Helicobacter pylori, A Sex Transmitted Bacteria?

Review Article

Chronic Dis Int. 2016; 3(1): 1019.

Helicobacter pylori, A Sex Transmitted Bacteria?

Yee JKC*

Research Division, Ameritek USA

*Corresponding author: John Kuo Ching Yee, Research Division, Ameritek USA, Everett, Washington 98208, USA

Received: April 25, 2016; Accepted: June 22, 2016; Published: June 23, 2016

Abstract

Since oral sex is a very common sexual activity and recent evidence reported H. pylori exist in oral cavity as colonized site. Both facts indicated H. pylori may results sex transmitted disease such as vagina, breast and urethritis, However, further clinical studies and lab confirmation should be followed. Helicobacter pylori (H. pylori) passes through the mouth on its way to colonizing the stomach, where chronic infection is associated with ulcers, gastritis, and gastric adenocarcinoma. H. pylori is the only proven oncogenic bacterial species and detecting, preventing, or curing infection in the early stages is essential if gastric disease is to be prevented. However, beside of stomach H. pylori infection, there are several reports indicated non-gut organs have been harbored of H. pylori, such as vagina, nasopharyngeal sinus cavities, coronary plaque, otitis media, breast. Now it is time we should answer a question; is H. pylori a sex transmitted bacteria?

Introduction

Helicobacter pylori (H. pylori) passes through the mouth on its way to colonizing the stomach, where chronic infection is associated with ulcers, gastritis, and gastric adenocarcinoma. H. pylori is the only proven oncogenic bacterial species and detecting, preventing, or curing infection in the early stages is essential if gastric disease is to be prevented. However, beside of stomach H. pylori infection, there are several reports indicated non-gut organs have been harbored of H. pylori, such as vagina [1], nasopharyngeal sinus cavities [2], coronary plaque [3], otitis media [4], breast [5]. Now it is time we should answer a question; is H. pylori a sex transmitted bacteria?

Seroprevalence studies have shown that in sex partners with a man/woman who is infected with H. pylori the non-infected individual has an increased risk of transmitting the infection. Studies have shown that prevalence rates were statistically significant between couples with and without H. pylori infection (83.3% v 28.5%) respectively [6,7].

Ethnicity may also be an important predictor of sexual transmission of H. pylori infection. A number of studies have shown that the highest rates of sexually transmitted infections occur in ethnic minorities. The high prevalence of sexually transmitted infections correlates well with the high H. pylori prevalence rates that exist among these ethnic groups [8,9].

Molecular studies have produced evidence of H. pylori transmission between spouses. Schutze et al. [7] found that reinfection had been caused by the same H. pylori strain and identified the spouses of the patients as carriers of the identical strain. This was supported by other studies. Moreover, it has been shown that multiple strains of H. pylori may infect the same individual. There were very limited research published in association of sex transmitting disease with H. pylori. For example, Eslick GD [10] report no study conducted in the prevalence of H. pylori infection is increased in female sex workers when compared with the general population by met analysis.

H. pylori Infection Transmitted Sexual via Oral-Genital Contact

There have been many reviews that have been published looking at possible transmission, However, few published papers have examined the possibility of sexual transmission via the vagina. Several theoretical links exist, such H. pylori has been shown to colonize yeast within the vagina and has also been associated with biofilm formation, making it possible that H. pylori is one of many bacterial species seen in biofilms present in bacterial vaginosis leading to treatment failure. H. pylori is commonly found in the stomach and upper gastrointestinal tract, one of the few bacterial able to colonize this acidic environment. Eslick hypothesized that H. pylori may be able to also colonize the acidic vaginal environment, acting as a reservoir and allowing sexual transmission of the bacteria. H. pylori isolates have also been found to have an endosymbiotic relationship with Candida albicans, with bacterial isolated from within these yeast. This relationship may allow H. pylori to colonize the vagina. Candida isolated from the vagina has been found to contain H. pylori specific genes, one mechanism for the vertical transmission of H. pylori. The colonization of the high rates of treatment failure and infection recurrence in some women with bacterial vaginosis [1].

A few studies have been conducted in an attempt to isolate H. pylori from the vagina. Early attempts produced negative results. Recently, de-Argila et al. conducted a study which attempted to find H. pylori in vaginal secretions by taking vaginal brushings and using Polymerase Chain Reaction (PCR), culture, and Gram stain. However, the diagnostic methods used failed to detect H. pylori. This may be because the concentration of H. pylori in vagina is low. The technology of culture based on stomach where the concentration of H. pylori is very high.

