Jane R Schwebke

University of Alabama at Birmingham, Birmingham, Alabama, United States

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Publications (151)569.19 Total impact

  • Sexually Transmitted Infections 05/2015; 91(Suppl 1):A97-A97. DOI:10.1136/sextrans-2015-052126.290 · 3.08 Impact Factor
  • Christina A Muzny, Jane R Schwebke
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    ABSTRACT: Biofilms are microbial communities of surface-attached cells embedded in a self-produced extracellular matrix. They are of major medical significance because they decrease susceptibility to antimicrobial agents and enhance the spread of antimicrobial resistance. Biofilm-associated bacterial and fungal micro-organisms have increasingly been recognized to play a role in multiple infectious diseases, particularly in their persistence and recurrence. More recently, biofilms have also been implicated in vaginal infections, notably bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC), particularly in the setting of treatment failure and recurrence. The purpose of this review is to discuss the impact of biofilms on the management and treatment of BV and recurrent VVC and highlight the need for additional research and development of novel therapeutics targeting pathogenic vaginal biofilms. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.
    Clinical Infectious Diseases 05/2015; DOI:10.1093/cid/civ353 · 9.42 Impact Factor
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    ABSTRACT: Background. Vaginal infections are common, frequently recur, and may increase women's risk for sexually transmitted infections (STIs). We tested the efficacy of a novel regimen to prevent recurrent vaginal infections. Methods. Human immunodeficiency virus (HIV)-negative women 18-45 years old with 1 or more vaginal infections, including bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), or Trichomonas vaginalis (TV), were randomly assigned to receive vaginal suppositories containing metronidazole 750 mg plus miconazole 200 mg or matching placebo for 5 consecutive nights each month for 12 months. Primary endpoints, evaluated every 2 months, were BV (Gram stain) and VVC (positive wet mount and culture). Results. Participants (N = 234) were randomly assigned to the intervention (N = 118) or placebo (N = 116) arm. Two hundred seventeen (93%) women completed an end-of-study evaluation. The intervention reduced the proportion of visits with BV compared to placebo (21.2% vs 32.5%; relative risk [RR] 0.65, 95% confidence interval [CI] .48-.87). In contrast, the proportion of visits with VVC was similar in the intervention (10.4%) versus placebo (11.3%) arms (RR 0.92, 95% CI .62-1.37). Conclusions. Monthly treatment with intravaginal metronidazole plus miconazole reduced the proportion of visits with BV during 12 months of follow-up. Further study will be important to determine whether this intervention can reduce women's risk of STIs.
    The Journal of Infectious Diseases 12/2014; 211(12). DOI:10.1093/infdis/jiu818 · 5.78 Impact Factor
  • Christina A Muzny, Jane R Schwebke
    Clinical Infectious Diseases 12/2014; DOI:10.1093/cid/ciu1132 · 9.42 Impact Factor
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    ABSTRACT: As part of a larger study using 454 pyrosequencing to investigate the vaginal microbiota of women with BV, we found an association between a novel BV-associated bacterium (BVAB1) and high Nugent scores and propose that BVAB1 is the curved Gram-negative rod traditionally identified as Mobiluncus spp. in vaginal Gram stains.
    Diagnostic Microbiology and Infectious Disease 09/2014; 80(4). DOI:10.1016/j.diagmicrobio.2014.09.008 · 2.57 Impact Factor
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    ABSTRACT: Background. Trichomonas vaginalis (TV) is the most common nonviral sexually transmitted infection (STI) in the world. However, TV is not a reportable STI and, with the exception of HIV-positive women, there are no guidelines for screening in women or men. The objective of this study was to determine the added value of nucleic acid amplification tests (NAATs) for detection of TV in men and women at high risk for infection as well as correlates of infection. Methods. This was a review of clinical and laboratory data of men and women presenting to the Jefferson County Department of Health Sexually Transmitted Diseases (STD) Clinic and receiving a TV NAAT. Results. During 2012-2013, 6335 patients (3821 women and 2514 men) received a TV NAAT on endocervical, urethral, or urine specimens. Overall TV prevalence was 20.2%; 27.0% in women and 9.8% in men. Correlates of TV among men included age >40 years, African American race, and >= 5 polymorphonuclear cells per high-power field on urethral Gram stain. Age >40 years, African American race, leukorrhea on wet mount, elevated vaginal pH, positive whiff test, and concurrent gonococcal infection were positively associated with TV among women. TV NAAT detected approximately one-third more infections among women than wet mount alone. Conclusions. TV prevalence among men and women was high in this study, suggesting that both groups should be routinely screened, including those aged >40 years. Improved detection of TV by routine implementation of NAATs should result in better control of this common, treatable STI.
