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Lupus and Bacterial Vaginosis: Is There a Connection?

Medically reviewed by Florentina Negoi, M.D.
Written by Bora Lee, Ph.D.
Posted on July 14, 2023

Living with systemic lupus erythematosus (SLE) typically means managing chronic inflammation that can cause joint pain and skin issues — but some people develop less common symptoms as well, which can be unexpected and jarring. One MyLupusTeam member asked, “I recently got diagnosed with lupus and ever since, I’ve noticed a white, lightly scented discharge from my vagina. Am I the only one experiencing this?”

No, they’re not alone — another member replied, “I’ve noticed this as well.”

If you’ve experienced vaginal symptoms since being diagnosed with lupus, read on to see whether there may be a connection.

Lupus and Infections

One of the most common complications of SLE is susceptibility to infection. In fact, one review of people with SLE found that about 36 percent of participants who were on immunosuppressive therapy developed infections during the 10-year study period. The findings were published in the journal Medicine.

While the most common infection sites in people with lupus are the respiratory system, bloodstream, skin, and urinary system, some people with SLE develop bacterial infections of the vagina, known as bacterial vaginosis. As with other infections, lupus may be a factor that makes you more susceptible to vaginal infections.

What Causes Infections?

Infections are caused by the invasion and growth of microbes, such as bacteria, fungi, and viruses. When disease-causing microbes known as pathogens invade the body, the immune system becomes activated to fight them. Some infections are caused by foreign microbes, and other infections can be caused by pathogens that live on or in the body.

Many microbes are naturally present on the body’s surfaces, including the skin, gut, linings of organs, and vaginal tract. The collection of these microbes is known as the microbiome. Microbiomes play an important role in maintaining health by allowing a wide range of types of microbes to exist together in a balance without causing harm. When this balance is disturbed, an overgrowth of pathogens can lead to infections.

What Puts People With Lupus at Higher Risk?

The risk of developing infections, in general, is much higher in people with lupus. One study found that people with SLE, the most common type of lupus, develop infections two to six times more often than those who don’t have the condition.

People with SLE are at a higher risk of developing infections for two main reasons:

  • As an autoimmune disease, lupus causes an abnormal immune response.
  • Medications that treat SLE dampen the immune system’s ability to protect against infections.

Multiple components of the immune system, including the production of cytokines and autoantibodies (infection-fighting proteins), are impaired in people with SLE, leaving them unable to fight off pathogens effectively. Also, SLE is often treated with strong immunosuppressive drugs, such as corticosteroids (prednisone) and cyclophosphamide (Cytoxan).

Immunosuppressants diminish the immune system’s activity that defeats pathogens, which makes infections more likely. “I’ve noticed bacterial vaginosis occurs frequently since starting my medicine,” one MyLupusTeam member noted.

In addition, researchers have found that the microbiomes in the gut, skin, and mouths of people with lupus differ from those of other individuals. In general, the microbiomes of people with SLE show fewer numbers of certain types of bacteria compared with the general population.

Researchers also have found that differences in the microbiome in people with lupus reflect the disease activity — more severe symptoms and flares occur when certain types of bacteria, such as Staphylococcus aureus, are present at high levels.

What Is Bacterial Vaginosis?

Bacterial vaginosis is a common vaginal infection caused by an overgrowth of certain types of bacteria. In bacterial vaginosis, there is an imbalance between the “good” and “bad” bacteria that are normally present in the vagina. Lactobacillus, which is considered a good type of bacteria, is plentiful in healthy vaginas and prevents pathogenic bacteria from overgrowing.

When a shift in the balance between Lactobacillus and other types of bacteria results in an overabundance of pathogenic bacteria, vaginal infections can result. Bacterial vaginosis occurs more commonly during the childbearing years (ages 15 to 44). Although the cause of bacterial vaginosis remains unclear, risk factors include:

  • Having a new sex partner or multiple partners
  • Douching
  • Having naturally low numbers of Lactobacillus in the vagina

The main symptoms of bacterial vaginosis include:

  • Off-white or gray vaginal discharge
  • Discharge that smells like fish
  • Vaginal itching
  • A burning feeling when urinating

The symptoms of bacterial vaginosis are similar to those of other vaginal infections, such as yeast infections. If you are experiencing these types of vaginal symptoms, see your health care provider to be tested and get the proper treatment for the condition you have. In most cases, bacterial vaginosis can be treated with antibiotics.

