Influence of Hormonal Factors, Number of Sexual Partners, Surgical Intervention on Gastrointestinal and Urogenital Microbiota of Patients Endometriosis.

Problem: Endometriosis is associated with gastrointestinal (GI) and urogenital (UG) microbial dysbiosis in patients with endometriosis (P-EOSIS). Sexual partner exposure may contribute to microbial dysbiosis but has not been studied in P-EOSIS. We hypothesized that sexual partner number, hormonal and surgical therapy would affect GI/UG microbial dysbiosis in P-EOSIS.

Methods Of Study: Urine, fecal and vaginal swabs from control (n = 15) and P-EOSIS (n = 33) were collected on the day of surgery (DOS) and ∼1-3 weeks post-surgical intervention (PSI). Control and P-EOSIS were grouped based on hormonal therapy (HT) to determine the effect of HT on microbial profiles, Control (HT n = 8; no HT n = 7) and P-EOSIS (HT n = 18; no HT n = 15). Samples underwent DNA extraction and sequencing of the V4 region of 16S rRNA gene. Sequences were processed using QIIME2 and amplicon sequence variants (ASV) were analyzed for microbial differences. Pearson's and Spearman correlation analyses determined associations among microbial features and sexual partner exposure.

Results: P-EOSIS had microbial dysbiosis characterized by unique GI/UG bacteria and altered microbial richness and diversity. Hormonal and surgical intervention in P-EOSIS restored GI microbial diversity. Increased sexual partner exposure decreased GI/UG microbial diversity. P-EOSIS who had 10 or more sexual partners had greater microbial dysbiosis compared to 4-6 partners. Surgical intervention negatively correlated with sexual partner numbers and GI/UG microbial abundance.

Discussion: Increased sexual partner exposure may enhance microbial dysbiosis in P-EOSIS and diminish the effectiveness of HT and surgical interventions.