Although every female has unique vaginal microbiome, entire community of microbes living in vagina are grouped into 5 categories also referred to as Community State Types(CST)
This categorization in itself is a unique & transparent way of decoding composition & functional activity of your vaginal microbiome, what is causing vaginal dysbiosis, what kind of symptoms you may experience & whether you are at the risk of developing recurrent infections, UTI, preterm births & more.
So what is the main difference in these five community state types? It is the composition & activity of protective species- Lactobacillus
As discussed in our previous blog, Lactobacillus species work in following ways to regulate your biology
-Creates lactic acid that keeps Vaginal pH level between 3.8 & 4.5
-Colonizing the vaginal wall & preventing pathogens from occupying the vaginal corner.
-Producing bacteriocins that further prevents growth of unfriendly microbes.
Let us deep dive into each of these five community state types (CST)
Each community state type is characterized by type & composition of different lactobacillus species present. The following paragraphs explains about each of CST & the dominant bacteria present
Type 1- Dominant bacteria-Lactobacillus Crispatus; nature: Protective/beneficial
Type 1 is the most healthiest type as dominant bacteria in type 1-Lactobacillus Crispatus plays a key role in preventing various infections such as Urinary Tract infection(UTI), Bacterial Vaginosis(BV) & Sexually transmitted infections(STI). Besides, this bacteria plays a key role in reducing risk of other female related health issues such as infertility, preterm births & more.
The dominant bacteria is capable of producing high amounts of both types of lactic acid- D Lactic acid & L Lactic Acid. Although both types are protective & beneficial, D-lactic acid makes sure that type 1 maintains an acidic environment with vaginal pH level of <4.5, thereby preventing pathogens from taking over
With type 1 there are two subtypes Type 1A & Type 1B. Type 1A has a higher proportion of lactobacillus Crispatus as compared to type 1B. Both are considered to be playing a key role in keeping your vaginal microbiome healthy & less diverse
Type 2- Dominant bacteria-Lactobacillus gasseri; nature: Protective/beneficial
Type 2 is also considered to be promoting a healthy vaginal microbiome, dominated by Lactobacillus gasseri. Like Lactobacillus crispatus, lactobacillus gasseri produced D-lactic acid but the level of production of this lactic acid is less than that produced by Lactobacillus crispatus & therefore is considered to be less protective than its type 1 counterpart
Research has shown that Lactobacillus gasseri provides a strong wall against pathogens & decreased risk of infections such as Urinary Tract infection(UTI), Bacterial Vaginosis(BV) & Sexually transmitted infections(STI). It also reduces risk for development of other issues such as infertility, pelvic inflammatory disease, neonatal issues & more
Type 3- Dominant bacteria-Lactobacillus iners; nature: Neutral- Can be protective & disruptive
Type 3 is dominated by a different category of lactobacillus species-Lactobacillus iners. Although lactobacillus is what should populate your vagina, Lactobacillus iners can act as both friendly & disruptive bacteria & can trigger vaginal dysbiosis & make your vaginal microbiome move out of a healthy state.
If this bacteria is found along with disruptive bacteria, it can make you develop symptoms such as itching & abnormal vaginal discharge. On the other hand, if Lactobacillus iners is found along with other beneficial lactobacillus, it can be neutral or even beneficial.
Lactobacillus iners do offer some bit of protection by producing L-Lactic acid & takes up some space in vagina which protects pathogens from dominating the vaginal ecosystem L-lactic acid keeps vaginal pH level low & healthy. Since L-actic acid is less effective than other other vaginal lactic acids, a larger proportion of Lactobacillus iners is required to keep pathogens from the vaginal environment.
Some of research has found that Lactobacillus iners are less protective against sexually transmitted infections & pregnancy as compared to other lactobacillus organisms.
There are two subtypes for type 3- Type 3A & Type 3B. Type 3 has a higher percentage of Lactobacillus iners as compared to Type 3B. However while evaluating activities of Lactobacillus iners, it is important to consider the presence of other bacterial species. This relative composition will determine where your vaginal microbiome ecosystem is beneficial or harmful.
