{"id":1287,"date":"2017-04-28T14:56:53","date_gmt":"2017-04-28T13:56:53","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=1287"},"modified":"2017-04-28T14:56:53","modified_gmt":"2017-04-28T13:56:53","slug":"bacterial-vaginosis-associated-bacterium-gardnerella-may-after-all-have-a-role-in-the-aetiology-of-non-gonococcal-urethritis","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2017\/04\/28\/bacterial-vaginosis-associated-bacterium-gardnerella-may-after-all-have-a-role-in-the-aetiology-of-non-gonococcal-urethritis\/","title":{"rendered":"Bacterial vaginosis-associated bacterium (Gardnerella) may after all have a role in the aetiology of non-gonococcal urethritis"},"content":{"rendered":"

The question of the aetiology of \u2018non-gonococcal\u2019 or \u2018non-specific\u2019 urethritis (NGU\/NSU) has been a hot topic of debate in this journal and its predecessors since before 1951, when it was officially acknowledged in the Chief Medical Officer\u2019s report as an independent category of infection (Oriel (STI)<\/a>). More recently, a number of infectious agents have been recognized as potentially responsible (Hallen & Wallin (STIs)<\/a>; Moi & Moghaddam (STIs)<\/a>).\u00a0 But it would be misleading to suggest that, even today, the aetiological question has been altogether resolved.<\/p>\n

The controversial hypothesis that bacterial vaginosis (BV) associated bacteria (i.e. Gardnerella) might have a role \u2013 proposed in 2001 in an STI editorial by a former editor (Shamanesh (STIs)<\/a>) \u2013 seems to have raised its head once again in a recent animal-based study, Gilbert & Lewis<\/a> (G&A). Results from studies that have tested for the presence of these \u2013 amongst other \u2013 bacterial agents seem not to have been particularly favourable to the hypothesis (Manhart & Fredericks (STI)<\/a>; Froelund & Jensen (STIs)<\/a>).\u00a0 It must be borne in mind, however, that \u2018fastidious growth requirements make G. vaginalis<\/em> unrecoverable, or at least unidentifiable, under conditions most often used by clinical microbiology labs for the culture and identification of potential uropathogens\u2019 (G&A, p.11).<\/p>\n

G&A hypothesize G.<\/em> vaginalis<\/em> operates indirectly in the case of NSU by triggering the emergence of Escherichia coli<\/em> from reservoirs in the bladder of the pre-infected individual.\u00a0 In this way repeated sexual contact could, they suggest, lead to recurrent UTI infections by an infection that is not itself sexually transmitted.\u00a0 This theory of \u2018covert pathogenesis\u2019 is tested by exposing mice with latent E-coli infection \u2013 i.e. mice that had been transurethrally pre-infected but were now negative for bacteriuria \u2013 to repeated doses of G. vaginalis<\/em> or Lactobacillus crispatus<\/em>.\u00a0 It was found that double exposure to G.v. triggered E-coli bacteriuria while exposure to L.c.\u00a0 did not.\u00a0 Furthermore, G.v. exposed mice had neutrophilic infiltrates, confirming the presence of active UTI.\u00a0 In sacrificed mice, G.v. was also found to have induced bladder epithelial exfoliation and apoptosis in the bladder epithelium.<\/p>\n

The theory of covert pathogenesis is intriguing \u2013 not least because it overrides any hard-and-fast distinction been sexually-related and non-sexually-related UTIs.\u00a0 But, assuming it turns out to be correct, it also has practical implications.\u00a0 The conventional paradigm assumes that the pathogen present at time of clinical presentation is the main driver of disease. \u00a0Given the alarming rise of multi-drug resistant E-coli, the authors point to the potential benefit of preventing UTI and sequelae<\/em> (e.g. pyelonephritis) by targeting the organism that triggers the infection (i.e. G. vaginalis<\/em>) rather than the pathogen that causes the symptoms.<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

The question of the aetiology of \u2018non-gonococcal\u2019 or \u2018non-specific\u2019 urethritis (NGU\/NSU) has been a hot topic of debate in this journal and its predecessors since before 1951, when it was officially acknowledged in the Chief Medical Officer\u2019s report as an independent category of infection (Oriel (STI)). More recently, a number of infectious agents have been […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[16507,16496,16506,16505],"tags":[],"class_list":["post-1287","post","type-post","status-publish","format-standard","hentry","category-aetiology","category-bacterial-vaginosis","category-non-gonococcal-urethritis","category-non-specific-urethritis"],"yoast_head":"\nBacterial vaginosis-associated bacterium (Gardnerella) may after all have a role in the aetiology of non-gonococcal urethritis - Sexually Transmitted Infections<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/sti\/2017\/04\/28\/bacterial-vaginosis-associated-bacterium-gardnerella-may-after-all-have-a-role-in-the-aetiology-of-non-gonococcal-urethritis\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Bacterial vaginosis-associated bacterium (Gardnerella) may after all have a role in the aetiology of non-gonococcal urethritis - Sexually Transmitted Infections\" \/>\n<meta property=\"og:description\" content=\"The question of the aetiology of \u2018non-gonococcal\u2019 or \u2018non-specific\u2019 urethritis (NGU\/NSU) has been a hot topic of debate in this journal and its predecessors since before 1951, when it was officially acknowledged in the Chief Medical Officer\u2019s report as an independent category of infection (Oriel (STI)). 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