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Does Bacterial Vaginosis Contribute to Urinary Tract Infection?

  • Female Genital Tract Infections (jd Sobel, Section Editor)
  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Antibiotic-sparing therapies to treat and prevent urinary tract infections (UTIs) are needed. Interest surrounds the question of whether bacterial vaginosis (BV) enhances susceptibility to urinary tract infections (UTIs) in women, and, whether, by extension, the vaginal microbiota could serve as a therapeutic target for UTI prevention. In this review, we outline research on the relationship between BV and the vaginal microbiota, associations between BV and UTI risk, plausible mechanisms, future directions, and finally clinical take home messages for providers.

Recent Findings

An optimal vaginal microbiota is dominated by protective Lactobacillus spp. BV represents a disorder of the vaginal microbiota marked by decreased lactobacilli and increases in a variety of anaerobic bacteria. Limited epidemiologic data link BV to an increased risk of UTI, whereas vaginal lactobacilli may be protective against UTI. Multiple plausible mechanisms, mainly involving the ability of lactobacilli to inhibit uropathogens’ growth, adhesion, and virulence factors, may explain associations between BV, the vaginal microbiota, and UTIs. However, substantial research gaps remain.

Summary

Currently there are insufficient data to support treatment of BV (e.g., via antibiotics or live biotherapeutic drugs) to prevent UTI. However, additional research into the role of BV in UTI pathogenesis is warranted. Ultimately, this may lead to new treatment strategies to improve women’s urogenital health.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Victoria L. Handa

  2. Institute for Genome Sciences, Department of Immunology and Microbiology, University of Maryland, Baltimore, USA

    Rebecca M. Brotman & Jacques Ravel

  3. Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, MFL Center Tower, 5200 Eastern AveSuite 381, Baltimore, MD, 21224, USA

    Susan Tuddenham

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  1. Victoria L. Handa
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  2. Rebecca M. Brotman
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  3. Jacques Ravel
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  4. Susan Tuddenham
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Corresponding author

Correspondence to Susan Tuddenham.

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Conflict of Interest

JR is co-founder of LUCA Biologics, a biotechnology company focusing on translating microbiome research into live biotherapeutics drugs for women’s health. ST has been a consultant for Biofire Diagnostics, Roche Molecular Diagnostics, and LUCA Biologics; receives royalties from UPTODATE; and has received speaker honoraria from Roche Molecular Diagnostics and Medscape/WebMD. ST, RB, and VH participate in research supported by NIH grant RO1DK130856 (PI: Handa).

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Highlights/Key Take Home Points

1. Limited data suggest that BV may plausibly increase susceptibility to UTI or rUTI in women, and that conversely a Lactobacillus-dominated vaginal microbiota may be protective against these infections.

2. However, currently, there is little that clinicians can offer to patients to modify the association between BV, the vaginal microbiome, and UTIs.

• There is no evidence to support antibiotic treatment of BV for the purpose of reducing UTI.

• As per guidelines, eligible postmenopausal women may be offered VET—it is hypothesized (but not certain) that benefits of this therapy may be mediated in part through the vaginal microbiota.

• There is currently insufficient evidence to support recommendations for either oral or intravaginal live biotherapeutics (i.e., probiotics) to prevent rUTI.

3. Additional research into the role of BV and the vaginal microbiota in UTI pathogenesis is warranted and may, in the long run, lead to new treatments to prevent UTIs and improve women’s urogenital health.

This article is part of the Topical Collection on Female Genital Tract Infections

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Handa, V.L., Brotman, R.M., Ravel, J. et al. Does Bacterial Vaginosis Contribute to Urinary Tract Infection?. Curr Infect Dis Rep 25, 17–27 (2023). https://doi.org/10.1007/s11908-022-00795-0

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  • DOI: https://doi.org/10.1007/s11908-022-00795-0

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