    Clinical Infectious Diseases 06/2014; 59(6). DOI:10.1093/cid/ciu446 · 9.42 Impact Factor
  • J R Schwebke, C A Muzny, W E Josey
    The Journal of Infectious Diseases 05/2014; DOI:10.1093/infdis/jiu304 · 5.78 Impact Factor
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    ABSTRACT: The ESwab collection device was compared to the collection swab provided as part of the Affirm VPIII Microbial Identification Test kit for testing vaginal specimens with the Affirm test system. There was excellent agreement between the two sampling devices for Candida, Gardnerella and Trichomonas vaginalis.
    Journal of clinical microbiology 02/2014; 52(5). DOI:10.1128/JCM.00048-14 · 4.23 Impact Factor
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    ABSTRACT: Background. Bacterial vaginosis (BV) is the most common cause of vaginal discharge and is associated with important public health complications such as preterm birth and acquisition/transmission of HIV and sexually transmitted infections. Continued controversy concerning the pathogenesis of BV has led to a lack of progress in prevention and management of this infection.Methods. Development of a conceptual model for the pathogenesis of BV based on review of past and current research.Results. Our model suggests that BV is initiated by the sexual transmission of Gardnerella vaginalis (GV). GV possesses the appropriate virulence factors to adhere to host epithelium, create a biofilm community, and successfully compete with lactobacilli for dominance in the vaginal environment. It is possible that the genetic diversity of GV results in virulent and avirulent strains. Symbiotic relationships with normally dormant vaginal anaerobes lead to increases in the latter which contribute to the symptoms of BV.Conclusions. GV is the pathogen responsible for the initiation of BV. Future research should focus on prevention of GV transmission and improved therapeutics for the biofilm infection that is caused by GV and host anaerobes.
    The Journal of Infectious Diseases 02/2014; 210(3). DOI:10.1093/infdis/jiu089 · 5.78 Impact Factor
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    ABSTRACT: The contribution of sexual transmission to genital Candida infection remains unclear. This study sought to investigate whether sexual behaviours were associated with the presence of genital Candida species among a cohort of women who have sex with women (WSW) in addition to determining the genetic concordance of genital Candida spp. among WSW in sexual partnerships. WSW ≥18 years of age presenting to the Mississippi State Department of Health STD Clinic during 2009-2010 completed a sexual behaviour survey. Culture of vaginal fluid was performed for Candida spp. identification; associations with participant characteristics were determined using logistic regression analysis. Random amplified polymorphic DNA (RAPD) PCR was performed on DNA extracted from yeast cultures of WSW in sexual partnerships in which both partners had isolates of Candida spp. identified and among a set of age/sexual behaviour matched controls. RAPD genetic fingerprints were evaluated by hierarchical cluster analysis for concordance. Genital Candida spp. were isolated in 105/196 (53.6%) of women: 13/105 (12.4%) had symptomatic vulvovaginal candidiasis while 92/105 (87.6%) had asymptomatic vaginal colonisation. Bisexual identity, sex with women and men during the past 12 months and numbers of male sexual partners during the past 12 months were the only significant predictors of genital Candida spp. in bivariate analysis. 13 pairs of WSW in sexual partnerships in which both partners had genital Candida spp. and 11 WSW with genital Candida spp. not in sexual partnerships were identified. Candida spp. RAPD banding patterns were discordant for all isolates among WSW within partnerships and in controls. This study found no evidence supporting sexual transmission of genital Candida spp. between women.
    Sexually transmitted infections 01/2014; 90(2). DOI:10.1136/sextrans-2013-051361 · 3.08 Impact Factor
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    ABSTRACT: Trichomonas vaginalis is the most prevalent non-viral sexually transmitted infection worldwide and improved diagnostics are critical to controlling this pathogen. Diagnostic assays that can be used in conjunction with routine chlamydia/gonorrhea nucleic acid-based screening are likely to have the most impact on disease control. Here we describe the performance of the new BD TVQ(x) amplified DNA Assay (TVQ) that can be performed on the automated BD Viper System. We focus on data from vaginal swab samples since this is the specimen type routinely used for traditional trichomonas testing and the recommended specimen type for chlamydia/gonorrhea screening. Vaginal swabs were obtained from women attending STD or family planning clinics at 7 sites. A patient collected vaginal swab was tested by TVQ; APTIMA TV (ATV) testing was performed using a clinician obtained vaginal swab. Additional clinician obtained vaginal swabs were used for wet mount and culture. Analyses included comparison against the patient infection status (PIS), defined by either a wet mount or culture positive result; head-to-head comparisons assessed by κ-scores; and latent class analysis (LCA) as an unbiased estimator of test accuracy. Data from 838 women, 116 of whom were infected with TV, were analyzed. TVQ sensitivity and specificity estimates based on the PIS were 98.3% and 99.0%, respectively. TVQ performed similarly to ATV (κ=0.938) in head-to-head analysis. LCA estimated TVQ sensitivity and specificity at 98.3 and 99.6%, respectively. The TVQ assay performed well using self-obtained vaginal swabs, the optimal sample type as recommended by the CDC for chlamydia/gonorrhea screening among women.
