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Xpert Xpress MVP test
Cepheid 

Cepheid 

Équipe de rédaction

Lecture de 5 m

22 octobre 2026

LA SANTÉ COMMUNAUTAIRE ET MONDIALE

Article

From Targets to Treatment Decisions: Understanding the design of the Xpert® Xpress MVP test

When evaluating molecular tests for vaginitis, it is easy to focus on the number of organisms included in a multiplex panel. However, a more important question is: Which targets provide the most clinically meaningful information?

The purpose of molecular testing is to generate results that support accurate diagnosis and informed treatment decisions. For conditions such as bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and trichomoniasis, target selection plays a critical role in achieving that goal.

The goal of molecular testing is not simply organism detection. It is to provide clinically meaningful information that supports accurate diagnosis and appropriate treatment.. Tamara Ooms, Medical Science Liaison, Cepheid

Targets of the Xpert Xpress MVP test1

Targets of the Xpert Xpress MVP test graphic

Bacterial Vaginosis: Looking Beyond Single Organisms

BV is not caused by a single pathogen.2.3 Rather, it reflects a shift in the vaginal microbiome, where protective flora are displaced by communities of anaerobic bacteria.2.3 This creates a diagnostic challenge: identifying the organisms that best distinguish BV-associated dysbiosis from normal vaginal flora.

Research has shown that several anaerobic organisms, including Atopobium vaginae (Fannyhessea vaginae), BVAB-2, and Megasphaera type 1 (Megasphaera lornae), are strongly associated with BV and provide complementary diagnostic performance when evaluated together in molecular approaches.4-7 These markers have demonstrated utility for distinguishing BV-positive and BV-negative states, particularly when incorporated into multitarget molecular algorithms rather than interpreted as isolated organism callouts.4-7

By contrast, some organisms long associated with BV may have limited diagnostic value when considered alone. For example, Gardnerella vaginalis can be detected in up to 70% of patients who do not have BV4, limiting its specificity as a standalone marker.4.8 Target selection therefore involves more than choosing organisms linked to disease; it requires selecting markers that contribute to meaningful diagnostic discrimination.

 

The Challenge of Using “Healthy Flora” Markers

The vaginal microbiome varies considerably among healthy individuals.2.3 While Lactobacillus species are generally associated with vaginal health, the specific types and relative abundance of these organisms can differ across populations and vaginal microbiome community states.2.3

As a result, relying heavily on the absence or presence of specific Lactobacillus species may not always provide a consistent indicator of disease status. Target-selection strategies for molecular testing often place greater emphasis on organisms directly associated with BV-related dysbiosis and on quantitative or algorithmic patterns rather than solely measuring markers of healthy flora.5.7

Target selection focuses on markers that best distinguish BV-associated dysbiosis from non-BV states

Target selection focuses on markers that best distinguish BV-associated dysbiosis from non-BV states

Designing for Clinical Relevance in Candida Detection

Target selection also matters for vulvovaginal candidiasis.

While Candida albicans remains the most common cause of VVC,9 not all Candida species carry the same treatment implications.10 Some non-albicans species, including C. glabrata and C. krusei, are associated with reduced susceptibility to commonly used azole antifungals.9,10

For this reason, separating these organisms from the broader Candida group can provide clinically relevant information that may help guide treatment considerations. The goal is not merely to identify the presence of candida, but to distinguish findings that may influence patient management. 

Why is there a separate Candida glabrata/krusei callout? • Associated with reduced azole susceptibility9,10 • Different treatment considerations10 • Clinically meaningful distinction beyond simple candida detection

Emerging Bacterial Targets

Sneathia is an emerging area of scientific interest in bacterial vaginosis research, and ongoing work continues to improve our understanding of its role in the vaginal microbiome.11,12 However, the presence of a novel target does not, by itself, demonstrate improved clinical performance of one algorithm over another. When assessing methods for diagnosing vaginitis, the key question is not whether a test includes the newest biomarkers, but whether its diagnostic algorithm has been shown to accurately identify BV and support appropriate treatment decisions.

 

Clinical Utility Ultimately Matters Most

Scientific rationale is essential, but the ultimate test of a target selection strategy is whether it helps improve patient care. The right target set and algorithm should do more than identify organisms; it should provide clinically actionable information clinicians can use to make appropriate treatment decisions.

Clinical utility evidence for Xpert Xpress MVP supports this principle.13,14 In a randomized study comparing usual care with Xpert Xpress MVP testing at the point of care, molecular results increased the likelihood of appropriate treatment of vaginal infections, reduced unnecessary treatment when no pathogen was detected, and improved the diagnosis and management of mixed infections compared to usual care.14

These findings underscore why target selection matters: the most useful targets are those that deliver actionable information. A molecular test should help reduce uncertainty, support management of mixed infections, and guide treatment decisions in the same visit when possible.

In a randomized study of 276 women with vaginitis symptoms: Among women with BV, trichomoniasis, or vulvovaginal candidiasis, 89,6% of those tested with Xpert® Xpress MVP received appropriate treatment within 24 hours of their clinic visit compared to 51,9% with usual care.14

Le résultat final

At Cepheid, we believe that the most informative tests are designed around targets that help distinguish disease from non-disease, provide clinically relevant information, and support confident treatment decisions. In molecular diagnostics, selecting the right targets is essential to answering the clinical question at hand. 

