{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T02:28:17Z","timestamp":1793672897390,"version":"4.5.1"},"reference-count":82,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T00:00:00Z","timestamp":1793664000000},"content-version":"vor","delay-in-days":116,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Commun Med"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Vaginal dysbiosis, characterized by\n                      <jats:italic>Lactobacillus<\/jats:italic>\n                      depletion and anaerobic enrichment, may be relevant to ovarian cancer (OC) outcomes, yet comprehensive microbiome characterization in OC patients remains limited. Here, we characterize the prevalence and predictors of vaginal microbiome dysbiosis among racially diverse OC patients in the US.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed 16S rRNA gene sequencing on vaginal samples from 132 OC patients recruited as part of the population-based ORCHiD study. Latent Dirichlet Allocation (LDA), a computational topic modeling approach, was applied to identify distinct microbial community signatures representing co-occurring bacterial taxa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Here, we show that\n                      <jats:italic>Lactobacillus<\/jats:italic>\n                      is detected in only 47.7% of patients. Topic modeling identifies seven distinct microbial signatures spanning\n                      <jats:italic>Lactobacillus<\/jats:italic>\n                      -dominated and anaerobe-enriched community types. Anaerobic bacterial enrichment (\n                      <jats:italic>Peptoniphilus<\/jats:italic>\n                      ,\n                      <jats:italic>Anaerococcus<\/jats:italic>\n                      ) increases significantly with age (approximately 35% per decade of life, FDR q\u2009=\u20090.019). Racial differences are observed, with non-Hispanic Black patients demonstrating a 5-fold higher prevalence of an Actinomycetaceae-classified amplicon sequence variant (ASV54) compared with non-Hispanic white patients (40.9% vs 8.2%, FDR q\u2009=\u20090.005), while\n                      <jats:italic>Lactobacillus crispatus<\/jats:italic>\n                      is detected only among non-Hispanic white patients (6.4% vs 0%) in this cohort.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings demonstrate a high burden of vaginal microbiome dysbiosis among OC patients and identify age- and race-associated microbial patterns that may be relevant to understanding disparities in OC outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1038\/s43856-026-01771-8","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T18:14:44Z","timestamp":1783707284000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Characterizing the composition and diversity of the vaginal microbiome in ovarian cancer"],"prefix":"10.1038","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1185-7750","authenticated-orcid":false,"given":"April","family":"Deveaux","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oyomoare L.","family":"Osazuwa-Peters","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1118-5026","authenticated-orcid":false,"given":"Yeon Ji","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pixu","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Drew","family":"Neish","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashwini","family":"Joshi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8600-5640","authenticated-orcid":false,"given":"Veronica","family":"Duck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashliegh","family":"Williams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2111-6227","authenticated-orcid":false,"given":"Margaret","family":"Gates