Type 4- Dominant bacteria-diverse bacteria, no lactobacillus dominance; nature: Neutral- Harmful
Type 4 is the most non-desirable type of vaginal microbiome composition & is dominated by highly diverse bacteria & less of protective/beneficial lactobacillus species. This community state type is associated with a less stable vaginal environment & risk of development of vaginal dysbiosis. It also increases risk of developing recurrent infections.
Research has found that highly diverse vaginal microbiome is connected with serious health issues such as infertility, sexually transmitted infections(STI) & pelvic inflammatory disease
Having type 4 CST means that you have to be cautious & vagina needs extra care.The changes in vagina composition is impacted by dietary choices, medication & supplements.
Not all type 4 bacteria are harmful. Some females having type 4 vaginal microbiome community state type are asymptomatic. While vagina of some females having type 4 microbiome are co-colonised by bifidobacterium species
Type 4 is further divided into 3 subtypes
Type 4A is characterized by moderate to high proportion of Gardnerella vaginalis & bacterial vaginosis associated bacteria. Presence of these bacteria can trigger bacterial vaginosis. Presence of bacterial vaginosis associated bacteria can lead to recurrence of bacterial vaginosis.
Type 4B is dominated by moderate to high proportions of Atopobium vaginae and Gardnerella vaginalis. Both these harmful microbes can combine together to form biofilms which can lead to development of bacterial vaginosis. The existence of biofilm is one of the reasons why bacterial vaginosis keeps on coming back.
Type 4C is further divided into 5 subtypes
-Type 4C(a)-It is one of the most diverse community of vaginal microbiomes with prevotella being present which plays a key role in biofilm formation & associated with bacterial vaginosis
-Type4C(b)- This consists of streptococcus, one of the most common bacteria in the vaginal microbiome. Streptococcus can play both beneficial or harmful roles depending upon the time of your life. It also produces L-lactic acid which maintains an acidic environment to keep the vaginal microbiome healthy. However, it is also considered to play important role in development of sexually transmitted infection & aerobic vaginitis.
-Type4C(c)-This consists of enterococcus which is part of normal vaginal microbiome but this bacteria can also play a role in infections such as Urinary Tract Infection.
-Type4C(d)- Here Bifidobacterium enjoys dominance. This beneficial bacteria is said to protect the vaginal environment by producing L-lactic acid to keep the pH level low. Since it does not produce D-Lactic acid, it offers less protection that Lactobacillus crispatus or Lactobacillus gasseri
-Type4C(e)- This is dominated by staphylococcus which is associated with Urinary Tract Infection as well as aerobic vaginitis.
Type 5- Dominant bacteria;Lactobacillus jensenii nature: Neutral- Protective/Beneficial
Type 5 ,dominated by Lactobacillus Jensenii, is a healthy vaginal microbiome community state type.
Lactobacillus Jensenii creates a protective environment by taking space in the vaginal environment & producing bacteriocins. This beneficial bacteria also produced D-Lactic acid
Research shows this to be one of the most protective types in preventing infections like BV, STI, and UTIs. Subsequently, Type 5 is also linked with very low risk for health issues such as infertility, pelvic inflammatory disease & many others.
Testing your Vaginal Microbiome
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Unlike a one time genetic test which gives you the same information every time you test, your gut + vaginal microbiome testing will give a clear picture of ever evolving & changing microbiome ecosystem profile & how your interventions are bringing improvements in your health every time you retest. With Genefitletics, you have an option to test every 6 months, making it cost effective. By re-testing, you can make sure that your gut &vaginal microbiome activities are promoting your biology for health. Proceed to https://genefitletics.com/vageco/ to learn what is happening inside the body at molecular level right now & which specific nutrition, supplement, prebiotic & probiotic interventions can regulate your biology & keep you away from chronic illnesses.
