li, W. et al. Genome-wide identification and expression profiling analysis of the mitochondrial calcium uniporter gene family under abiotic stresses in Medicago sativa. Plants 13, 3176 (2024).","journal-title":"Plants"},{"key":"1410_CR39","doi-asserted-by":"publisher","first-page":"2929","DOI":"10.1099\/ijsem.0.001122","volume":"66","author":"ME Bell","year":"2016","unstructured":"Bell, M. E. et al. Lawsonella clevelandensis gen. nov., sp. nov., a new member of the suborder Corynebacterineae isolated from human abscesses. Int. J. Syst. Evol. Microbiol. 66, 2929\u20132935 (2016).","journal-title":"Int. J. Syst. Evol. Microbiol."},{"key":"1410_CR40","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.00150-22","volume":"61","author":"AB Morton","year":"2023","unstructured":"Morton, A. B., Boyle, E., Pettengill, M. A. & Gancher, E. The brief case: strictly anaerobic and staining acid fast. J. Clin. Microbiol. 61, e0015022 (2023).","journal-title":"J. Clin. Microbiol."},{"key":"1410_CR41","first-page":"966","volume":"218","author":"CA Muzny","year":"2018","unstructured":"Muzny, C. A. et al. Identification of key bacteria involved in the induction of incident bacterial vaginosis: a prospective study. J. Infect. Dis. 218, 966\u2013978 (2018).","journal-title":"J. Infect. Dis."},{"key":"1410_CR42","doi-asserted-by":"publisher","first-page":"e78633","DOI":"10.1371\/journal.pone.0078633","volume":"8","author":"S Srinivasan","year":"2013","unstructured":"Srinivasan, S. et al. More than meets the eye: associations of vaginal bacteria with gram stain morphotypes using molecular phylogenetic analysis. PLoS ONE 8, e78633 (2013).","journal-title":"PLoS ONE"},{"key":"1410_CR43","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1186\/1471-2180-9-102","volume":"9","author":"S Weyers","year":"2009","unstructured":"Weyers, S. et al. Microflora of the penile skin-lined neovagina of transsexual women. BMC Microbiol. 9, 102 (2009).","journal-title":"BMC Microbiol."},{"key":"1410_CR44","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1002\/path.1700390118","volume":"39","author":"R Cruickshank","year":"1934","unstructured":"Cruickshank, R. The conversion of the glycogen of the vagina into lactic acid. J. Pathol. 39, 213\u2013219 (1934).","journal-title":"J. Pathol."},{"key":"1410_CR45","doi-asserted-by":"crossref","unstructured":"Dinh, M. H., Okocha, E. A., Koons, A., Veazey, R. S. & Hope, T. J. Expression of structural proteins in human female and male genital epithelia and implications for sexually transmitted infections. Biol. Reprod. 86, 32 (2012).","DOI":"10.1095\/biolreprod.111.094789"},{"key":"1410_CR46","doi-asserted-by":"publisher","first-page":"769950","DOI":"10.3389\/fcimb.2021.769950","volume":"11","author":"Y Krakowsky","year":"2022","unstructured":"Krakowsky, Y. et al. The effect of gender-affirming medical care on the vaginal and neovaginal microbiomes of transgender and gender-diverse people. Front. Cell. Infect. Microbiol. 11, 769950 (2022).","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"1410_CR47","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1097\/01.sap.0000258953.00234.50","volume":"59","author":"JJML Dekker","year":"2007","unstructured":"Dekker, J. J. M. L., Hage, J. J., Karim, R. B. & Bloemena, E. Do histologic changes in the skin-lined neovagina of male-to-female transsexuals really occur? Ann. Plast. Surg. 59, 546\u2013549 (2007).","journal-title":"Ann. Plast. Surg."},{"key":"1410_CR48","doi-asserted-by":"publisher","first-page":"1480","DOI":"10.1038\/mi.2017.27","volume":"10","author":"AC Hearps","year":"2017","unstructured":"Hearps, A. C. et al. Vaginal lactic acid elicits an anti-inflammatory response from human cervicovaginal epithelial cells and inhibits production of pro-inflammatory mediators associated with HIV acquisition. Mucosal Immunol. 10, 1480\u20131490 (2017).","journal-title":"Mucosal Immunol."