Gonorrhea: lactobacilli to the rescue?

Sexual infection

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

Created 05 May 2022

Updated 12 May 2022

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.

Sexually transmitted infections (STIs)

STIs are mainly transmitted through skin contact during vaginal, anal, or oral sex, but can also be transmitted from mother to child (pregnancy, childbirth, breastfeeding). STI carriers can be asymptomatic.
Among the bacteria, viruses and parasites known to be transmitted through sexual contact, eight are linked to the greatest incidence of sexually transmitted disease.

Four can be cured:

Syphilis
Gonorrhea
Chlamydia
Trichomoniasis

Four are incurable viral infections:

Hepatitis B
Herpes (herpes simplex virus or HSV)
HIV
Human papillomavirus (HPV)

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https://www.who.int/news-room/fact-sheets/detail/sexually-transmitted-infections-(stis)

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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).

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(sidenote:

https://www.who.int/news-room/fact-sheets/detail/multi-drug-resistant-gonorrhoea

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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.