    Journal of clinical microbiology 01/2014; 52(3). DOI:10.1128/JCM.02966-13 · 4.23 Impact Factor
  • Christina A Muzny, Jane R Schwebke
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    ABSTRACT: This report describes a case of suspected heterosexual transmission of bacterial vaginosis to a woman from a male partner who had undergone a radical prostatectomy. The most likely method of transmission in this case was through contact with infected desquamated epithelial cells from the male partner's distal urethra or coronal sulcus.
    Sexually transmitted diseases 01/2014; 41(1):58-60. DOI:10.1097/OLQ.0000000000000057 · 2.75 Impact Factor
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    ABSTRACT: The pathogenesis of bacterial vaginosis (BV) remains elusive. BV may be more common among women who have sex with women (WSW). The objective of this study was to use 454 pyrosequencing to investigate the vaginal microbiome of WSW, women who have sex with women and men (WSWM), and women who have sex with men (WSM) with BV to determine if there are differences in organism composition between groups that may inform new hypotheses regarding the pathogenesis of BV. Vaginal swab specimens from eligible women with BV at the Mississippi State Department of Health STD Clinic were used. After DNA extraction, 454 pyrosequencing of PCR-amplified 16S rRNA gene sequences was performed. Sequence data was classified using the Ribosomal Database Program classifer. Complete linkage clustering analysis was performed to compare bacterial community composition among samples. Differences in operational taxonomic units with an abundance of ≥2% between risk behavior groups were determined. Alpha and beta diversity were measured using Shannon's Index implemented in QIIME and Unifrac analysis, respectively. 33 WSW, 35 WSWM, and 44 WSM were included. The vaginal bacterial communities of all women clustered into four taxonomic groups with the dominant taxonomic group in each being Lactobacillus, Lachnospiraceae, Prevotella, and Sneathia. Regarding differences in organism composition between risk behavior groups, the abundance of Atopobium (relative ratio (RR)=0.24; 95%CI 0.11-0.54) and Parvimonas (RR=0.33; 95%CI 0.11-0.93) were significantly lower in WSW than WSM, the abundance of Prevotella was significantly higher in WSW than WSWM (RR=1.77; 95%CI 1.10-2.86), and the abundance of Atopobium (RR=0.41; 95%CI 0.18-0.88) was significantly lower in WSWM than WSM. Overall, WSM had the highest diversity of bacterial taxa. The microbiology of BV among women in different risk behavior groups is heterogeneous. WSM in this study had the highest diversity of bacterial taxa. Additional studies are needed to better understand these differences.
    PLoS ONE 12/2013; 8(11):e80254. DOI:10.1371/journal.pone.0080254 · 3.53 Impact Factor
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    ABSTRACT: Bacterial vaginosis (BV) is a common gynecologic diagnosis characterized by dysbiosis of the vaginal microbiota. It is often accompanied by vaginal symptoms such as odor and discharge, but can be asymptomatic. Despite over 50 years of research, the etiology of BV is not well understood, which is a major impediment to treatment and prevention of BV. http://www.microbiomejournal.com/content/pdf/2049-2618-1-29.pdf Here we report on the temporal dynamics of 25 vaginal communities over a 10 week period using samples collected daily from women who were diagnosed with symptomatic BV (15 women), asymptomatic BV (6 women), and women who did not have BV (4 women). This unique resource of samples and data will contribute to a better understanding of the role that the vaginal microbes have in the natural history of BV and lead to improved diagnosis and treatment.