Kuliszewski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Ward","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Pisu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Tucker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8087-9120","authenticated-orcid":false,"given":"Rebecca","family":"Previs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Berchuck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomi","family":"Akinyemiju","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,10]]},"reference":[{"key":"1771_CR1","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2021.631972","volume":"11","author":"X Chen","year":"2021","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).","journal-title":"Front. Cell Infect. Microbiol."},{"key":"1771_CR2","doi-asserted-by":"publisher","first-page":"1936","DOI":"10.3389\/fmicb.2016.01936","volume":"7","author":"EA Miller","year":"2016","unstructured":"Miller, E. A., Beasley, D. E., Dunn, R. R. & Archie, E. A. Lactobacilli dominance and vaginal pH: why is the human vaginal microbiome unique? Front. Microbiol. 7, 1936 (2016).","journal-title":"Front. Microbiol."},{"key":"1771_CR3","doi-asserted-by":"publisher","first-page":"1171","DOI":"10.1016\/S1470-2045(19)30340-7","volume":"20","author":"NR Nene","year":"2019","unstructured":"Nene, N. R. et al. Association between the cervicovaginal microbiome, BRCA1 mutation status, and risk of ovarian cancer: a case-control study. Lancet Oncol. 20, 1171\u20131182 (2019).","journal-title":"Lancet Oncol."},{"key":"1771_CR4","doi-asserted-by":"publisher","first-page":"3793","DOI":"10.1007\/s00203-021-02414-3","volume":"203","author":"VS Saraf","year":"2021","unstructured":"Saraf, V. S. et al. Vaginal microbiome: normalcy vs dysbiosis. Arch. Microbiol. 203, 3793\u20133802 (2021).","journal-title":"Arch. Microbiol."},{"key":"1771_CR5","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1038\/s41585-020-0286-z","volume":"17","author":"P Laniewski","year":"2020","unstructured":"Laniewski, P., Ilhan, Z. E. & Herbst-Kralovetz, M. M. The microbiome and gynaecological cancer development, prevention and therapy. Nat. Rev. Urol. 17, 232\u2013250 (2020).","journal-title":"Nat. Rev. Urol."},{"key":"1771_CR6","doi-asserted-by":"publisher","first-page":"3447","DOI":"10.1016\/j.csbj.2020.10.033","volume":"18","author":"W Li","year":"2020","unstructured":"Li, W. & Ma, Z. S. Dominance network analysis of the healthy human vaginal microbiome not dominated by Lactobacillus species. Comput. Struct. Biotechnol. J. 18, 3447\u20133456 (2020).","journal-title":"Comput. Struct. Biotechnol. J."},{"key":"1771_CR7","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1158\/2767-9764.CRC-22-0075","volume":"2","author":"H Hakimjavadi","year":"2022","unstructured":"Hakimjavadi, H. et al. The vaginal microbiome is associated with endometrial cancer grade and histology. Cancer Res. Commun. 2, 447\u2013455 (2022).","journal-title":"Cancer Res. Commun."},{"key":"1771_CR8","first-page":"7","volume":"72","author":"RL Siegel","year":"2022","unstructured":"Siegel, R. L., Miller, K. D., Fuchs, H. E. & Jemal, A. Cancer statistics, 2022. CA Cancer J. Clin. 72, 7\u201333 (2022).","journal-title":"CA Cancer J. Clin."},{"key":"1771_CR9","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-018-38031-2","volume":"9","author":"B Zhou","year":"2019","unstructured":"Zhou, B. et al. The biodiversity composition of microbiome in ovarian carcinoma patients. Sci. Rep. 9, 1691 (2019).","journal-title":"Sci. Rep."},{"key":"1771_CR10","doi-asserted-by":"publisher","DOI":"10.1016\/j.gene.2021.146083","volume":"811","author":"A Morikawa","year":"2022","unstructured":"Morikawa, A. et al. Altered cervicovaginal microbiota in premenopausal ovarian cancer patients. Gene. 811, 146083 (2022).","journal-title":"Gene"},{"key":"1771_CR11","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1186\/s10020-021-00295-2","volume":"27","author":"A Sipos","year":"2021","unstructured":"Sipos, A. et al. The role of the microbiome in ovarian cancer: mechanistic insights into oncobiosis and to bacterial metabolite signaling. Mol. Med. 27, 33 (2021).","journal-title":"Mol. Med."