{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T19:01:46Z","timestamp":1790017306969,"version":"4.0.1"},"update-to":[{"DOI":"10.1371\/journal.pcbi.1014768","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000}}],"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006492","name":"Division of Intramural Research, National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R01AI146065"],"award-info":[{"award-number":["R01AI146065"]}],"id":[{"id":"10.13039\/100006492","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006492","name":"Division of Intramural Research, National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["K23AI106957"],"award-info":[{"award-number":["K23AI106957"]}],"id":[{"id":"10.13039\/100006492","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1TR003096"],"award-info":[{"award-number":["UL1TR003096"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["U54CA143924"],"award-info":[{"award-number":["U54CA143924"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000001","name":"National Science Foundation","doi-asserted-by":"publisher","award":["2018936"],"award-info":[{"award-number":["2018936"]}],"id":[{"id":"10.13039\/100000001","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.ploscompbiol.org"],"crossmark-restriction":false},"short-container-title":["PLoS Comput Biol"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Bacterial vaginosis (BV) is a vaginal dysbiosis associated with adverse reproductive and infectious outcomes. Current diagnostics identify BV after symptom onset. We evaluated whether artificial neural network (ANN) models of the vaginal microbiome could predict incident BV (iBV) up to 14 days before clinical diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>ANNs were trained using 16S rRNA gene sequencing data from 1,201 longitudinal vaginal specimens collected from 58 women across two prospective cohorts. Models classified individual specimens as pre-iBV or healthy using the relative abundance of vaginal bacterial taxa. Model performance was assessed using a held-out participant-level test set, participant-level cross-validation, and external validation. SHAP analysis was used to identify taxa associated with model predictions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      On the held-out participant-level test set, the ANN achieved 93% accuracy (AUC\u2009=\u20090.97, sensitivity\u2009=\u200995%, specificity\u2009=\u200992%). Models using only five taxa (\n                      <jats:italic>Lactobacillus crispatus<\/jats:italic>\n                      ,\n                      <jats:italic>Gardnerella<\/jats:italic>\n                      spp.,\n                      <jats:italic>L. iners<\/jats:italic>\n                      ,\n                      <jats:italic>L. mulieris<\/jats:italic>\n                      , and\n                      <jats:italic>Megamonas<\/jats:italic>\n                      spp.) maintained &gt;91% accuracy, sensitivity, and specificity. SHAP analysis identified\n                      <jats:italic>Lactobacillus<\/jats:italic>\n                      spp. and\n                      <jats:italic>Gardnerella<\/jats:italic>\n                      spp. as the taxa most strongly associated with model predictions. Participant-level cross-validation produced lower and more variable performance (AUC\u2009=\u20090.826\u2009\u00b1\u20090.076; accuracy\u2009=\u200971.5%\u2009\u00b1\u20098.2%), while external validation achieved approximately 80% balanced accuracy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>Vaginal microbiome composition contains predictive information that can identify women at risk of iBV before clinical onset. Lower performance during participant-level cross-validation and external validation indicates that additional validation in larger, more diverse cohorts is required before clinical implementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pcbi.1014768","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T18:03:38Z","timestamp":1789495418000},"page":"e1014768","update-policy":"https:\/\/doi.org\/10.1371\/journal.pcbi.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Predicting bacterial vaginosis incidence using artificial neural networks"],"prefix":"10.1371","volume":"22","author":[{"given":"Jacob H.","family":"Elnaggar","sequence":"first","affiliation":[{"name":"Louisiana State University Health Sciences Center","place":["New Orleans, Louisiana, United States of America"],"department":["Department of Microbiology, Immunology, and Parasitology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8892-4576","authenticated-orcid":true,"given":"John W.","family":"Lammons","sequence":"additional","affiliation":[{"name":"Louisiana State University Health Sciences Center","place":["New Orleans, Louisiana, United States of America"],"department":["Department