},{"key":"1410_CR49","doi-asserted-by":"crossref","unstructured":"Delgado-Diaz, D. J. et al. Lactic acid from vaginal microbiota enhances cervicovaginal epithelial barrier integrity by promoting tight junction protein expression. Microbiome 10, 141 (2022).","DOI":"10.1186\/s40168-022-01337-5"},{"key":"1410_CR50","doi-asserted-by":"publisher","DOI":"10.1111\/aji.13749","volume":"90","author":"A Joseph","year":"2023","unstructured":"Joseph, A. et al. Intrauterine colonization with Gardnerella vaginalis and Mobiluncus mulieris induces maternal inflammation but not preterm birth in a mouse model. Am. J. Reprod. Immunol. 90, e13749 (2023).","journal-title":"Am. J. Reprod. Immunol."},{"key":"1410_CR51","doi-asserted-by":"publisher","first-page":"342075","DOI":"10.5402\/2012\/342075","volume":"2012","author":"ACC Campos","year":"2012","unstructured":"Campos, A. C. C., Murta, E. F. C., Michelin, M. A. & Reis, C. Evaluation of cytokines in endocervical secretion and vaginal pH from women with bacterial vaginosis or human papillomavirus. ISRN Obstet. Gynecol. 2012, 342075 (2012).","journal-title":"ISRN Obstet. Gynecol."},{"key":"1410_CR52","doi-asserted-by":"publisher","first-page":"965","DOI":"10.1016\/j.immuni.2015.04.019","volume":"42","author":"MN Anahtar","year":"2015","unstructured":"Anahtar, M. N. et al. Cervicovaginal bacteria are a major modulator of host inflammatory responses in the female genital tract. Immunity 42, 965\u2013976 (2015).","journal-title":"Immunity"},{"key":"1410_CR53","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1111\/j.1365-2303.2009.00663.x","volume":"21","author":"S Weyers","year":"2010","unstructured":"Weyers, S. et al. Cytology of the \u2018penile\u2019 neovagina in transsexual women. Cytopathology 21, 111\u2013115 (2010).","journal-title":"Cytopathology"},{"key":"1410_CR54","doi-asserted-by":"publisher","first-page":"456","DOI":"10.46747\/cfp.700708456","volume":"70","author":"E Potter","year":"2024","unstructured":"Potter, E. et al. Hypergranulation management following penile inversion vaginoplasty. Can. Fam. Physician 70, 456\u2013461 (2024).","journal-title":"Can. Fam. Physician"},{"key":"1410_CR55","doi-asserted-by":"publisher","first-page":"1732","DOI":"10.1111\/andr.13030","volume":"9","author":"R Hontscharuk","year":"2021","unstructured":"Hontscharuk, R., Alba, B., Hamidian Jahromi, A. & Schechter, L. Penile inversion vaginoplasty outcomes: complications and satisfaction. Andrology 9, 1732\u20131743 (2021).","journal-title":"Andrology"},{"key":"1410_CR56","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1002\/nau.25132","volume":"42","author":"E Potter","year":"2023","unstructured":"Potter, E. et al. Patient reported symptoms and adverse outcomes seen in Canada\u2019s first vaginoplasty postoperative care clinic. Neurourol. Urodyn. 42, 523\u2013529 (2023).","journal-title":"Neurourol. Urodyn."},{"key":"1410_CR57","doi-asserted-by":"publisher","first-page":"157.e1","DOI":"10.1016\/j.ajog.2019.08.008","volume":"222","author":"MC Verwijs","year":"2020","unstructured":"Verwijs, M. C., Agaba, S. K., Darby, A. C. & van de Wijgert, J. H. H. M. Impact of oral metronidazole treatment on the vaginal microbiota and correlates of treatment failure. Am. J. Obstet. Gynecol. 222, 157.e1\u2013157.e13 (2020).","journal-title":"Am. J. Obstet. Gynecol."},{"key":"1410_CR58","doi-asserted-by":"publisher","first-page":"S98","DOI":"10.1093\/cid\/civ072","volume":"60","author":"EJC Goldstein","year":"2015","unstructured":"Goldstein, E. J. C., Tyrrell, K. L. & Citron, D. M. Lactobacillus species: taxonomic complexity and controversial susceptibilities. Clin. Infect. Dis. 60, S98\u2013S107 (2015).","journal-title":"Clin. Infect. Dis."},{"key":"1410_CR59","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1016\/j.nmni.2016.09.011","volume":"15","author":"K Diop","year":"2017","unstructured":"Diop, K., Raoult, D., Bretelle, F. & Fenollar, F. \u2018Ezakiella massiliensis\u2019 sp. nov., a new bacterial species isolated from human female genital tract. New Microbes New Infect. 15, 16\u201317 (2017).","journal-title":"New Microbes New Infect."