},{"key":"1771_CR12","doi-asserted-by":"crossref","unstructured":"Mehra, Y. et al. The microbiome and ovarian cancer: insights, implications, and therapeutic opportunities. J. Cancer Metas. Treat. 9, 38 (2023).","DOI":"10.20517\/2394-4722.2023.107"},{"key":"1771_CR13","doi-asserted-by":"publisher","first-page":"1342","DOI":"10.1097\/01.AOG.0000265207.27755.28","volume":"109","author":"JK Chan","year":"2007","unstructured":"Chan, J. K. et al. Influence of the gynecologic oncologist on the survival of ovarian cancer patients. Obstet. Gynecol. 109, 1342\u20131350 (2007).","journal-title":"Obstet. Gynecol."},{"key":"1771_CR14","unstructured":"National Cancer Institute. Cancer Stat Facts: Ovarian Cancer. https:\/\/seer.cancer.gov\/statfacts\/html\/ovary.html (2025)."},{"key":"1771_CR15","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1097\/GME.0b013e3182a4690b","volume":"21","author":"RM Brotman","year":"2014","unstructured":"Brotman, R. M. et al. Association between the vaginal microbiota, menopause status, and signs of vulvovaginal atrophy. Menopause 21, 450\u2013458 (2014).","journal-title":"Menopause"},{"key":"1771_CR16","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":"1771_CR17","doi-asserted-by":"publisher","first-page":"1012","DOI":"10.1038\/s41591-019-0450-2","volume":"25","author":"JM Fettweis","year":"2019","unstructured":"Fettweis, J. M. et al. The vaginal microbiome and preterm birth. Nat. Med. 25, 1012\u20131021 (2019).","journal-title":"Nat. Med."},{"key":"1771_CR18","doi-asserted-by":"publisher","DOI":"10.1128\/msystems.00017-22","volume":"7","author":"S Sun","year":"2022","unstructured":"Sun, S. et al. Race, the vaginal microbiome, and spontaneous preterm birth. mSystems 7, e0001722 (2022).","journal-title":"mSystems"},{"key":"1771_CR19","doi-asserted-by":"publisher","first-page":"2272","DOI":"10.1099\/mic.0.081034-0","volume":"160","author":"JM Fettweis","year":"2014","unstructured":"Fettweis, J. M. et al. Differences in vaginal microbiome in African American women versus women of European ancestry. Microbiology 160, 2272\u20132282 (2014).","journal-title":"Microbiology"},{"key":"1771_CR20","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1038\/ismej.2007.12","volume":"1","author":"X Zhou","year":"2007","unstructured":"Zhou, X. et al. Differences in the composition of vaginal microbial communities found in healthy Caucasian and black women. ISME J. 1, 121\u2013133 (2007).","journal-title":"ISME J."},{"key":"1771_CR21","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.28898","volume":"95","author":"C Li","year":"2023","unstructured":"Li, C. et al. Association between vaginal microbiota and the progression of ovarian cancer. J. Med. Virol. 95, e28898 (2023).","journal-title":"J. Med. Virol."},{"key":"1771_CR22","first-page":"743","volume":"10","author":"J Xu","year":"2020","unstructured":"Xu, J., Peng, J. J., Yang, W., Fu, K. & Zhang, Y. Vaginal microbiomes and ovarian cancer: a review. Am. J. Cancer Res. 10, 743\u2013756 (2020).","journal-title":"Am. J. Cancer Res."},{"key":"1771_CR23","doi-asserted-by":"publisher","first-page":"1257","DOI":"10.1089\/jwh.2011.3053","volume":"20","author":"SL Stewart","year":"2011","unstructured":"Stewart, S. L., Rim, S. H. & Richards, T. B. Gynecologic oncologists and ovarian cancer treatment: avenues for improved survival. J. Womens Health 20, 1257\u20131260 (2011).","journal-title":"J. Womens Health"},{"key":"1771_CR24","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1016\/j.ygyno.2011.11.025","volume":"125","author":"M Terplan","year":"2012","unstructured":"Terplan, M., Schluterman, N., McNamara, E. J., Tracy, J. K. & Temkin, S. M. Have racial disparities in ovarian cancer increased over time? An analysis of SEER data. Gynecol. Oncol. 125, 19\u201324 (2012).","journal-title":"Gynecol. Oncol."