Microbial cell-type-based grouping model as a potential indicator of cervicovaginal flora prone to biofilm formation

Cervicovaginal (CV) microbiota is critical for the well-being of host. We investigated the relationship between the ratio of Lactobacilli (LB) and cocci/coccobacilli (C/CB)-type microbial cells with biofilm formation of CV mixed cultures of women with no inflammation/infection or any epithelial abnormalities in Pap-stained smears Group 1 (G1) corresponds to the flora with LB-type cells alone, whereas G2 corresponds to the LB-dominated flora. G3 contains balanced LB and C/CB cells and G4 is dominated with C/CB. G5 corresponds to a flora with C/CB-type cells alone. Biofilm formation of CV mixed cultures was assessed by crystal violet binding assay and optical density (OD)≥0.8 were defined as biofilm producers. G1 and G3 exist in higher frequencies compared to the other smear groups. However, although the frequency of G5 dominated with C/CB-type cells were the lowest (4%); biofilm formation in that group was observed in the highest frequency (42.9%). The least biofilm formation frequency was observed in G3 smears with balanced flora (1%). Biofilm formation in healthy CV flora increases when there becomes an imbalance between LB and C/CB-type cells and an increase in C/CB-type cells. Our approach may enable early detection of vaginal dysbiosis in healthy flora prone to biofilm-associated CV infections such as bacterial vaginosis (BV).