},{"key":"1410_CR60","doi-asserted-by":"publisher","first-page":"102697","DOI":"10.1016\/j.anaerobe.2023.102697","volume":"79","author":"F Cobo","year":"2023","unstructured":"Cobo, F., P\u00e9rez-Carrasco, V., Garc\u00eda-Salcedo, J. A. & Navarro-Mar\u00ed, J. M. New anaerobic bacteria causing infection: bacteremia due to Murdochiella asaccharolytica. Anaerobe 79, 102697 (2023).","journal-title":"Anaerobe"},{"key":"1410_CR61","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1016\/j.anaerobe.2016.12.009","volume":"43","author":"G Dahlen","year":"2017","unstructured":"Dahlen, G. & Preus, H. R. Low antibiotic resistance among anaerobic Gram-negative bacteria in periodontitis 5 years following metronidazole therapy. Anaerobe 43, 94\u201398 (2017).","journal-title":"Anaerobe"},{"key":"1410_CR62","doi-asserted-by":"publisher","first-page":"648134","DOI":"10.1155\/2015\/648134","volume":"2015","author":"II Shilnikova","year":"2015","unstructured":"Shilnikova, I. I. & Dmitrieva, N. V. Evaluation of antibiotic susceptibility of Gram-positive anaerobic cocci isolated from cancer patients of the N. N. Blokhin Russian Cancer Research Center. J. Pathog. 2015, 648134 (2015).","journal-title":"J. Pathog."},{"key":"1410_CR63","doi-asserted-by":"publisher","first-page":"1447","DOI":"10.1016\/j.cmi.2019.07.008","volume":"25","author":"D Goldenberger","year":"2019","unstructured":"Goldenberger, D. et al. Emerging anaerobic and partially acid-fast Lawsonella clevelandensis: extended characterization by antimicrobial susceptibility testing and whole genome sequencing. Clin. Microbiol. Infect. 25, 1447\u20131448 (2019).","journal-title":"Clin. Microbiol. Infect."},{"key":"1410_CR64","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1111\/j.1467-2494.2006.00344.x","volume":"28","author":"H Lambers","year":"2006","unstructured":"Lambers, H., Piessens, S., Bloem, A., Pronk, H. & Finkel, P. Natural skin surface pH is on average below 5, which is beneficial for its resident flora. Int. J. Cosmet. Sci. 28, 359\u2013370 (2006).","journal-title":"Int. J. Cosmet. Sci."},{"key":"1410_CR65","doi-asserted-by":"publisher","first-page":"120","DOI":"10.4103\/ijstd.IJSTD_98_16","volume":"39","author":"S Muthusamy","year":"2018","unstructured":"Muthusamy, S., Varghese, J., Raveendran, V., Ezilarasan, K. & Easow, J. Evaluation of interobserver reliability of Nugent score for diagnosis of bacterial vaginosis. Indian J. Sex. Transm. Dis. 39, 120 (2018).","journal-title":"Indian J. Sex. Transm. Dis."},{"key":"1410_CR66","first-page":"88","volume":"131","author":"S Mohanty","year":"2010","unstructured":"Mohanty, S., Sood, S., Kapil, A. & Mittal, S. Interobserver variation in the interpretation of Nugent scoring method for diagnosis of bacterial vaginosis. Indian J. Med. Res. 131, 88\u201391 (2010).","journal-title":"Indian J. Med. Res."},{"key":"1410_CR67","unstructured":"prodgerlab. TransBiota\/Nugent_scoring_paper. GitHub https:\/\/github.com\/prodgerlab\/TransBiota\/tree\/main\/Nugent_scoring_paper (2025)."}],"container-title":["Communications Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s43856-026-01410-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s43856-026-01410-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s43856-026-01410-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T16:03:18Z","timestamp":1773158598000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s43856-026-01410-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,3]]},"references-count":67,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["1410"],"URL":"https:\/\/doi.org\/10.1038\/s43856-026-01410-2","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-7428168\/v1","asserted-by":"object"}]},"ISSN":["2730-664X"],"issn-type":[{"value":"2730-664X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,3]]},"assertion":[{"value":"21 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 February 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"136"}}