},{"key":"1771_CR25","doi-asserted-by":"publisher","unstructured":"Williams, D. R. & Mohammed, S. A. Racism and health I: Pathways and scientific evidence. Am. Behav. Sci. https:\/\/doi.org\/10.1177\/0002764213487340 (2013).","DOI":"10.1177\/0002764213487340"},{"key":"1771_CR26","doi-asserted-by":"publisher","first-page":"e0181135","DOI":"10.1371\/journal.pone.0181135","volume":"12","author":"H Borgdorff","year":"2017","unstructured":"Borgdorff, H. et al. The association between ethnicity and vaginal microbiota composition in Amsterdam, the Netherlands. PLoS ONE 12, e0181135 (2017).","journal-title":"PLoS ONE"},{"key":"1771_CR27","doi-asserted-by":"publisher","first-page":"36225","DOI":"10.18632\/oncotarget.16717","volume":"8","author":"S Banerjee","year":"2017","unstructured":"Banerjee, S. et al. The ovarian cancer oncobiome. Oncotarget 8, 36225\u201336245 (2017).","journal-title":"Oncotarget"},{"key":"1771_CR28","doi-asserted-by":"publisher","DOI":"10.7717\/peerj.11574","volume":"9","author":"D Jacobson","year":"2021","unstructured":"Jacobson, D. et al. Shifts in gut and vaginal microbiomes are associated with cancer recurrence time in women with ovarian cancer. PeerJ 9, e11574 (2021).","journal-title":"PeerJ"},{"key":"1771_CR29","doi-asserted-by":"crossref","unstructured":"Yu, B. et al. Identification of fallopian tube microbiota and its association with ovarian cancer. Elife 12, RP89830 (2024).","DOI":"10.7554\/eLife.89830.3"},{"key":"1771_CR30","doi-asserted-by":"crossref","unstructured":"Schloss, P. D. Identifying and overcoming threats to reproducibility, replicability, robustness, and generalizability in microbiome research. mBio 9, e00525-18 (2018).","DOI":"10.1128\/mBio.00525-18"},{"key":"1771_CR31","doi-asserted-by":"publisher","DOI":"10.1186\/s40168-017-0237-y","volume":"5","author":"S Weiss","year":"2017","unstructured":"Weiss, S. et al. Normalization and microbial differential abundance strategies depend upon data characteristics. Microbiome 5, 27 (2017).","journal-title":"Microbiome"},{"key":"1771_CR32","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-022-28034-z","volume":"13","author":"JT Nearing","year":"2022","unstructured":"Nearing, J. T. et al. Microbiome differential abundance methods produce different results across 38 datasets. Nat. Commun. 13, 342 (2022).","journal-title":"Nat. Commun."},{"key":"1771_CR33","doi-asserted-by":"publisher","first-page":"e052808","DOI":"10.1136\/bmjopen-2021-052808","volume":"11","author":"T Akinyemiju","year":"2021","unstructured":"Akinyemiju, T. et al. Ovarian Cancer Epidemiology, Healthcare Access and Disparities (ORCHiD): methodology for a population-based study of Black, Hispanic and White patients with ovarian cancer. BMJ Open 11, e052808 (2021).","journal-title":"BMJ Open"},{"key":"1771_CR34","unstructured":"Caporaso, J. G. et al. EMP 16S Illumina Amplicon Protocol. https:\/\/wwwearthmicrobiome.org\/protocols-and-standards\/16s (2018)."},{"key":"1771_CR35","unstructured":"R Core Team. R: A Language and Environment for Statistical Computing (R Foundation for Statistical Computing, 2024)."},{"key":"1771_CR36","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1038\/nmeth.3869","volume":"13","author":"BJ Callahan","year":"2016","unstructured":"Callahan, B. J. et al. DADA2: high-resolution sample inference from Illumina amplicon data. Nat. Methods 13, 581\u2013583 (2016).","journal-title":"Nat. Methods"},{"key":"1771_CR37","doi-asserted-by":"publisher","first-page":"D643","DOI":"10.1093\/nar\/gkt1209","volume":"42","author":"P Yilmaz","year":"2014","unstructured":"Yilmaz, P. et al. The SILVA and \u201cAll-species Living Tree Project (LTP)\u201d taxonomic frameworks. Nucleic Acids Res. 42, D643\u2013D648 (2014).","journal-title":"Nucleic Acids Res."