Vaginal and urethral Helicobacter pylori (H. pylori)

H pylori Helicobacter pylori bacteria

Helicobacter pylori (H. pylori) colonises the stomach and causes ulcers, gastritis, and sometimes stomach cancers, but it’s still unclear what the impact is on the vagina, or just how transmissible it is. It’s possible that it could be a cause of bacterial vaginosis​1​.

There is some evidence that H. pylori can colonise the mouth, and could be spread via oral sex to the genitals. H. pylori has been found in the vagina, nose, coronary (heart artery) plaque, the ears and the breast. It is a known cancer-causing microbe.

Is H. pylori transmitted via sexual contact?​1–4​

There is some evidence of a transmission between the mouth and genitals, and theoretical links. H. pylori colonises yeast in the vagina, and has been associated with biofilm formation. It could be a cause of bacterial vaginosis that resists treatment.

H. pylori is most commonly found in the stomach and upper gastrointestinal tract, being well adapted for colonising this very acidic environment. The vagina is also very acidic, which may allow it to act as a reservoir, allowing sexual transmission to a partner’s mouth.

H. pylori has been found to have a symbiotic relationship with Candida albicans (which causes yeast infections), as bacteria have been isolated from these yeasts, and genes specific to H. pylori have been found in yeast. This piggy-backing with yeast may allow H. pylori to colonise the vagina.

Studies trying to isolate H. pylori from the vagina

Early attempts to isolate H. pylori from the vagina did not produce results, but probable low concentrations of the bacteria may produce negative results. The tests used are designed for high bacterial counts in the gut, not for low bacteria counts in the vagina.

How does transmission of H. pylori work?

Studies have shown that in sexual partners with H. pylori, the non-infected partner has an increased risk of becoming infected. Spouses have been known to infect or re-infect partners, including with the same strain. Multiple strains may exist in one person.

Transmission could also occur during birth if H. pylori is in the vagina. Studies show that the incidence of H. pylori during pregnancy is about 20 per cent.

Why hasn’t an H. pylori species been found in the vagina during vaginal swab cultures?

Taking a sample from the vagina via a swab and then performing a culture is one of the ways doctors commonly test for sexually transmitted infections and vaginal infections.

The reason researchers may not have found H. pylori – despite the possibility that it exists in the vagina – is that H. pylori species are hard to culture.

This might be because the colonies are very small in the vagina, and that in the culture, competition from other bacteria may influence outcomes of culture.

The number of H. pylori in the stomach are three times more than in the mouth, so using stomach culturing techniques for oral H. pylori isn’t enough. Newer DNA sequencing methods can detect H. pylori.

Mouth-to-breast transmission of H. pylori​5,6​

A case involving oral contact with the nipple may have resulted in H. pylori entering the breast duct leading to fibrocystic breast changes in one person.

H. pylori was also found in the faeces of half of all breast-fed three-day-old babies whose mothers had documented H. pylori antibodies. H. pylori was found in four out of  66 milk samples from mothers.

Mouth-to-mouth and mouth-to-anus transmission of  H. pylori

H. pylori can be passed around families via shared objects and food that has come into contact with an infected mouth. This bacteria can also be passed on by coming into contact with vomit, faeces, dental plaque, gastric juices or saliva, with waterborne H. pylori also being a factor.

H. pylori infections tend to appear in clusters, such as in families. There is a link between oral infection and stomach infection, and any infection in the mouth can be easily passed on via wet kisses. Mouth-to-anus transmission of H. pylori is possible.

H. pylori and urethritis​7,8​

A link between urethritis and H. pylori has been suggested. It is possible for H. pylori to be transmitted to the urethra via oral sex from someone with an infected mouth. The bacteria could colonise, causing symptoms and disease. 

There are a large proportion of men with urethritis not caused by gonorrhoea where no other organisms can be found.

Oral and vaginal yeasts and how they harbour H. pylori

Oral yeasts were found more often in babies born vaginally, with the frequency of H. pylori genes in the vaginal yeasts of the mother significantly higher than in the mother’s oral yeasts.

A correlation was found between H. pylori genes in vaginal yeasts and oral H. pylori in babies. It is hypothesised that babies’ mouths could act as a reservoir for H. pylori.

Vaginal yeasts are far more accommodating to H. pylori than oral yeasts, so vaginal yeast is considered to be the primary reservoir of H. pylori, facilitating transmission to babies via vaginal delivery.

Treating H. pylori vaginal or urethral infections

H. pylori is can be difficult to treat even with antibiotics, so a combined approach with conventional treatments and herbal medicine or other support may be recommended.

References

  1. 1.
    Bleicher J, Stockdale CK. Association between recurrent bacterial vaginosis and Helicobacter pylori infection: a case report. Proc Obstet Gynecol. Published online September 9, 2015:1-6. doi:10.17077/2154-4751.1289
  2. 2.
    Dimitriadi D. Helicobacter pylori: a sexually transmitted bacterium? CEJU. Published online 2014. doi:10.5173/ceju.2014.04.art18
  3. 3.
    Eslick GD. Helicobacter pylori infection transmitted sexually via oral-genital contact: a hypothetical model. Sexually Transmitted Infections. Published online December 1, 2000:489-492. doi:10.1136/sti.76.6.489
  4. 4.
    Sgambato D, Visciola G, Ferrante E, et al. Prevalence of Helicobacter pylori infection in sexual partners of H. pylori‐infected subjects: Role of gastroesophageal reflux. UEG Journal. Published online December 2018:1470-1476. doi:10.1177/2050640618800628
  5. 5.
    Soltani J, Nikkhoo B, Khormehr J, Ataee P, Hakhamaneshi M, Gharibi F. Breastfeeding and Helicobacter pylori Infection in Early Childhood: a Continuing Dilemma. Iran J Pediatr. 2014;24(6):745-752. https://www.ncbi.nlm.nih.gov/pubmed/26019781
  6. 6.
    Kast RE. Some fibrocystic breast change may be caused by sexually transmitted H. pylori during oral nipple contact: Supporting literature and case report of resolution after gut H. pylori eradication treatment. Medical Hypotheses. Published online January 2007:1041-1046. doi:10.1016/j.mehy.2006.09.050
  7. 7.
    Eslick GD. Non-gonococcal urethritis, Helicobacter pylori infection and fellatio: a new ménage à trois? Microbiology. Published online March 1, 2004:520-522. doi:10.1099/mic.0.26945-0
  8. 8.
    Salmi IA. Helicobacter Pylori Induced Interstitial Cystitis. AJBSR. Published online February 8, 2021:535-537. doi:10.34297/ajbsr.2021.11.001690


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Jessica Lloyd - Vulvovaginal Specialist Naturopathic Practitioner, BHSc(N)

Jessica is a degree-qualified naturopath (BHSc) specialising in vulvovaginal health and disease, based in Melbourne, Australia.

Jessica is the owner and lead naturopath of My Vagina, and is a member of the:

  • International Society for the Study of Vulvovaginal Disease (ISSVD)
  • International Society for the Study of Women's Sexual Health (ISSWSH)
  • National Vulvodynia Association (NVA) Australia
  • New Zealand Vulvovaginal Society (ANZVS)
  • Australian Traditional Medicine Society (ATMS)
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