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Positive effects of local therapy with a vaginal lactic acid gel on dysuria and E.coli bacteriuria question our current views on recurrent cystitis

Archives of Gynecology and Obstetrics volume 285, pages 1619–1625 (2012)Cite this article

Abstract

Objective

We tested the effect of vaginally applied lactic acid gel on symptoms and bacteriuria in acutely exacerbated recurrent Eschericia coli cystitis.

Methods

Carnoy fixed samples of the morning urine from 20 women with a history of recurrent E.coli cystitis were prospectively investigated for bacteriuria using fluorescence in situ hybridization (FISH).

Results

In 11/20 women with acute cystitis, the symptoms and bacteriuria were regressive with lactic acid gel treatment, without the need for antibiotic treatment. The complete regression of symptoms took between 1 week (7 women) and 4 weeks (4 women). In parallel with this regression, the microscopic shape of E.coli bacteria in these women changed from short rods to long curly filaments starting within the first days of therapy. The filamentous transformation affected 100% of the E.coli population in six women and at least 50% of E.coli population in five women and was not observed in urine samples from untreated women or in women without clinical response to lactic acid gel. This could not happen if the bladder was the origin of the infection.

Conclusions

A number of recurrent and probably acute cystitis is a local vagino-urethritis caused by an adhesive invasive E.coli biofilm of the vaginal surface.

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Abbreviations

FISH:

Fluorescence in situ hybridization

Cy3, FITC, Cy5, DAPI:

Different fluorescent dyes corresponding to orange, green, dark red, and blue colors

ECO1167:

Eschericia coli

Eub338:

Eubacteria (virtually all bacteria)

BV:

Bacterial vaginosis

Carnoy solution:

A fixative with composition of 6/6/1 vol. ethanol/glacial acetic acid/chloroform

References

  1. Donlan RM, Costerton JW (2002) Biofilms: survival mechanisms of clinically relevant microorganisms. Clin Microbiol Rev 15(2):167–193

    PubMed  Article  CAS  Google Scholar 

  2. Cos P, Toté K, Horemans T, Maes L (2010) Biofilms: an extra hurdle for effective antimicrobial therapy. Curr Pharm Des 16(20):2279–2295

    PubMed  Article  CAS  Google Scholar 

  3. Patterson JL, Girerd PH, Karjane NW, Jefferson KK (2007) Effect of biofilm phenotype on resistance of Gardnerella vaginalis to hydrogen peroxide and lactic acid. Am J Obstet Gynecol 197(2):170.e1–170.e7

    Article  Google Scholar 

  4. Swidsinski A, Mendling W, Loening-Baucke V, Ladhoff A, Swidsinski S, Hale LP et al (2005) Adherent biofilms in bacterial vaginosis. Obstet Gynecol 106:1013–1023

    PubMed  Article  Google Scholar 

  5. Neef A, Amann R, Schleifer K-H (1995) Detection of microbial cells in aerosols using nucleic acid probes. Syst Appl Microbiol 18:113–122

    Article  CAS  Google Scholar 

  6. Swidsinski A (2006) Standards for bacterial identification by fluorescence in situ hybridization within eukaryotic tissue using ribosoma rRNA-based probes. Inflamm Bowel Dis 12:824–826

    PubMed  Article  Google Scholar 

  7. Piette A, Fraipont C, Den Blaauwen T, Aarsman ME, Pastoret S, Nguyen-Distèche M (2004) Structural determinants required to target penicillin-binding protein 3 to the septum of Escherichia coli. J Bacteriol 186:6110–6117

    PubMed  Article  CAS  Google Scholar 

  8. Schaeffer AJ, Jones JM, Dunn JK (1981) Association of in vitro Escherichia coli adherence to vaginal and buccal epithelial cells with susceptibility of women to recurrent urinary-tract infections. N Engl J Med 304:1062–1066