If left untreated, bacterial vaginosis can lead to complications, including:

  • Greater risk of sexually transmitted infections, such as HIV, herpes simplex virus, chlamydia, and gonorrhea
  • Pelvic inflammatory disease, which can increase the risk of infertility
  • Pregnancy complications leading to premature birth or low birth weight

Bacterial Vaginosis vs. Vaginal Yeast Infection

Yeast infections in the mouth (oral thrush) and vagina (vaginal candidiasis), which are caused by an overgrowth of a Candida fungus, are also common in people with lupus. Vaginal yeast infections produce symptoms similar to those of bacterial vaginosis, including:

  • Vaginal discharge that looks like cottage cheese
  • Itching or burning feeling in the vagina and vulva
  • Swelling and redness of the vagina and vulva
  • A burning feeling when peeing

However, vaginal discharge from a yeast infection is usually odorless, while discharge from bacterial vaginosis often has a strong fishy smell.

Are People With Lupus More Likely To Get Bacterial Vaginosis?

Researchers are still figuring out if having lupus makes a person more likely to get bacterial vaginosis, but a small 2023 study suggests a link.

The study authors found that the vaginal microbiome in 30 people with SLE was clearly different from 30 people of a similar age and body mass index who didn’t have the condition. Compared to the other participants, those with SLE had a significantly lower number of Lactobacillus, the bacteria shown to maintain vaginal health. Also, the numbers of Streptococcus and Escherichia-Shigella — pathogenic bacteria shown to cause vaginitis, urinary tract infections, and other vaginal infections — were higher in people with SLE.

The reduced volume of Lactobacillus in the vaginal microbiome of people with SLE suggests a greater likelihood to develop infections such as bacterial vaginosis. However, more research is needed to confirm a connection.

Ask Your Doctor About Treatment for Bacterial Vaginosis

A faulty immune system, use of strong immunosuppressants, and the resulting change in the vaginal microbiome’s balance appear to put people with lupus at a greater risk of bacterial vaginosis. If you have lupus and notice symptoms of bacterial vaginosis, contact your health care provider. They can review your medical history and discuss treatment options to help you manage both conditions and feel your best.

Talk With Others Who Understand

MyLupusTeam is the social network for people with lupus and their loved ones. On MyLupusTeam, more than 223,000 members come together to ask questions, give advice, and share their stories with others who understand life with lupus.

Do you have lupus and are experiencing bacterial vaginosis? Have you and your doctor discussed a connection between the two conditions? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. Lupus — Mayo Clinic
  2. The Risk of Infections in Adult Patients With Systemic Lupus Erythematosus: Systematic Review and Meta-Analysis — Rheumatology
  3. Morbidity and Mortality in Systemic Lupus Erythematosus During a 10-Year Period: A Comparison of Early and Late Manifestations in a Cohort of 1,000 Patients — Medicine
  4. Triggers of Autoimmunity: The Role of Bacterial Infections in the Extracellular Exposure of Lupus Nuclear Autoantigens — Frontiers in Immunology
  5. Bacterial Vaginosis — Office on Women’s Health
  6. What You Need To Know About Infectious Disease: How Infection Works — National Academy of Sciences
  7. Immune Response — MedlinePlus
  8. Microbiome — National Institute of Environmental Health Sciences
  9. Microbiota in Health and Diseases — Signal Transduction and Targeted Therapy
  10. Finding a Balance in the Vaginal Microbiome: How Do We Treat and Prevent the Occurrence of Bacterial Vaginosis? — Antibiotics
  11. Lactobacillus iners: Friend or Foe? — Trends in Microbiology
  12. Vaginal Microbiota and the Potential of Lactobacillus Derivatives in Maintaining Vaginal Health — Microbial Cell Factories
  13. The Female Vaginal Microbiome in Health and Bacterial Vaginosis — Frontiers in Cellular and Infection Microbiology
  14. Bacterial Vaginosis — Mayo Clinic
  15. Invasive Fungal Infection as the Initial Presentation of Systemic Lupus Erythematosus — Journal of Antimicrobial Agents
  16. Vaginal Yeast Infection — Cleveland Clinic
  17. Alterations of the Fecal and Vaginal Microbiomes in Patients With Systemic Lupus Erythematosus and Their Associations With Immunological Profiles — Frontiers in Immunology
  18. Group A Streptococcal Vaginitis: An Unrecognized Cause of Vaginal Symptoms in Adult Women — Archives of Gynecology and Obstetrics
  19. Invasion of Vaginal Epithelial Cells by Uropathogenic Escherichia coli — Nature Communications
  20. Dilemma of Immunosuppression and Infection Risk in Systemic Lupus Erythematosus — Rheumatology
  21. Bacterial Infections in Lupus: Roles in Promoting Immune Activation and in Pathogenesis of the Disease — Journal of Translational Autoimmunity
    Posted on July 14, 2023
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    Florentina Negoi, M.D. attended the Carol Davila University of Medicine and Pharmacy in Bucharest, Romania, and is currently enrolled in a rheumatology training program at St. Mary Clinical Hospital. Learn more about her here
    Bora Lee, Ph.D. has more than 10 years of translational research experience in reproductive medicine and women’s health, with a focus on fertility and placental health. Learn more about her here

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