Gonorrhea: lactobacilli to the rescue?
When it comes to gonorrhea, not all women are equal. Some feel no symptoms, while others fully understand why this infection has such a bad reputation. This unfair difference may be linked to their vaginal microbiota.
About this article
Also known as “the clap” or “drip”, gonorrhea is a sexually transmitted infection (STI) that poses a public health problem for both sexes. In women, it can remain silent (more than 50% of women are asymptomatic) or show symptoms such as purulent discharge, lower abdominal pain or burning urination. The reasons for this difference are not known.
(sidenote: https://www.who.int/news-room/fact-sheets/detail/sexually-transmitted-infections-(stis) )
Neisseria gonorrhoeae to blame
Gonorrhea is caused by Neisseria gonorrhoeae, a very discreet bacterium which, according to one recent study, represents only 0.24% of the bacteria present in the vagina and cervix of infected women (it is obviously absent in uninfected women). The presence of other bacteria in the vagina of infected women varies according to the symptoms.
Upwards of 50% of lower genital tract infections in females are asymptomatic.
Gonorrhea: a question of lactobacilli?
In asymptomatic infected women lactobacilli dominate. These rod-shaped bacteria, well known to yogurt lovers, represent more than 92% of the bacteria found in the cervix and vagina of these women. This results in the correct acidification of the vagina, which is thought to keep other microorganisms at bay.
On the other hand, in symptomatic infected women, lactobacilli are depleted, accounting for less than a quarter of the bacteria present (21.2%). Instead of being dominated by these “good” bacteria, the microbiota shows significant diversity and heterogeneity in terms of the microorganisms present. This composition is generally not a good sign for the vaginal microbiota. Unlike the body’s other microbiota (gut, skin, etc.), the vaginal microbiota is healthy when lactobacilli dominate. Furthermore, the bacteria found in the vagina of symptomatic women are not to be desired, since they are frequently associated with bacterial vaginosis.
82.4 million new cases of gonorrhea were reported among 15-49 year olds worldwide (in 2020).
(sidenote: https://www.who.int/news-room/fact-sheets/detail/multi-drug-resistant-gonorrhoea )
Systematic condom use
This is only one short step from saying that lactobacilli protect women against the symptoms of gonorrhea, but for the moment this is a step too far. While we await studies on a larger number of women to confirm this finding, we can only continue to emphasize the importance of systematically using condoms. In 2016, an estimated 87 million new cases of gonorrhea were reported among 15-49 year olds worldwide, with cases increasing in many countries.