Causes & Risk Factors

The Link Between HIV and Bacterial Vaginosis

October 29, 2018

Bacterial vaginosis (BV), happens when the normal healthier flora of the vagina are replaced by a combination of different germs, often including Mycoplasma genitalium.

Whenever someone has BV, lots of changes occur in the anus. Some of the main changes include an increase in vaginal pH and a reduction in other substances that can control the degradation of bacteria, like peroxide.

Through these and other alterations, BV creates an environment where it is simpler for germs to grow and STDs to spread.

HIV is just one of the STDs that spreads more readily in the presence of BV. Women with BV are a lot more likely to acquire HIV during sexual activity. On the other hand, the increase in HIV risk related to BV is not just for the woman. Bacterial vaginosis has also been shown to boost the threat that male sexual partners will get HIV. In fact, 1 study in Africa found that it had been three times as possible for a girl with BV to transmit HIV to her sexual partner as it was for a female with healthy vaginal flora.

Risk Factors and Health Disparities

Scientists do not yet understand all the ways in which BV and HIV interact. However, it’s clear that both BV and HIV are more common in certain groups of individuals than others. In the United States, for example, both states are found a lot more frequently in African Americans than in the people as a whole.

With respect to HIV, there are a range of explanations for why this might be the situation. These include insufficient access to healthcare and treatment, increased risk of incarceration, and smaller sexual networks which may raise the likelihood of becoming exposed to the virus. Absolutely, these and other risk factors add up to an HIV infection rate that is twenty times greater in Black women than in white girls.

It’s less well known why African American women are at heightened risk of BV. Research suggests that as many as half of African American girls have, or have had BV, compared to 30 percent of women in the total population.  1 potential explanation is that the sort of lactobacillus that is most common in African American women is less effective at acidifying the vagina than the type that is quite frequent in white, non-Hispanic women.

In addition, scientists have good evidence that there’s an association between bacterial vaginosis and douching. Douching, the custom of cleaning the vagina, is somewhat more prevalent in African American and Caribbean women than in many other groups. But it must be said that the association between BV and douching may be similar to the issue of the chicken and the egg.  Douching may increase the risk of BV, but African American women may be more likely to douche since they’re more likely to go through the vaginal odors along with other symptoms of BV.

Even if all the manners that BV and HIV interact aren’t yet apparent, scientists have identified a range of risk factors they have in common. Genital herpes infection is associated with a risk of BV and HIV.

So are poverty and lack of access to care. Finally, chronic stress has been associated with both illnesses, as anxiety can have negative effects on immunity. These common factors can make it hard to untangle all the ways that BV might raise the risk of HIV, and vice versa.

Examining the Link

There are lots of hypotheses for how BV can increase the risk of HIV disease. 1 hypothesis looks at the makeup of vaginal secretions. In the healthy vagina, lactobacilli may earn a number of anti inflammatory compounds, such as lactic acid and peroxide, that could inactivate HIV. Whenever there’s a change from a lactobacillus dominated vaginal flora to some BV flora, then these chemicals go away.

That may make it possible for HIV to remain alive longer in the vagina and increase the speed of transmission to your sexual partner.

Additionally, there are other techniques BV bacteria could influence HIV transmission. Certain BV bacteria have been shown to increase HIV replication by stimulating tissues that contain the virus. BV was demonstrated to disrupt the skin cells at the surface of the vagina, which might make it easier for HIV to achieve deeper layers of cells that are susceptible to disease. Finally, BV can provoke inflammation in the uterus more commonly, something which also increases the odds of infection with HIV.

A Word From Verywell

Coping with recurrent BV could be bothersome. It can be very difficult to restore the normal vaginal flora. Therefore, it might be disheartening to hear that BV is associated with a greater risk of HIV and other STDs. Luckily, practicing safer sex is a highly efficient means to decrease STD risk. Additionally, for women who are at very high risk of HIV acquisition, there are other options.

If you’re a woman with recurrent BV who’s at high risk of HIV, for example as you’ve got an HIV infected sexual partner, you might choose to talk to your doctor about pre-exposure prophylaxis or even PrEP. With PrEP, you take HIV medications in order to reduce your chance of getting HIV if exposed. However, it’s important to note that women with recurrent BV ought to be provided oral PrEP as opposed to a vaginal gel. There’s some evidence that the bacterial increase in BV can produce the gel significantly less effective.