Does the cure for UTIs, HPV, and BV lie in the microbiome?
In my 20s, a routine pap test diagnosed abnormal cells. That led to a biopsy of my cervix called a colposcopy, which revealed I had CIN3, or “severely abnormal” precancerous cells. I was lucky to catch it while I was still asymptomatic and before the abnormal cells morphed into advanced cervical cancer.
Cervical cancer is primarily caused by the human papillomavirus (HPV). There are approximately 13 potentially cancer-causing strains of HPV, though 70% of cervical cancers are caused by just two: HPV 16 and HPV 18.
HPV, which is contracted through sexual activity, it doesn’t just cause cervical cancer. At least one strain of HPV can cause cancers of the penis, anus, vulva, vagina, and even head and neck cancers.
The HPV vaccine was a huge step forward in preventing these cancers—the most recent version, Gardasil 9, is nearly 100% effective at preventing cervical, vulvar, and vaginal infections and pre-cancers. But no vaccine is 100% effective—I personally contracted a cancer-causing strain of HPV despite getting the vaccine when it first became available.
No matter who you are, any type of cancer scare is a wakeup call. In the months between my abnormal pap test, the confirmatory biopsy, and the eventual LEEP procedure I had to remove the suspicious cells, I made changes.
I was in my third year of medical school at Columbia at the time and I wanted to learn everything I could about how I could give myself the best possible outcome. I started a daily meditation practice, taking time each day to lower my stress level and visualize the pre-cancerous cells disappearing. I made changes in my diet and started taking new-to-me supplements including folate, methylated B vitamins, vitamin D3, and a probiotic to support the health of my gut microbiome, since 70-80% of the body’s immune cells lie in the gut.
After the LEEP cut out the affected area of the cervix, my doctor called me with the pathology results. It was the strangest thing, she said—she was sure of the biopsy result, but there were no longer any precancerous cells.
Obviously, this is just my N of 1 experience, not a clinical trial with any kind of rigor. But I have to believe that the changes I made had some impact on shrinking the lesion to an undetectable size which shocked both me and my doctor.
I believe we have the power to support our body in healing itself. High-stress, poor metabolic health, and gut dysbiosis are all biological processes that reduce the effectiveness of our body’s most important defense against everything from colds to cancer.
I see huge numbers of patients at Parsley with recurrent UTIs, yeast infections, and HPV, all of which are effectively failures of the immune system. When it comes to vaginal and cervical health, women are taught basically nothing about prevention. In addition to vaccines and routine screenings, new research on the vaginal microbiome has me focused on new ways to optimize outcomes.
The research says
For many people, their immune system is able to fight off common genital urinary infections keeping the bacteria in check on its own. For others, that’s not the case. Could the microbiome be the key?
In addition to the gut microbiome, the vaginal microbiome plays an important role in the development of infections. A healthy vaginal microbiome, dominated by Lactobacillus species, helps maintain an acidic environment that inhibits pathogen growth.
The microbiome and UTIs
Disruptions in the balance of the vaginal microbiome can increase UTI risk. But there’s also evidence that a UTI can start in your gut.
Research on the connection between the gut microbiome and vaginal health is still limited, but we know that the gut microbiome can act as a “reservoir for UTI-causing pathogens.” The mechanism explaining how dysbiosis (i.e. an imbalance in harmful vs. helpful bacteria) increases your chances of getting a UTI isn’t totally clear; some studies suggest low gut microbiome diversity may lead to a drop in short-chain fatty acid production. This can lead to an overabundance of bugs like E. coli, which cause UTIs.
A lot more research is needed to understand this connection and if our primary method of treating UTIs—antibiotics—is actually making things worse. Antibiotic treatments decimate the gut microbiome, and early research suggests this might contribute to recurrent UTI infections. (A quarter of women get another infection within six months of being treated by antibiotics for the original UTI.)
A small study published in Nature Microbiology found that women with repeat UTIs had decreased diversity of healthy bugs in their gut microbiome. Specifically, they were low in butyrate, a short-chain fatty acid with powerful anti-inflammatory effects, which I wrote about in a recent newsletter.
The microbiome and BV
Bacterial Vaginosis (BV) is the most common vaginal infection in women of reproductive age, characterized by an imbalance in the vaginal microbiome. Not only is it annoying, it can increase the risk of STIs and pelvic inflammatory disease.
Remember, a healthy vaginal microbiome is rich in Lactobacillus species, which produce lactic acid to help kill pathogens. BV results when these healthy bugs are choked out and anaerobic bacteria like Gardnerella vaginalis take over.
Researchers are currently exploring the increasingly promising strategy of treating infections like BV with probiotics instead of antibiotics; specifically introducing Lactobacillus crispatus straight to the source.
The microbiome and HPV
So if an acidic vaginal microbiome dominated by pathogen-killing Lactobacillus species can help reduce infections like UTIs and BV, can it also help prevent more serious infections like HPV (and ultimately cervical cancer)?
Yes. Research shows that HPV infection is associated with decreased levels of Lactobacillus and increased microbial diversity (i.e. more bad bugs).
HPV infection further harms vaginal microbiome diversity potentially leading to persistent infection, according to a study published in Nature Communications in 2022. This may directly contribute to the risk of developing cervical cancer since “oxidative stress resulting from microbial dysbiosis” encourages the progression of HPV-positive cervical lesions.
What I’m doing for my own body
Vaginal health has remained top of mind for me since my brush with HPV. Now I know that supporting my microbiome is even more important. Here’s what I’m doing:
Screening
Screening is one of the most important tools we have for preventing cancer. I worked with Johns Hopkins’ JHPIEGO, a non-profit funded by USAID, in Nepal treating women with HPV and cervical cancer and saw first-hand the importance of getting screened to improve disease outcomes.
Since my scare, my Pap tests have been normal. So I follow current ACOG guidelines for cervical cancer screening, and get a Pap and HPV test every five years. I got my most recent Pap results as I was drafting this newsletter and am pleased do say everything is clear.
Optimizing my diet
Sugar feeds yeast, which can increase the risk of GU infections and trigger inflammation. I aim for less than 25g of sugar per day to support various health goals, including my vaginal microbiome health.
Probiotics and prebiotics are also key for me. The bacterial strain Lactobacillus, which is found in many probiotic supplements and foods like fermented dairy, veggies, and soy, can help maintain a balanced vaginal microbiome.
I back that up with fiber, prebiotics that feed the beneficial bacteria. My current fiber goal is 40-50g per day.
What I recommend for you
In addition to the tips I follow above, at Parsley, I use a combination of probiotics and antimicrobials (prescription or herbal) to help treat GU conditions in the moment and resolve them for good.
- Supplement if needed. For patients struggling with uro-gynecological issues, I sometimes recommend Fem-dophilus.
- Reconsider tampons. The recent study showing concerning levels of heavy metals found in tampons made me rethink my period products. I use the brand Nataracare, which use organic GOTS-certified cotton that is third party tested and confirmed not to contain detectable levels of heavy metals.
- Choose the right lubricant. What you put down there—particularly its pH level—has a big impact on the vaginal microbiome. The World Health Organization recommends using a lubricant with a pH of 4.5. I recommend a water-based lubricant which won’t damage the vaginal microbiome over time, according to a small study of postmenopausal women.
Parsley’s free Symptom Index quiz will give you a snapshot of your overall health and flag areas of concern. Use my code RBMDCREW for $150 off your membership.
As always, this newsletter is for informational and educational purposes only and is not intended as medical advice. Always consult your healthcare provider before making any health decisions or changes to your treatment plan.