Figure 1

Study design. (a) Diagram of geographic locations (black points in the map) of the 7 villages and the urban town (Puerto Ayacucho, indicated with a star) of the study. Pictures depict the town (top) and Piaroa communities with intermediate and low access to urban services (middle and bottom pictures, respectively). (b) Numbers of women recruited, urban stratification, sampling, and sample analyses. In traditional communities, permission by the captain (Chief) preceded individual consent. In the urban town there was a public invitation to participate. From 228 women, who received a gynecological evaluation, 111 agreed to participate and complied with the inclusion criteria. A total of 82 Amerindians and 29 mestizos were included in the study. Surveys to assess urbanization status and clinical conditions were applied. A gynecologist sampled vaginal introitus and cervicovaginal (endo/ectocervix/posterior fornix) sites, using sterile swabs; Papanicolaou smear was performed and vaginal pH was taken. Additionally, blood for HIV, hemoglobin, hepatitis diagnostic, and fecal samples for parasite detection were also collected for ancillary studies. DNA was extracted from swabs, and used for human papillomavirus (HPV) detection and amplification of the regions V1-V3 of the 16S rRNA gene, which was then sequenced with Illumina MiSeq.