Vaginal discharge and UTI frequently come hand in hand but not for the reasons you might think. UTI is an infection that affects bladder but misbalanced vaginal flora could predispose you to contract a UTI.
It appears vaginal health is a critical factor in predicting your chances to get sick with a UTI. If you have vaginal discharge caused by bacterial vaginosis (BV) or yeast infection, you might be heading for a UTI as well.
Another way vaginal discharge and UTI are connected goes back to the effect that antibiotics have on our body. When you take antibiotics for your UTI and notice a change in your vaginal health, this might predispose you to new UTIs afterward.
#1 Healthy vagina could prevent UTI
Research shows that vaginal health plays a key role in UTIs in women. (Czaja, 2009). We now know that the vagina can be a source of the bugs that cause UTIs and can also be a target for preventing UTIs. This is because the vagina contains naturally occurring bacteria that prevent UTIs and keep the vagina healthy.
Research shows that losing good vaginal bacteria increases our risk for UTIs (Czaja, 2009).
There are also several other factors that increase a woman’s risk for poor vaginal health such as:
- Low vaginal estrogen after menopause
- Some contraceptives.
If you noticed changes to your normal vaginal discharge, it’s important to understand what caused it and get treated since not only it could be indicative of an STD, BV or yeast infection but also make you more susceptible to bacteria causing UTIs.
#2 Vaginal health is crucial in the post-antibiotic era
Despite decades of research on UTIs, the main tool for preventing UTIs is still low dose antibiotics. There is mounting concern about the rise of “super-bugs,” bacteria that are resistant to all antibiotics because of their rampant overuse. The vagina can be the starting point for understanding how we get UTIs and finding alternative ways to treat and prevent them.
UTIs are very common in women; they are much more likely than men to be affected. A woman has a 60% chance of having a UTI in her lifetime (Stapleton, 2011). Our risk peaks in the 20s drops during adulthood then increases again during middle age and menopause and continues to rise thereafter.
#3 The vagina as protector
The vagina plays a major role in protecting women from UTIs. The “bad” bacteria, such as Escherichia coli (E.coli), that cause UTIs generally come from the gastrointestinal system.
These bacteria make their way to the vagina and periurethral area as a pit stop to the bladder and the kidneys. The vagina, therefore, can be a source of protection by stopping the bacteria from getting to the bladder. Understanding the vaginal environment may be a vital step in preventing UTIs.
We know that the predominant “good” bacteria within the vagina are the lactobacilli species. These species are associated with improved vaginal health and a decrease in sexually transmitted diseases (STDs). (Stapleton, 2016).
In a study of over 300 sexually active women, 71% had lactobacilli species and the most common were L. crispatus and jensenii. These two species, more than any other, were associated with a decreased risk of bacterial vaginosis, E. coli, and STDs such as gonorrhea. (Antonio, 1999).
Studies further show that women with bacterial vaginosis (BV) are more likely to get infected with HIV, meaning that treating one disease may prevent another. (Antonio, 1999).
Both L. crispatus and jensenii produce hydrogen peroxide, which is vital to a healthy vaginal ecosystem. Peroxide actively kills the “bad” bacteria that cause UTIs and bacterial vaginosis.
Women with lactobacilli that do not make peroxide are less likely to be protected from infections. Furthermore, lactobacilli compete with the bad bacteria for space in the bladder and vagina wall and make the vagina more acidic, which is important to its health. (Antonio, 1999).
#4 Our microbiome changes when we get a UTI
One more reason for vaginal discharge and UTI could be that UTIs change the composition of bacteria within the vagina.
Before a UTI occurs, the vaginal introitus (opening) and periurethral area are contaminated with E. coli or other bad bacteria (Czaja, 2009). There are also fewer lactobacilli, suggesting that lactobacilli inhibit the growth of the bad bacteria. Multiple studies show that the more lactobacilli in the vagina, the less likely a woman is to have recurring UTIs (Stapleton, 2016).
Importantly, immediately after a UTI, the lactobacilli have not fully recovered, which increases the period that we are at increased risk for a repeat UTI.
#5 Estrogen and the vaginal microbiome
Women who have gone through menopause lose much of their naturally occurring vaginal lactobacilli (Pabich, 2003). This is a time in a woman’s life that she is more susceptible to UTIs; in fact, UTIs are so common that they are part of the syndrome of menopause (Stapleton, 2016).
Studies show that E. coli colonization is more common in postmenopausal women who are not on estrogen replacement.
A study of almost 500 post-menopausal women showed that vaginal estrogen use increases lactobacilli, decreases E. coli (Pabich, 2003) and improves vaginal acidity, all normalizing events in the vagina. Options for women include estrogen creams, suppositories and estradiol-releasing vaginal rings (Stapleton, 2016).
#6 Antibiotics change the vaginal microbiome
Antibiotics alter the bacterial residents of the vagina. In fact, the use of antibiotics for any reason has been associated with increased risk of UTI.
The type of antibiotics used to treat UTIs also matter.
Keflex and other beta-lactam antibiotics (such as cefpodoxime) are worse at resolving vaginal colonization of E.coli– even when the urine is clear of this bacteria. In a study of women treated with a beta-lactam antibiotic, 40% still had vaginal E.coli after treatment (Hooton, 2012). This can lead to more recurring infections. (Stapleton, 2016).
Your physician must have a plan to improve your vaginal health! For a sample plan to discuss with your doctor, check out this Actionable guide.
#7 Contraceptives have a varying effect on vaginal microbiome and UTIs
Spermicides such as nonoxynol-9 are toxic to lactobacilli and increase E. coli colonization and UTIs. Unfortunately, we do not have as much information about other contraceptives.
One study looking at the effect of two months of oral contraceptive pills (OCP) did not show any difference in physical changes or vaginal discharge. Interestingly, there was a decrease in high levels of both peroxide-producing lactobacilli and ureaplasma urealyticum, a UTI-causing bug. (Eschenbach, 2000) It is unclear if these changes in flora cancel each other, but overall it appears that OCPs have a minimal effect on UTI risk.
Read more about IUD & UTI
Of note, another study found that oral contraceptives did not affect vaginal lactobacilli at all. (Antonio, 1999) There is conflicting evidence regarding intrauterine devices (IUD) (Stapleton, 2016). Interestingly, a small study of 34 women using the copper IUD for 2-3 years showed that they had higher rates of E. coli colonization, bacterial vaginosis and of vaginal inflammation compared to women who did not use hormonal contraceptives or were on OCPs (Ocak, 2007).
The vagina is very important to your risk of UTIs; keep it healthy. Vaginal discharge and UTI could be connected.
UTIs, especially recurring ones may be due to a change in your vaginal flora. Here are some tips:
- Don’t use spermicides. OCPs appear to be the safest hormonal contraceptives for UTIs. Be aware that other forms of birth control may impact your risk of UTIs.
- Vaginal (not oral) estrogen may be helpful if you are past menopause and you do not have any health conditions that may make them dangerous, such as breast cancer.
- Try intravaginal probiotics, rather than oral ones, which do not consistently reduce the risk of UTIs. (Schewenger, 2015) See if you can use intravaginal peroxide producing lactobacilli suppositories as these may be more beneficial if you have recurring UTIs (Antonio, 1999). One study showed that intravaginal lactobacilli crispatus suppository reduces the number of recurring UTIs (Stapleton, 2011).