of Microbiology, Immunology, and Parasitology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caleb M.","family":"Ardizzone","sequence":"additional","affiliation":[{"name":"Louisiana State University Health Sciences Center","place":["New Orleans, Louisiana, United States of America"],"department":["Department of Microbiology, Immunology, and Parasitology"]},{"name":"Indiana University School of Medicine","place":["Indianapolis, Indiana, United States of America"],"department":["Division of Infectious Diseases, Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristal J.","family":"Aaron","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham","place":["Birmingham, Alabama, United States of America"],"department":["Division of Infectious Diseases, Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clayton","family":"Jacobs","sequence":"additional","affiliation":[{"name":"Louisiana State University Health Sciences Center","place":["New Orleans, Louisiana, United States of America"],"department":["Department of Microbiology, Immunology, and Parasitology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keonte J.","family":"Graves","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham","place":["Birmingham, Alabama, United States of America"],"department":["Division of Infectious Diseases, Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7420-9753","authenticated-orcid":true,"given":"Sheridan D.","family":"George","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham","place":["Birmingham, Alabama, United States of America"],"department":["Division of Infectious Diseases, Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1545-7826","authenticated-orcid":true,"given":"Megan","family":"Amerson-Brown","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham","place":["Birmingham, Alabama, United States of America"],"department":["Division of Laboratory Science, Department of Pathology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng","family":"Luo","sequence":"additional","affiliation":[{"name":"Louisiana State University Health Sciences Center","place":["New Orleans, Louisiana, United States of America"],"department":["Department of Microbiology, Immunology, and Parasitology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashutosh","family":"Tamhane","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham","place":["Birmingham, Alabama, United States of America"],"department":["Division of Nephrology, Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pawe\u0142","family":"\u0141aniewski","sequence":"additional","affiliation":[{"name":"College of Medicine-Phoenix, University of Arizona","place":["Phoenix, Arizona, United States of America"],"department":["Department of Basic Medical Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison J.","family":"Quayle","sequence":"additional","affiliation":[{"name":"Louisiana State University Health Sciences Center","place":["New Orleans, Louisiana, United States of America"],"department":["Department of Microbiology, Immunology, and Parasitology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa M.","family":"Herbst-Kralovetz","sequence":"additional","affiliation":[{"name":"College of Medicine-Phoenix, University of Arizona","place":["Phoenix, Arizona, United States of America"],"department":["Department of Basic Medical Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuno","family":"Cerca","sequence":"additional","affiliation":[{"name":"Centre of Biological Engineering, Laboratory of Research in Biofilms Ros\u00e1rio Oliveira, Minho University","place":["Braga, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina A.","family":"Muzny","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham","place":["Birmingham, Alabama, United States of America"],"department":["Division of Infectious Diseases, Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7983-5275","authenticated-orcid":true,"given":"Christopher M.","family":"Taylor","sequence":"additional","affiliation":[{"name":"Louisiana State University Health Sciences Center","place":["New Orleans, Louisiana, United States of America"],"department":["Department of Microbiology, Immunology, and Parasitology"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"pcbi.1014768.ref001","first-page":"737","article-title":"Bacterial vaginosis.","volume-title":"Bacterial vaginosis","author":"S Hillier","year":"2008","edition":"4"},{"key":"pcbi.1014768.ref002","doi-asserted-by":"crossref","first-page":"750479","DOI":"10.1155\/2008\/750479","article-title":"The human vaginal bacterial biota and bacterial vaginosis","volume":"2008","author":"S Srinivasan","year":"2008","journal-title":"Interdiscip Perspect Infect Dis"},{"issue":"11","key":"pcbi.1014768.ref003","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1097\/OLQ.0b013e318074e565","article-title":"The prevalence