    12/2013; 1(1):29. DOI:10.1186/2049-2618-1-29
  • Jane R Schwebke, Moira S Flynn, Charles A Rivers
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    ABSTRACT: To determine the prevalence of Gardnerella vaginalis in women with normal vaginal flora. Women without symptoms or signs of vaginal infection and five or fewer lifetime sexual partners were recruited for a longitudinal study of vaginal flora. Negative Amsel criteria and a Nugent score of 0-3 were required for enrolment. Vaginal specimens were self-collected daily for Gram stain and every 3 days for PCR for G vaginalis for 30 days. Women completed daily diaries recording sexual activity, symptoms and menses. Twenty women were recruited for the study with 19 completing all specimens and 1 lost to follow-up. During the 30-day study period, 13/19 (68.4%) of women had normal Nugent scores (0-3) whereas 6/19 (31.6%) of women had at least 2 days of Nugent scores in the intermediate range (p=0.09). Among the 19 women, 9 (47%) were negative for G vaginalis by PCR throughout the study period whereas 10 (53%) had at least one specimen that demonstrated the presence of G vaginalis by PCR. Of those women with intermediate flora on Gram stain during the course of the study 5/6 (83.3%) were positive for G vaginalis while 5/13 (38.5%) of those women with only normal Nugent scores were positive for G vaginalis. Thus, 61.5% of women with normal Nugent scores had no evidence of G vaginalis by serial PCR. Gardnerella may not be part of the normal flora in women with optimal vaginal health.
    Sexually transmitted infections 11/2013; 90(1). DOI:10.1136/sextrans-2013-051232 · 3.08 Impact Factor
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    ABSTRACT: Trichomonas vaginalis is the most prevalent nonviral sexually transmitted infection in the United States, affecting 3.1% of women of reproductive age. Infection is associated with HIV acquisition and pelvic inflammatory disease. In the United States, Centers for Disease Control and Prevention guidelines recommend testing all women with vaginal discharge for T. vaginalis, but except for HIV-infected women, there are no national guidelines for screening asymptomatic persons. The objective of this analysis is to assess testing and screening practices for T. vaginalis among symptomatic and asymptomatic women in the sexually transmitted disease (STD) clinic setting. We analyzed data on demographics, clinical presentation, and laboratory testing for all women visiting a clinician in 2010 to 2011 at any of 15 STD clinics participating in the STD Surveillance Network. Prevalence of laboratory-confirmed T. vaginalis infection was calculated among symptomatic women tested and among asymptomatic women screened. A total of 59,176 women visited STD clinicians: 39,979 were considered symptomatic and 19,197 were considered asymptomatic for T. vaginalis infection, whereas 211 were HIV-infected. Diagnostic practices varied by jurisdiction: 4.0% to 96.1% of women were tested or screened for T. vaginalis using any laboratory test. Among 17,952 symptomatic women tested, prevalence was 26.2%. Among 3909 asymptomatic women screened, prevalence was 6.5%. Among 92 HIV-infected women tested/screened, prevalence was 29.3%. Trichomoniasis is common among STD clinic patients. In this analysis, most STD clinics tested symptomatic women seeking care, in accordance with national guidelines. All HIV-infected women should be screened annually. Additional evidence and national guidance are needed regarding potential benefits of T. vaginalis screening in other asymptomatic women.
    Sexually transmitted diseases 11/2013; 40(11):865-869. DOI:10.1097/OLQ.0000000000000038 · 2.75 Impact Factor
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    ABSTRACT: The InPouch™ TV test is the gold standard for clinical culture for Trichomonas vaginalis screening. The current package insert recommends an examination period of three days. After review of 2,499 InPouch™ tests spanning 13 years, we observed that examination up to three days will only detect 82.8% (95%CI: 79.0%-86.2%) of positive specimens.
    Journal of clinical microbiology 09/2013; DOI:10.1128/JCM.02006-13 · 4.23 Impact Factor
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    ABSTRACT: Bacterial vaginosis (BV) is a frequent cause of vaginal discharge that may be more common among women reporting sex with women (WSW). The objective of this study was to determine the prevalence of BV and predictors of infection among a sample of African American WSW. African American WSW aged 18 years or older presenting to the Mississippi State Department of Health STD Clinic between 2009 and 2010 and reporting a history of sexual activity with a female partner during the preceding year were invited to participate. A survey on sexual history and sexual behavior characteristics was completed. Bacterial vaginosis was defined by Amsel criteria. Associations with participant characteristics were determined using logistic regression analysis. Bacterial vaginosis was diagnosed in 93 (47.4%) of 196 women. Bisexual identity (odds ratio [OR], 1.94; 95% confidence interval [CI], 1.03-3.66; P = 0.04), douching within the past 30 days (OR, 1.93; 95% CI, 1.09-3.43; P = 0.02), age 18 years or less at first sexual encounter with a female partner (OR, 3.18; 95% CI, 1.16-8.71; P = 0.02), and report of more than 1 lifetime male sexual partners (OR, 1.94; 95% CI, 1.01-3.74; P = 0.04) were significant predictors of BV in bivariate analysis. Bacterial vaginosis was less common among women who reported more than 1 lifetime female sexual partner (OR, 0.26; 95% CI, 0.09-0.76; P = 0.01). In multivariable analysis, age 18 years or less at first sex with a female partner approached significance, while report of 1 lifetime female sexual partner remained strongly associated with BV. Bacterial vaginosis was common in this sample of African American WSW and significantly associated with report of 1 lifetime female sexual partner.