},{"key":"1771_CR38","doi-asserted-by":"publisher","first-page":"D590","DOI":"10.1093\/nar\/gks1219","volume":"41","author":"C Quast","year":"2012","unstructured":"Quast, C. et al. The SILVA ribosomal RNA gene database project: improved data processing and web-based tools. Nucleic Acids Res. 41, D590\u2013D596 (2012).","journal-title":"Nucleic Acids Res."},{"key":"1771_CR39","doi-asserted-by":"publisher","DOI":"10.1186\/s12859-024-05930-3","volume":"25","author":"JB Holm","year":"2024","unstructured":"Holm, J. B., Gajer, P. & Ravel, J. SpeciateIT and vSpeciateDB: novel, fast, and accurate per sequence 16S rRNA gene taxonomic classification of vaginal microbiota. BMC Bioinform. 25, 313 (2024).","journal-title":"BMC Bioinform."},{"key":"1771_CR40","doi-asserted-by":"publisher","first-page":"1312","DOI":"10.1093\/bioinformatics\/btu033","volume":"30","author":"A Stamatakis","year":"2014","unstructured":"Stamatakis, A. RAxML version 8: a tool for phylogenetic analysis and post-analysis of large phylogenies. Bioinformatics 30, 1312\u20131313 (2014).","journal-title":"Bioinformatics"},{"key":"1771_CR41","doi-asserted-by":"crossref","unstructured":"Shrode, R. L., Ollberding, N. J. & Mangalam, A. K. Looking at the full picture: utilizing topic modeling to determine disease-associated microbiome communities. Gut Microbes Rep. 1, 1\u201311 (2024).","DOI":"10.1080\/29933935.2024.2378067"},{"key":"1771_CR42","doi-asserted-by":"publisher","first-page":"627","DOI":"10.3389\/fgene.2019.00627","volume":"10","author":"K Sankaran","year":"2019","unstructured":"Sankaran, K. & Holmes, S. P. Multitable methods for microbiome data integration. Front. Genet. 10, 627 (2019).","journal-title":"Front. Genet."},{"key":"1771_CR43","volume":"290","author":"L Symul","year":"2023","unstructured":"Symul, L. et al. Sub-communities of the vaginal microbiota in pregnant and non-pregnant women. Proc. Biol. Sci. 290, 20231461 (2023).","journal-title":"Proc. Biol. Sci."},{"key":"1771_CR44","volume":"28","author":"JP Brooks","year":"2017","unstructured":"Brooks, J. P. et al. Changes in vaginal community state types reflect major shifts in the microbiome. Micro. Ecol. Health Dis. 28, 1303265 (2017).","journal-title":"Micro. Ecol. Health Dis."},{"key":"1771_CR45","unstructured":"Nikita, \u039c. & Chaney, N. ldatuning: Tuning of the Latent Dirichlet Allocation Models Parameters (2020). https:\/\/github.com\/nikita-moor\/ldatuning."},{"key":"1771_CR46","first-page":"391","volume":"6118","author":"R Arun","year":"2010","unstructured":"Arun, R., Suresh, V., Madhavan, C. E. V. & Murty, M. N. On finding the natural number of topics with latent Dirichlet allocation: some observations. Lect. Notes Artif. Int. 6118, 391\u2013402 (2010).","journal-title":"Lect. Notes Artif. Int."},{"key":"1771_CR47","doi-asserted-by":"publisher","first-page":"1775","DOI":"10.1016\/j.neucom.2008.06.011","volume":"72","author":"J Cao","year":"2009","unstructured":"Cao, J., Xia, T., Li, J. T., Zhang, Y. D. & Tang, S. A density-based method for adaptive LDA model selection. Neurocomputing 72, 1775\u20131781 (2009).","journal-title":"Neurocomputing"},{"key":"1771_CR48","doi-asserted-by":"publisher","first-page":"5228","DOI":"10.1073\/pnas.0307752101","volume":"101","author":"TL Griffiths","year":"2004","unstructured":"Griffiths, T. L. & Steyvers, M. Finding scientific topics. Proc. Natl. Acad. Sci. USA 101, 5228\u20135235 (2004).","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"1771_CR49","first-page":"61","volume":"17","author":"R Deveaud","year":"2014","unstructured":"Deveaud, R., SanJuan, E. & Bellot, P. Accurate and effective latent concept modeling for ad hoc information retrieval. Doc. Numer. 17, 61\u201384 (2014).","journal-title":"Doc. Numer."},{"key":"1771_CR50","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v040.i13","volume":"40","author":"B Gr\u00fcn","year":"2011","unstructured":"Gr\u00fcn, B. & Hornik, K. Topicmodels: an R package for fitting topic models. J. Stat. Softw. 40, 1\u201330 (2011).","journal-title":"J. Stat. Softw."