of bacterial vaginosis in the United States, 2001\u20132004; associations with symptoms, sexual behaviors, and reproductive health","volume":"34","author":"EH Koumans","year":"2007","journal-title":"Sex Transm Dis"},{"issue":"6","key":"pcbi.1014768.ref004","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001251","article-title":"Bacterial vaginosis associated with increased risk of female-to-male HIV-1 transmission: a prospective cohort analysis among African couples","volume":"9","author":"CR Cohen","year":"2012","journal-title":"PLoS Med"},{"key":"pcbi.1014768.ref005","article-title":"Bacterial vaginosis and anaerobes in obstetric-gynecologic infection","author":"DA Eschenbach","year":"1993","journal-title":"Clin Infect Dis"},{"issue":"7","key":"pcbi.1014768.ref006","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1136\/sextrans-2018-053824","article-title":"Incubation period and risk factors support sexual transmission of bacterial vaginosis in women who have sex with women","volume":"95","author":"CA Muzny","year":"2019","journal-title":"Sex Transm Infect"},{"issue":"10","key":"pcbi.1014768.ref007","doi-asserted-by":"crossref","first-page":"1562","DOI":"10.1093\/infdis\/jit664","article-title":"The influence of behaviors and relationships on the vaginal microbiota of women and their female partners: the WOW Health Study","volume":"209","author":"CS Bradshaw","year":"2014","journal-title":"J Infect Dis"},{"issue":"10","key":"pcbi.1014768.ref008","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1056\/NEJMoa2405404","article-title":"Male-partner treatment to prevent recurrence of bacterial vaginosis","volume":"392","author":"LA Vodstrcil","year":"2025","journal-title":"N Engl J Med"},{"issue":"1","key":"pcbi.1014768.ref009","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1038\/s41572-025-00626-1","article-title":"Bacterial vaginosis","volume":"11","author":"CS Bradshaw","year":"2025","journal-title":"Nat Rev Dis Primers"},{"issue":"9","key":"pcbi.1014768.ref010","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.1093\/infdis\/jiz342","article-title":"An Updated Conceptual Model on the Pathogenesis of Bacterial Vaginosis","volume":"220","author":"CA Muzny","year":"2019","journal-title":"J Infect Dis"},{"issue":"11","key":"pcbi.1014768.ref011","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0014116","article-title":"Characteristic male urine microbiomes associate with asymptomatic sexually transmitted infection","volume":"5","author":"DE Nelson","year":"2010","journal-title":"PLoS One"},{"issue":"3","key":"pcbi.1014768.ref012","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1093\/infdis\/jiu089","article-title":"Role of Gardnerella vaginalis in the pathogenesis of bacterial vaginosis: a conceptual model","volume":"210","author":"JR Schwebke","year":"2014","journal-title":"J Infect Dis"},{"issue":"1","key":"pcbi.1014768.ref013","first-page":"36","article-title":"Phage infection in vaginal lactobacilli: an in vitro study","volume":"5","author":"SI Pavlova","year":"1997","journal-title":"Infect Dis Obstet Gynecol"},{"issue":"5","key":"pcbi.1014768.ref014","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1136\/sti.75.5.352","article-title":"Vaginal bacterial phaginosis","author":"AL Blackwell","year":"1999","journal-title":"Sex Transm Infect"},{"issue":"3","key":"pcbi.1014768.ref015","first-page":"244","article-title":"Analysis of lactobacillus products for phages and bacteriocins that inhibit vaginal lactobacilli","volume":"5","author":"L Tao","year":"1997","journal-title":"Infect Dis Obstet Gynecol"},{"issue":"1","key":"pcbi.1014768.ref016","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/S1383-5718(00)00003-6","article-title":"Induction of vaginal Lactobacillus phages by the cigarette smoke chemical benzo[a]pyrene diol epoxide","volume":"466","author":"SI Pavlova","year":"2000","journal-title":"Mutat Res"},{"issue":"12","key":"pcbi.1014768.ref017","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0082599","article-title":"Longitudinal analysis of vaginal microbiome dynamics in women with recurrent bacterial vaginosis: recognition of the conversion process","volume":"8","author":"JA Lambert","year":"2013","journal-title":"PLoS One"},{"key":"pcbi.1014768.ref018","doi-asserted-by":"crossref","first-page":"634511","DOI":"10.3389\/fmicb.2021.634511","article-title":"Applications of Machine Learning in Human Microbiome Studies: A Review on Feature Selection, Biomarker Identification, Disease Prediction and Treatment","volume":"12","author":"LJ Marcos-Zambrano","year":"2021","journal-title":"Front Microbiol"},{"issue":"6","key":"pcbi.1014768.ref019","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1109\/TNB.2015.2461219","article-title":"Multi-Layer and Recursive Neural Networks for Metagenomic Classification","volume":"14","author":"G