Characterization of the novaginal microflora after surgical gender reassignment in HIV, HBV and HCV Seronegative transsexual women

Aim of the Study: The knowledge of the neovaginal microflora can help to understand the physiological mechanisms of the surgical reassigned genitalia and to ensure a proper therapy in case of infectious disease. We mapped the neovaginal microflora during the early perioperative days after male to female (M-F) gender reassignment surgery in HIV, HBV and HCV seronegative and healthy transsexual women. Materials and Methods: Between November 2016 and January 2017 we collected 2 neovaginal swabs (one in the neo-vaginal fundus and one in the proximity of the urethral meatus) during the early perioperative days from 8 patients (pts) who underwent M-F gender surgical reassignment. The V3-16S rRNA Next Generation Sequencing (NGS) and a multiplex PCR technology were used to investigate the microbial composition and the presence of Sexual Transmitted Infections, respectively. QIIME 1.8.01 was used to process the NGS data. Results: Patients median age was 35 (24–49) years. For at least one year, all pts were taking an androgen deprivation therapy and an estrogen therapy, which was suspended 7 days before surgery. All pts were HIV, HBV and HCV seronegative and heterosexual. Swabs were performed between the 4th and the 10th postoperative days when no sign of infection was clinically present. All pts were using an iodone solution for the daily neovaginal hygiene. No STI, including Chlamydia tracomatis, Neisseria gonorrhoeae, Mycoplasma/Ureaplasma, HPV, Trichomonas vaginalis and Treponema pallidum, was detected in the samples analyzed. The microbial composition of the samples from neovagina and periurhetra is showed in Fig. A. Prevotella was the predominant genus in the neovagina. Moreover, the samples showed the presence of Bacteroides, Escherichia, and Proteus while no Lactobacilli were reported. Discussion: We characterized the microbiome of the neovagina in the early postoperative days after M-F gender reassignment surgery. Despite estrogen substitute therapy, neovagina appeared massively colonized by microorganisms usually resident in the male urogenital tract and often responsible for genito-urinary infections in women while the native vaginal Lactobacilli were absent. To our knowledge, this is the first report describing the neovaginal microbiota in the early postoperative days after M-F gender reassignment surgery in healthy transsexuals women. Therefore, our study provides the standard model of vaginal microbiota of healthy transsexual women.