},{"key":"1771_CR51","doi-asserted-by":"publisher","unstructured":"Robinson, S. & Silge, J. tidytext: text mining and analysis using tidy data principles in R. J. Open Source Softw. https:\/\/doi.org\/10.21105\/joss.00037JOSS (2016).","DOI":"10.21105\/joss.00037JOSS"},{"key":"1771_CR52","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.1093\/biostatistics\/kxac018","volume":"24","author":"J Fukuyama","year":"2023","unstructured":"Fukuyama, J., Sankaran, K. & Symul, L. Multiscale analysis of count data through topic alignment. Biostatistics 24, 1045\u20131065 (2023).","journal-title":"Biostatistics"},{"key":"1771_CR53","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1037\/1082-989X.11.1.54","volume":"11","author":"M Smithson","year":"2006","unstructured":"Smithson, M. & Verkuilen, J. A better lemon squeezer? Maximum-likelihood regression with beta-distributed dependent variables. Psychol. Methods 11, 54\u201371 (2006).","journal-title":"Psychol. Methods"},{"key":"1771_CR54","doi-asserted-by":"publisher","first-page":"e61217","DOI":"10.1371\/journal.pone.0061217","volume":"8","author":"PJ McMurdie","year":"2013","unstructured":"McMurdie, P. J. & Holmes, S. phyloseq: an R package for reproducible interactive analysis and graphics of microbiome census data. PLoS ONE 8, e61217 (2013).","journal-title":"PLoS ONE"},{"key":"1771_CR55","doi-asserted-by":"publisher","first-page":"1463","DOI":"10.1093\/bioinformatics\/btq166","volume":"26","author":"SW Kembel","year":"2010","unstructured":"Kembel, S. W. et al. Picante: R tools for integrating phylogenies and ecology. Bioinformatics 26, 1463\u20131464 (2010).","journal-title":"Bioinformatics"},{"key":"1771_CR56","unstructured":"Oksanen, J. et al. Package \u2018vegan\u2019. Community ecology package. Version 2, 1\u2013295 (2013)"},{"key":"1771_CR57","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1890\/0012-9658(2001)082[0290:FMMTCD]2.0.CO;2","volume":"82","author":"BH McArdle","year":"2001","unstructured":"McArdle, B. H. & Anderson, M. J. Fitting multivariate models to community data: a comment on distance-based redundancy analysis. Ecology 82, 290\u2013297 (2001).","journal-title":"Ecology"},{"key":"1771_CR58","doi-asserted-by":"crossref","unstructured":"Kassambara, A. rstatix: pipe-friendly framework for basic statistical tests. CRAN (The Comprehensive R Archive Network), Vienna, Austria (2019). https:\/\/CRAN.R-project.org\/package=rstatix.","DOI":"10.32614\/CRAN.package.rstatix"},{"key":"1771_CR59","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v034.i02","volume":"34","author":"F Cribari-Neto","year":"2010","unstructured":"Cribari-Neto, F. & Zeileis, A. Beta regression in R. J. Stat. Softw. 34, 1\u201324 (2010).","journal-title":"J. Stat. Softw."},{"key":"1771_CR60","doi-asserted-by":"crossref","unstructured":"Wickham, H. ggplot2: elegant graphics for data analysis. Use R! 1\u2013212 (New York, NY, 2009).","DOI":"10.1007\/978-0-387-98141-3_1"},{"key":"1771_CR61","unstructured":"Wilke, C. cowplot: streamlined plot theme and plot annotations for \u2018ggplot2\u2019. 1.2.0 ed (2025). https:\/\/CRAN.R-project.org\/package=cowplot."},{"key":"1771_CR62","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1093\/biostatistics\/kxy018","volume":"20","author":"K Sankaran","year":"2019","unstructured":"Sankaran, K. & Holmes, S. P. Latent variable modeling for the microbiome. Biostatistics 20, 599\u2013614 (2019).","journal-title":"Biostatistics"},{"key":"1771_CR63","doi-asserted-by":"publisher","unstructured":"Schaffer J. N., Pearson M. M. Proteus mirabilis and urinary tract infections. Microbiol. Spectr. https:\/\/doi.org\/10.1128\/microbiolspec.uti-0017-2013 (2015).","DOI":"10.1128\/microbiolspec.uti-0017-2013"},{"key":"1771_CR64","doi-asserted-by":"publisher","DOI":"10.1002\/mbo3.661","volume":"8","author":"K Diop","year":"2019","unstructured":"Diop, K. et al. Description of three new