Ditzler","year":"2015","journal-title":"IEEE Trans Nanobioscience"},{"key":"pcbi.1014768.ref020","article-title":"Artificial Neural Network (ANN)","author":"A Ali","year":"2019","journal-title":"Medium"},{"issue":"2","key":"pcbi.1014768.ref021","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2023-083516","article-title":"Microbial interactions among Gardnerella, Prevotella and Fannyhessea prior to incident bacterial vaginosis: protocol for a prospective, observational study","volume":"14","author":"CA Muzny","year":"2024","journal-title":"BMJ Open"},{"issue":"9","key":"pcbi.1014768.ref022","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofaf556","article-title":"Investigating Bacterial Vaginosis Pathogenesis Using Peptide Nucleic Acid-Fluorescence In Situ Hybridization With a Focus on the Roles of Gardnerella Species, Prevotella bivia, and Fannyhessea vaginae","volume":"12","author":"SD George","year":"2025","journal-title":"Open Forum Infect Dis"},{"issue":"6","key":"pcbi.1014768.ref023","first-page":"966","article-title":"Identification of Key Bacteria Involved in the Induction of Incident Bacterial Vaginosis: A Prospective Study","volume":"218","author":"CA Muzny","year":"2018","journal-title":"J Infect Dis"},{"key":"pcbi.1014768.ref024","doi-asserted-by":"crossref","first-page":"4680","DOI":"10.1073\/pnas.1002611107","article-title":"Vaginal microbiome of reproductive-age women","volume":"108","author":"J Ravel","year":"2011","journal-title":"Proc Natl Acad Sci U S A"},{"key":"pcbi.1014768.ref025","article-title":"A Unified Approach to Interpreting Model Predictions","author":"S Lundberg","year":"2017","journal-title":"arXiv"},{"key":"pcbi.1014768.ref026","doi-asserted-by":"crossref","first-page":"181","DOI":"10.3389\/fmed.2018.00181","article-title":"The vaginal microenvironment: the physiologic role of lactobacilli","volume":"5","author":"E Amabebe","year":"2018","journal-title":"Front Med"},{"issue":"132","key":"pcbi.1014768.ref027","doi-asserted-by":"crossref","DOI":"10.1126\/scitranslmed.3003605","article-title":"Temporal dynamics of the human vaginal microbiota","volume":"4","author":"P Gajer","year":"2012","journal-title":"Sci Transl Med"},{"issue":"2","key":"pcbi.1014768.ref028","doi-asserted-by":"crossref","DOI":"10.1128\/mSystems.00777-19","article-title":"Complementing 16S rRNA Gene Amplicon Sequencing with Total Bacterial Load To Infer Absolute Species Concentrations in the Vaginal Microbiome","volume":"5","author":"FA Tettamanti Boshier","year":"2020","journal-title":"mSystems"},{"issue":"20","key":"pcbi.1014768.ref029","doi-asserted-by":"crossref","first-page":"1906","DOI":"10.1056\/NEJMoa1915254","article-title":"Randomized trial of Lactin-V to prevent recurrence of bacterial vaginosis","volume":"382","author":"CR Cohen","year":"2020","journal-title":"N Engl J Med"},{"key":"pcbi.1014768.ref030","doi-asserted-by":"crossref","DOI":"10.1101\/2024.06.25.24309408","article-title":"Antibiotic-free vaginal microbiota transplantation (VMT) changes vaginal microbiota and immune profile in women with asymptomatic dysbiosis \u2013 reporting of a randomized, placebo-controlled trial","author":"EF Bosma","year":"2024","journal-title":"Obstetrics and Gynecology"},{"issue":"12","key":"pcbi.1014768.ref031","doi-asserted-by":"crossref","first-page":"1856","DOI":"10.1093\/infdis\/jiv338","article-title":"Influence of Biofilm Formation by Gardnerella vaginalis and Other Anaerobes on Bacterial Vaginosis","volume":"212","author":"A Machado","year":"2015","journal-title":"J Infect Dis"},{"issue":"5","key":"pcbi.1014768.ref032","doi-asserted-by":"crossref","first-page":"1306","DOI":"10.1038\/s41396-018-0337-0","article-title":"Unveiling the role of Gardnerella vaginalis in polymicrobial Bacterial Vaginosis biofilms: the impact of other vaginal pathogens living as neighbors","volume":"13","author":"J Castro","year":"2019","journal-title":"ISME J"},{"issue":"4","key":"pcbi.1014768.ref033","doi-asserted-by":"crossref","first-page":"2782","DOI":"10.1099\/ijsem.0.004107","article-title":"A taxonomic note on the genus Lactobacillus: description of 23 novel genera, emended description of the genus Lactobacillus Beijerinck 1901, and union of Lactobacillaceae and Leuconostocaceae","volume":"70","author":"J Zheng","year":"2020","journal-title":"Int J Syst Evol Microbiol"},{"key":"pcbi.1014768.ref034","first-page":"30484","article-title":"Characterisation of probiotic properties in human vaginal lactobacilli strains","volume":"27","author":"P H\u00fctt","year":"2016","journal-title":"Microb Ecol Health Dis"},{"key":"pcbi.1014768.ref035","doi-asserted-by":"crossref","first-page":"3146","DOI":"10.3389\/fmicb.2019.03146","article-title":"Comparative Analysis of Lactobacillus gasseri and Lactobacillus crispatus Isolated From Human Urogenital and Gastrointestinal Tracts","volume":"10","author":"M