    PubMed  Article  CAS  Google Scholar 

  9. Mildner M, Stichenwirth M, Abtin A, Eckhart L, Sam C, Gläser R, Schröder JM, Gmeiner R, Mlitz V, Pammer J, Geusau A, Tschachler E (2010) Psoriasin (S100A7) is a major Escherichia coli-cidal factor of the female genital tract. Mucosal Immunol 3:602–609

    Google Scholar 

  10. Kmet V, Lucchini F (1997) Aggregation-promoting factor in human vaginal Lactobacillus strains. FEMS Immunol Med Microbiol 19:111–114

    PubMed  Article  CAS  Google Scholar 

  11. Pascual L, Ruiz F, Giordano W, Barberis IL (2010) Vaginal colonization and activity of the probiotic bacterium Lactobacillus fermentum L23 in a murine model of vaginal tract infection. J Med Microbiol 59:360–364

    PubMed  Article  Google Scholar 

  12. Justice SS, Hunstad DA, Seed PC, Hultgren SJ (2006) Filamentation by Escherichia coli subverts innate defenses during urinary tract infection. Proc Natl Acad Sci USA 103:19884–19889

    PubMed  Article  CAS  Google Scholar 

  13. Finer G, Landau D (2004) Pathogenesis of urinary tract infections with normal female anatomy. Lancet Infect Dis 4:631–635

    PubMed  Article  Google Scholar 

  14. Smith PJ, Roberts JB, Ball AJ (1982) “Honeymoon” cystitis: a simple surgical cure. Br J Urol 54:708–710

    PubMed  Article  CAS  Google Scholar 

  15. Pinggera GM, Feuchtner G, Frauscher F, Rehder P, Strasser H, Bartsch G, Herwig R (2005) Effects of local estrogen therapy on recurrent urinary tract infections in young females under oral contraceptives. Eur Urol 47:243–249

    PubMed  Article  CAS  Google Scholar 

Download references

Acknowledgments

The study was funded by: University Funding (Charite Hospital, Berlin University), BMBF (Bundesministerium für Bildung und Forschung) network “Resistance and Susceptibility to Intestinal Infections—an Integrated Network to Study the Interaction between Microbial and Host Factors”. We thank Concile GmbH, Freiburg, Germany for the donation of Relactagel® (KoRa Healthcare, Swords, Co. Dublin, Ireland).

Conflict of interest

We declare that we have no conflict of interest.

Author information

Affiliations

  1. Polymicrobial Infections and Bacterial Biofilms, Laboratory for Molecular Genetics, CCM, Charité Hospital, Charité Universitätsmedizin Berlin, Campus Mitte, 10098, Berlin, Germany

    Alexander Swidsinski & Vera Loening-Baucke

  2. Department of Medicine, Gastroenterology, Universitätsmedizin Berlin, 10117, Berlin, Germany

    Alexander Swidsinski & Vera Loening-Baucke

  3. Vivantes Kliniken für Gynaekologie und Obstetrics am Urban and im Friedrichshain, Dieffenbachstraße 1, 10967, Berlin, Germany

    Werner Mendling

  4. Department of Microbiology, Vivantes Hospital, Neukölln, 12351, Berlin, Germany

    Sonja Swidsinski

Authors
  1. Alexander Swidsinski
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  2. Vera Loening-Baucke
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  3. Werner Mendling
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  4. Sonja Swidsinski
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Corresponding author

Correspondence to Alexander Swidsinski.

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Swidsinski, A., Loening-Baucke, V., Mendling, W. et al. Positive effects of local therapy with a vaginal lactic acid gel on dysuria and E.coli bacteriuria question our current views on recurrent cystitis. Arch Gynecol Obstet 285, 1619–1625 (2012). https://doi.org/10.1007/s00404-011-2196-z

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  • DOI: https://doi.org/10.1007/s00404-011-2196-z

Keywords

  • Repeat E.coli related cystitis
  • Bladder infections
  • Vaginal biofilms