Peptoniphilus species cultured in the vaginal fluid of a woman diagnosed with bacterial vaginosis: Peptoniphilus pacaensis sp. nov., Peptoniphilus raoultii sp. nov., and Peptoniphilus vaginalis sp. nov. MicrobiologyOpen 8, e00661 (2019).","journal-title":"MicrobiologyOpen"},{"key":"1771_CR65","doi-asserted-by":"publisher","first-page":"520","DOI":"10.1111\/1574-6976.12005","volume":"37","author":"EC Murphy","year":"2013","unstructured":"Murphy, E. C. & Frick, I. M. Gram-positive anaerobic cocci-commensals and opportunistic pathogens. FEMS Microbiol. Rev. 37, 520\u2013553 (2013).","journal-title":"FEMS Microbiol. Rev."},{"key":"1771_CR66","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-27555-x","volume":"13","author":"AE Asangba","year":"2023","unstructured":"Asangba, A. E. et al. Diagnostic and prognostic potential of the microbiome in ovarian cancer treatment response. Sci. Rep. 13, 730 (2023).","journal-title":"Sci. Rep."},{"key":"1771_CR67","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1128\/CMR.00075-15","volume":"29","author":"AB Onderdonk","year":"2016","unstructured":"Onderdonk, A. B., Delaney, M. L. & Fichorova, R. N. The human microbiome during bacterial vaginosis. Clin. Microbiol. Rev. 29, 223\u2013238 (2016).","journal-title":"Clin. Microbiol. Rev."},{"key":"1771_CR68","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1007\/s43032-023-01351-4","volume":"31","author":"KT Li","year":"2024","unstructured":"Li, K. T. et al. Changes in the vaginal microbiome during pregnancy and the postpartum period in South African women: a longitudinal study. Reprod. Sci. 31, 275\u2013287 (2024).","journal-title":"Reprod. Sci."},{"key":"1771_CR69","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-62537-7","volume":"14","author":"K McKee","year":"2024","unstructured":"McKee, K. et al. Host factors are associated with vaginal microbiome structure in pregnancy in the ECHO Cohort Consortium. Sci. Rep. 14, 11798 (2024).","journal-title":"Sci. Rep."},{"key":"1771_CR70","doi-asserted-by":"publisher","DOI":"10.1038\/s41522-021-00244-1","volume":"7","author":"M Movassagh","year":"2021","unstructured":"Movassagh, M. et al. Vaginal microbiome topic modeling of laboring Ugandan women with and without fever. NPJ Biofilms Microbiomes 7, 75 (2021).","journal-title":"NPJ Biofilms Microbiomes"},{"key":"1771_CR71","doi-asserted-by":"publisher","DOI":"10.3389\/frph.2021.780931","volume":"3","author":"NS de Oliveira","year":"2021","unstructured":"de Oliveira, N. S. et al. Postmenopausal vaginal microbiome and microbiota. Front. Reprod. Health 3, 780931 (2021).","journal-title":"Front. Reprod. Health"},{"key":"1771_CR72","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1186\/s12866-024-03648-z","volume":"24","author":"X Li","year":"2024","unstructured":"Li, X., Zhang, Z., Bai, H. & Liu, Z. Analysis of vaginal microbiota during postpartum and postmenopausal periods based on metagenomics. BMC Microbiol. 24, 501 (2024).","journal-title":"BMC Microbiol."},{"key":"1771_CR73","doi-asserted-by":"publisher","first-page":"e0270242","DOI":"10.1371\/journal.pone.0270242","volume":"17","author":"R Yoshikata","year":"2022","unstructured":"Yoshikata, R. et al. Evaluation of the efficacy of Lactobacillus-containing feminine hygiene products on vaginal microbiome and genitourinary symptoms in pre- and postmenopausal women: a pilot randomized controlled trial. PLoS ONE 17, e0270242 (2022).","journal-title":"PLoS ONE"},{"key":"1771_CR74","doi-asserted-by":"crossref","unstructured":"Witkin, S. S. et al. Influence of vaginal bacteria and D- and L-lactic acid isomers on vaginal extracellular matrix metalloproteinase inducer: implications for protection against upper genital tract infections. mBio. 4, e00460-13 (2013).","DOI":"10.1128\/mBio.00460-13"},{"key":"1771_CR75","doi-asserted-by":"publisher","first-page":"7063","DOI":"10.1128\/AEM.02385-16","volume":"82","author":"MT France","year":"2016","unstructured":"France, M. T., Mendes-Soares, H. & Forney, L. J. Genomic comparisons of Lactobacillus crispatus and Lactobacillus iners reveal potential ecological drivers of community composition in the vagina. Appl. Environ. Microbiol. 