Pan","year":"2020","journal-title":"Front Microbiol"},{"issue":"2","key":"pcbi.1014768.ref036","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1007\/s44197-024-00201-z","article-title":"The Vaginal Microbiota, Human Papillomavirus Infection, and Cervical Carcinogenesis: A Systematic Review in the Latina Population","volume":"14","author":"V Mancilla","year":"2024","journal-title":"J Epidemiol Glob Health"},{"issue":"1","key":"pcbi.1014768.ref037","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1097\/QCO.0000000000000620","article-title":"Host-vaginal microbiota interactions in the pathogenesis of bacterial vaginosis","volume":"33","author":"CA Muzny","year":"2020","journal-title":"Curr Opin Infect Dis"},{"issue":"11","key":"pcbi.1014768.ref038","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1016\/j.tim.2024.12.012","article-title":"Diversity in women and their vaginal microbiota","volume":"33","author":"S Condori-Catachura","year":"2025","journal-title":"Trends Microbiol"},{"issue":"11","key":"pcbi.1014768.ref039","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1158\/1940-6207.CAPR-24-0286","article-title":"Viewing Native American Cervical Cancer Disparities through the Lens of the Vaginal Microbiome: A Pilot Study","volume":"17","author":"P \u0141aniewski","year":"2024","journal-title":"Cancer Prev Res (Phila)"},{"issue":"8","key":"pcbi.1014768.ref040","article-title":"State of the Art for Diagnosis of Bacterial Vaginosis","volume":"61","author":"CA Muzny","year":"2023","journal-title":"J Clin Microbiol"},{"issue":"26","key":"pcbi.1014768.ref041","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1056\/NEJM199512283332604","article-title":"Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant","volume":"333","author":"SL Hillier","year":"1995","journal-title":"N Engl J Med"},{"issue":"1","key":"pcbi.1014768.ref042","first-page":"14","article-title":"Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations","volume":"74","author":"R Amsel","year":"1983","journal-title":"Am J Med"},{"issue":"2","key":"pcbi.1014768.ref043","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1128\/jcm.29.2.297-301.1991","article-title":"Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation","volume":"29","author":"RP Nugent","year":"1991","journal-title":"J Clin Microbiol"},{"issue":"4","key":"pcbi.1014768.ref044","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.rr7004a1","article-title":"Sexually transmitted infections treatment guidelines, 2021","volume":"70","author":"KA Workowski","year":"2021","journal-title":"MMWR Recomm Rep"},{"issue":"2","key":"pcbi.1014768.ref045","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1093\/infdis\/jiy508","article-title":"In silico and experimental evaluation of primer sets for species-level resolution of the vaginal microbiota using 16S ribosomal RNA gene sequencing","volume":"219","author":"WJ Van Der Pol","year":"2019","journal-title":"J Infect Dis"},{"issue":"7","key":"pcbi.1014768.ref046","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1038\/nmeth.3869","article-title":"DADA2: High-resolution sample inference from Illumina amplicon data","volume":"13","author":"BJ Callahan","year":"2016","journal-title":"Nat Methods"},{"key":"pcbi.1014768.ref047","article-title":"The SILVA ribosomal RNA gene database project: improved data processing and web-based tools","volume":"41","author":"C Quast","year":"2013","journal-title":"Nucleic Acids Res"},{"key":"pcbi.1014768.ref048","unstructured":"TensorFlow Developers. TensorFlow. https:\/\/zenodo.org\/record\/4758419 2021. Accessed 2021 June 13."},{"key":"pcbi.1014768.ref049","article-title":"Keras","author":"F Chollet","year":"2015","journal-title":"GitHub"},{"issue":"3","key":"pcbi.1014768.ref050","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1109\/MCSE.2007.55","article-title":"Matplotlib: A 2D Graphics Environment","volume":"9","author":"JD Hunter","year":"2007","journal-title":"Comput Sci Eng"}],"updated-by":[{"DOI":"10.1371\/journal.pcbi.1014768","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000}}],"container-title":["PLOS Computational Biology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pcbi.1014768","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T18:08:30Z","timestamp":1790014110000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pcbi.1014768"}},"subtitle":[],"editor":[{"given":"J. Gregory","family":"Caporaso","sequence":"first","affiliation":[{"name":"Northern Arizona University","place":["UNITED STATES OF AMERICA"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,9,15]]},"references-count":50,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,15]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pcbi.1014768","relation":{},"ISSN":["1553-7358"],"issn-type":[{"value":"1553-7358","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,15]]}}}