 

 

About Xpert Xpress MVP

The Xpert Xpress MVP test is a multiplex PCR test intended to aid in the diagnosis of vaginal infections in patients with a clinical presentation consistent with bacterial vaginosis, vulvovaginal candidiasis, or trichomoniasis. Xpert Xpress MVP is available for lab use and in facilities operating under a CLIA certificate of waiver (CLIA waived) . Pour en savoir plus, cliquez ici.

IVD. In vitro diagnostic medical device. Non disponible dans tous les pays.

Le contenu présenté sur cette page est destiné à des fins informatives et éducatives. Bien qu’il soit disponible à l’échelle mondiale, il peut refléter des pratiques cliniques ou des enjeux en matière de système de santé propres à une région particulière.

 

Références

1.  Xpert Xpress MVP Instructions for Use. 302-6886, Rev. B 2025-07

2.  Srinivasan S, Fredricks DN. The human vaginal bacterial biota and bacterial vaginosis. Interdisciplinary Perspectives on Infectious Diseases. 2008;2008:750479. doi:10.1155/2008/750479.

3.  Srinivasan S, Hoffman NG, Morgan MT, Matsen FA, Fiedler TL, Hall RW, et al. Bacterial communities in women with bacterial vaginosis: high-resolution phylogenetic analyses reveal relationships of microbiota to clinical criteria. PLoS One. 2012;7(6):e37818. doi:10.1371/journal.pone.0037818.

4.  Fredricks DN, Fiedler TL, Thomas KK, Oakley BB, Marrazzo JM. Targeted PCR for detection of vaginal bacteria associated with bacterial vaginosis. Journal of Clinical Microbiology. 2007;45(10):3270-3276. doi:10.1128/JCM.01272-07.

5.  Cartwright CP, Lembke BD, Ramachandran K, Body BA, Nye MB, Rivers CA, Schwebke JR. Development and validation of a semiquantitative, multitarget PCR assay for diagnosis of bacterial vaginosis. Journal of Clinical Microbiology. 2012;50(7):2321-2329. doi:10.1128/JCM.00506-12.

6.  Hilbert DW, Smith WL, Chadwick SG, Toner G, Mordechai E, Adelson ME, et al. Development and validation of a highly accurate quantitative real-time PCR assay for diagnosis of bacterial vaginosis. Journal of Clinical Microbiology. 2016;54(4):1017-1024. doi:10.1128/JCM.03104-15.

7.  Shipitsyna E, Roos A, Datcu R, Hallen A, Fredlund H, Jensen JS, et al. Composition of the vaginal microbiota in women of reproductive age: sensitive and specific molecular diagnosis of bacterial vaginosis is possible? PLoS One. 2013;8(4):e60670. doi:10.1371/journal.pone.0060670.

8.  Fredricks DN, Fiedler TL, Marrazzo JM. Molecular identification of bacteria associated with bacterial vaginosis. New England Journal of Medicine. 2005;353:1899-1911. doi:10.1056/NEJMoa043802.

9.  Centers for Disease Control and Prevention. Sexually Transmitted Infections Treatment Guidelines, 2021: Vulvovaginal Candidiasis. 2021. https://www.cdc.gov/std/treatment-guidelines/candidiasis.htm Accessed Sept 2026

10.  Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Clinical practice guideline for the management of candidiasis: Mise à jour de 2016 de la Infectious Diseases Society of America. Clinical Infectious Diseases. 2016;62(4):e1-e50. doi:10.1093/cid/civ933.

11.  Theis KR, Florova V, Romero R, Borisov AB, Winters AD, Galaz J, Gomez-Lopez N. Sneathia: an emerging pathogen in female reproductive disease and adverse perinatal outcomes. Critical Reviews in Microbiology. 2021;47(4):517-542. doi:10.1080/1040841X.2021.1905606.

12.  Panzer JJ, McGinnis N, Blom J, Winters AD, Sobel JD, Theis KR. Draft genomes of three Sneathia vaginalis isolates from a patient with bacterial vaginosis. Microbiology Resource Announcements. 2025;14(3). doi:10.1128/mra.00941-24.

13.  Lillis RA, et al. Clinical Evaluation of a New Molecular Test for the Detection of Organisms Causing Vaginitis and Vaginosis. J Clin Microbiol. 2023 Mar 23;61(3):e0174822. doi: 10.1128/jcm.01748-22. Epub 2023 Feb 28. PMID : 36853028; PMCID : PMC10035313.

14.  Hillier SL, et al. Randomized study of usual care vs Xpert Xpress MVP at the point of care for accurate diagnosis and appropriate treatment of vaginal infections. Sex Transm Dis. 2026 Sep 1;53(9):589-595. doi: 10.1097/OLQ.0000000000002343. Publication électronique le 2026 mai 12. PMID : 42117698; PMCID : PMC13440600. https://pubmed.ncbi.nlm.nih.gov/42117698/ Accessed Sept 2026

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