82, 7063\u20137073 (2016).","journal-title":"Appl. Environ. Microbiol."},{"key":"1771_CR76","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2021.792787","volume":"11","author":"N Zheng","year":"2021","unstructured":"Zheng, N., Guo, R., Wang, J., Zhou, W. & Ling, Z. Contribution of Lactobacillus iners to vaginal health and diseases: a systematic review. Front. Cell Infect. Microbiol. 11, 792787 (2021).","journal-title":"Front. Cell Infect. Microbiol."},{"key":"1771_CR77","doi-asserted-by":"publisher","first-page":"1945","DOI":"10.1016\/j.ccell.2023.09.012","volume":"41","author":"LE Colbert","year":"2023","unstructured":"Colbert, L. E. et al. Tumor-resident Lactobacillus iners confer chemoradiation resistance through lactate-induced metabolic rewiring. Cancer Cell 41, 1945\u20131962.e11 (2023).","journal-title":"Cancer Cell"},{"key":"1771_CR78","doi-asserted-by":"publisher","first-page":"106387","DOI":"10.1016\/j.ijscr.2021.106387","volume":"86","author":"MA Ferjaoui","year":"2021","unstructured":"Ferjaoui, M. A. et al. Pelvic actinomycosis: a confusing diagnosis. Int. J. Surg. Case Rep. 86, 106387 (2021).","journal-title":"Int. J. Surg. Case Rep."},{"key":"1771_CR79","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/928290","volume":"2013","author":"E Garcia-Gomez","year":"2013","unstructured":"Garcia-Gomez, E., Gonzalez-Pedrajo, B. & Camacho-Arroyo, I. Role of sex steroid hormones in bacterial-host interactions. Biomed. Res. Int. 2013, 928290 (2013).","journal-title":"Biomed. Res. Int."},{"key":"1771_CR80","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1097\/AOG.0000000000005210","volume":"142","author":"S Mei","year":"2023","unstructured":"Mei, S. et al. Health disparities in ovarian cancer: report from the ovarian cancer evidence review conference. Obstet. Gynecol. 142, 196\u2013210 (2023).","journal-title":"Obstet. Gynecol."},{"key":"1771_CR81","doi-asserted-by":"publisher","DOI":"10.1186\/s13048-017-0355-y","volume":"10","author":"SK Srivastava","year":"2017","unstructured":"Srivastava, S. K. et al. Racial health disparities in ovarian cancer: not just black and white. J. Ovarian Res. 10, 58 (2017).","journal-title":"J. Ovarian Res."},{"key":"1771_CR82","doi-asserted-by":"publisher","first-page":"e291","DOI":"10.1016\/S2666-5247(23)00257-4","volume":"5","author":"A Mitra","year":"2024","unstructured":"Mitra, A. et al. Genital tract microbiota composition profiles and use of prebiotics and probiotics in gynaecological cancer prevention: review of the current evidence, the European Society of Gynaecological Oncology prevention committee statement. Lancet Microbe 5, e291\u2013e300 (2024).","journal-title":"Lancet Microbe"}],"container-title":["Communications Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s43856-026-01771-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s43856-026-01771-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s43856-026-01771-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T02:03:39Z","timestamp":1793671419000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s43856-026-01771-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,10]]},"references-count":82,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["1771"],"URL":"https:\/\/doi.org\/10.1038\/s43856-026-01771-8","relation":{},"ISSN":["2730-664X"],"issn-type":[{"value":"2730-664X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,10]]},"assertion":[{"value":"26 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 July 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","label":"Competing interests","group":{"name":"EthicsHeading","label":"Ethics"}}],"article-number":"573"}}