Does Bacterial Vaginosis Contribute to Urinary Tract Infection?

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.