How to test your intimate microbiome

If you are suffering from recurring or chronic infections, or discomfort, you might be interested to dive a bit deeper to better understand the composition of your microbiome. There are a range of testing methods out there which differ in price, speed and depth of results.  Here I will go through some of the most popular methods available today. There is a simple comparison table at the end of this article.

 

If you think you have an active infection, you should start by contacting your doctor or other healthcare professional (e.g., GP, nurse, specialist, pharmacist). They will ask about your symptoms and medical history. This may be enough for them to diagnose an infection, but they may also offer further lab-based testing. If they are unsure if it is a UTI, or you have suffered from multiple infections, they may take a urine or vaginal sample depending on the type of infection they suspect to see what bacteria you have in your sample and what antibiotic is likely going to work. To grow microbes from the sample in a lab is often referred to culturing. There are two types of culturing that are generally done in a diagnostic lab. A standard culture should be covered by the NHS, and it will take a few days to receive the results. Annoyingly, you will have often started taking the antibiotics before you receive the results.

 

As the name suggests, this is what is done as standard in most healthcare settings and labs. This involves putting a small amount of the urine sample on a type of agar (with nutrients/food for the microbes) and see what pathogens grow. Antibiotics can also be added, to check if the prescribed antibiotics kill the pathogens on the plate. If they have developed resistance, your doctor will contact you to prescribe a different antibiotic.

This method is generally quite successful at detecting common bacteria that grow in “normal” conditions, i.e. in 37°C air. However, microbes that like to grow in different conditions for example don’t like oxygen, need different nutrients, or may need longer to grow. These can be i) underestimated, or ii) missed with this method. Standard culturing gives you a quick, and cheap insight of microbes present and is often used by the NHS, however it does not offer the most sensitive and accurate testing. Always ask for a culture if you see your healthcare provider, as this should be covered under the NHS and some information is better than none.

 

This is similar to standard culture but tries to get past the limit of only detecting specific microbes by using a selection of different nutrients /food and allowing them to grow for longer. This test aims to pick up more microbes in your sample and therefore might give you a better understanding what the cause is of your infection. These extended cultures are often not covered, so you will have to pay for them privately and results will take longer to come back.

Focus Labs offers this service with urine testing only or adding a swab for penile or vaginal swab testing.

There are simple at-home tests that you can do if you suspect you may have an infection. These tend to be cheap and quick, but are not always the most accurate, often missing infections. You may also need to visit a doctor or pharmacist to confirm the infection and to receive treatment. Test Strips are thin strips that contain various chemicals that can change colour when there are various substances present in a sample, e.g., white blood cells, nitrites or specific microbes. Some common examples are:

• dipsticks can indicate a UTI
• Candida strips detect thrush in vaginal discharge
• pH strips to check if vaginal or urine pH is normal (around 4 – 4.5 is a healthy vaginal pH, anywhere from 4.5 – 8 is normal for urine)

Microbiome Test Kits are available if you have recurrent or lingering infections that are not responding to your treatment, or if you are simply curious about your microbiota. Urine and vaginal kits are available from many different companies. You receive a kit in the post containing sampling supplies and instructions. Simply collect a sample (either a small amount of urine or a vaginal swab), fill out your details, and send the sample/s back to the company. They will use biochemical techniques, like PCR, to detect the DNA of microbes that are present. Because the organisms do not need to be alive (DNA can be retrieved from dead microbes) this is a great method to find organisms that are difficult to culture, like anaerobes to give you are more precise overview.

The downsides of these tests are that they are often very expensive, and it usually takes around two weeks for the results to get back. As the microbiome often changes depending on diet, hygiene, hormone levels, medication, sexual intercourse, etc. it is worth mentioning that the results will be outdated once you receive them, so might not reflect the state of your microbiome anymore. The data is also only as good as the quality of the kit, the sampling, the preservation of the sample during transit, the analysis etc. and can vary between providers. Some kits can be used for medical diagnosis and some only for educational insights.