    Sexually transmitted diseases 09/2013; 40(9):751-5. DOI:10.1097/OLQ.0000000000000004 · 2.75 Impact Factor
  • Jane R Schwebke, Shelly Y Lensing, Jack Sobel
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    ABSTRACT: Trichomonas vaginalis is the causative agent of the most common curable sexually transmitted disease in the world. The infection is treated with a single oral dose of metronidazole or tinidazole, currently the only licensed class of drugs available for this indication; however, both of these antimicrobials are associated with significant gastrointestinal adverse effects, and some individuals are unable to tolerate them because of these adverse effects. Randomized, dose-ranging pilot study conducted in 2 phases consisting of 20 participants in each phase. In the first phase, participants were randomized to the vaginal suppository (metronidazole 750 mg/miconazole nitrate 200 mg) twice a day for 7 days versus oral metronidazole 2 g single dose. In the second phase, participants randomized to suppository used it once a day for 7 days. Women were reevaluated on days 12 to 15 and 30 to 35. Treatment failures were defined as persistence of trichomonas by wet prep and/or culture. There were no significant differences in cure rates between the vaginal suppositories and oral metronidazole in either phase. The overall efficacy across both follow-up visits was 80% versus 90% for the suppository (2×/d) versus oral medication arms in phase 1 (P = 1.00) and 78% versus 70% for the suppository (1×/d) versus oral medication arms in phase 2 (P = 1.00). The results were also nonsignificant when combining results across arm (P = 1.00). High-dose intravaginal metronidazole combined with miconazole offers the possibility of a well-tolerated treatment that avoids the systemic adverse effects of nitroimidazoles for the treatment of trichomoniasis.
    Sexually transmitted diseases 09/2013; 40(9):710-4. DOI:10.1097/01.olq.0000431069.38601.d5 · 2.75 Impact Factor
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    ABSTRACT: A commercially available, non-amplified, nucleic-acid probe-based test system (BD Affirm(™) VP III) was compared with nucleic-acid amplification (NAA) based assays for determining the etiology of vaginitis in a cohort of 323 symptomatic women. Firstly, a semi-quantitative, multiplexed, PCR assay (BV-PCR) and the Affirm VP III G. vaginalis test were compared with a unified bacterial vaginosis (BV) reference standard incorporating both Nugent Gram-stain scores and Amsel clinical criteria. In the evaluable population of 305 patients, BV-PCR was 96.9% (191/197) sensitive and 92.6% specific (100/108) for BV, whilst Affirm VP III was 90.1% sensitive (179/197) and 67.6% specific (73/108). Secondly, a multiplexed, PCR assay detecting C. albicans and C. glabrata (CAN-PCR) was compared with the Affirm VP III Candida spp. test using a reference standard for vulvovaginal candidiasis (VVC) of yeast culture plus exclusion of alternate vaginitis etiologies. In the population evaluated (n=102), CAN-PCR was 97.7% sensitive (42/43) and 93.2% specific (55/59), and Affirm VP III 58.1% sensitive (25/43) and 100% specific (59/59) for VVC. Finally, the results of a commercial NAA test (GenProbe Aptima® Trichomonas vaginalis assay; ATV) for T. vaginalis were compared with the Affirm VP III T. vaginalis test. In the absence of an independent reference standard for trichomonal vaginitis (TV), a positive result in either assay was deemed to represent true infection. In the evaluable cohort of 388 patients, the sensitivity of ATV was 98.1% (53/54) versus 46.3% (25/54) for Affirm VP III. The diagnostic accuracy of the combined NAA-based test construct was approximately 20-25% higher than the Affirm VPIII when modeled in populations with varying prevalence of infectious vaginitis.
    Journal of clinical microbiology 08/2013; 51(11). DOI:10.1128/JCM.01537-13 · 4.23 Impact Factor

Publication Stats

3k Citations
569.19 Total Impact Points


  • 1995–2015
    • University of Alabama at Birmingham
      • • Division of Infectious Diseases
      • • Department of Medicine
      • • Department of Obstetrics and Gynecology
      Birmingham, Alabama, United States
  • 2001
    • Magee-Womens Hospital
      Pittsburgh, Pennsylvania, United States
  • 1990–1995
    • University of Washington Seattle
      • Department of Medicine
      Seattle, Washington, United States