A early case report which was published a year before Warren and Marshall’s original paper on “spiral bacteria in the stomach” may have found strains of H. pylori in a woman’s vagina associated with vaginitis. The article reports finding comma-shaped rods (1–4 μm in length), with a characteristic corkscrew motility having between four and eight flagellae. Some of the organisms were cultured under microaerophilic conditions and cultured after 72 hours incubation at 37°C. The biochemical profile of these unknown organisms matched very closely with that of H. pylori, although definitive tests such as urease activity were not undertaken. Could this unknown organism have been a H. pylori species? Vertical transmission may also occur during birth if H. pylori is present in the vagina. Studies have shown that the prevalence of H. pylori in pregnant women is about 20% [11,12]. The question remains, why hasn’t a H. pylori species been recovered from the female vagina when so many vaginal swabs have been done to culture organisms like Neisseria gonorrhoea? Several reasons may be that H. pylori species are difficult to grow in culture that key difficulties in cultivating oral H. pylori result from oral specimen collection, preservation, small colonies of H. pylori culture, and competition with other oral bacteria and H. pylori colonies. Because the concentration of H. pylori in stomach is three magnitudes higher than that of the oral cavity (105 CFU/mL versus102 CFU/ mL [13,14]), it would be insufficient to use conventional stomach culturing techniques for detecting oral H. pylori. The method must be adapted to obtain a high positive rate of oral H. pylori culture.

H. pylori Infection Transmitted Sexual via Oral-Breast Contact

Kast RE report a case that oral contact with the nipple may result in retrograde propulsion of H. pylori into breast ducts that leading fibrocystic breast changes which is a heterogenous group of benign. The woman had H. pyloriserology was negative. After antiobtic eradication, her breasts normalized and pain and tenderness stopped which leading to this hypothesis [5]. H. pylori in fecal were seen in half of all breastfed 3-day old neonates whose mothers have documented H. pylori antigenuria [15], H. pylori was found in 4 out of 66 milk samples from parturients [16].

H. pylori Infection Transmitted Sexual via Oral-Oral Contact

Overall, inadequate sanitation practices, low social class, and crowded or high-density living conditions seem to be related to a higher prevalence of H. pylori infection due to oral-oral contact. The poor hygiene and crowded conditions may facilitate transmission of infection among family members and is consistent with data on intrafamilial and institutional clustering of H. pylori infection. Understanding the route of H. pylori transmission is important if public health measures to prevent its spread are to be implemented. For the general population, the most likely mode of transmission is from person to person, by either the oral-oral route (through vomitus or possibly saliva). The person-to-person mode of transmission is supported by the higher incidence of infection among institutionalized children and adults and the clustering of H. pylori infection within families. Also lending support to this concept is the detection of H. pylori DNA in vomitus, saliva, dental plaque, gastric juice, and feces. Waterborne transmission, probably due to fecal contamination, may be an important source of infection, especially in parts of the world in which untreated water is common.

Dye BA et al. report that a total of 4504 participants who completed a periodontal examination and tested positive for H. pylori antibodies that show periodontal pockets with a depth of 5 mm or more were associated with increased odds of H. pylori seropositivity (Odds Ratio [OR] = 1.47; 95% Confidence Interval [CI] = 1.12, 1.94). The conclusion was that poor periodontal health, which is characterized by advanced periodontal pockets, could be associated with H. pylori infection in adults [17]. Fernández-Tilapa G et al. found that the prevalence of H. pylori in the oral cavity was higher among seropositive subjects than seronegative ones [18]. Furthermore, Nisha KJ et al. reported that there is a highly significant association between periodontal disease and the colonization of H. pylori in dental plaque [19]. Tsami A et al. detected H. pylori in subgingival dental plaque of children and their family [20]. Several reports have indicated that H. pylori colonies could be grown only from root canals, but not from plaque. The root canals of endodontic-infected teeth could be a reservoir for live H. pylori that could serve as a potential source of transmission [21,22].

If the discover of oral cavity is second colonized site beside stomach has been established [23], then saliva may contains H. pylori that can be a risk of H. pylori infection transmitted sexual via oraloral contact such as wet kiss.

H. pylori Infection Transmitted Sexual via Intercourse

H. pylori infection transmitted sexual may via intercourse that depends both of sex parties may have oral sex action or not. If saliva contains H. pylori that can transmitted to vagina. The intercourse can be a risk that H. pylori can cost urethritis.

H. pylori Infection Transmitted Sexual via Oral-Anal

The possibility of sexual transmission via the vagina in adults would contribute, in part, to the low rates. Previous data have suggested that sexual behaviour may be important in the transmission of H. pylori. The majority of these studies have concentrated on the possibility of oro-anal transmission between male homosexuals.

H. pylori Infection and Urethritis

The idea that H. pylori or another species of Helicobacter could cause urethritis has never before been proposed. There have been three conflicting studies conducted to determine if sexual contact plays any role in the transmission of H. pylori oral sex is one of the most common sexual practices in the world and it is possible that H. pylori could be transmitted via the act of fellatio to the urethra leading to infection. This organism may be the ‘missing link’ in explaining the large proportion of males with non-gonococcal urethritis where no other responsible organisms can be isolated. This is the first article to suggest a link between H. pylori infection and urethritis [24].

Oral yeasts were isolated more frequently from normallydelivered neonates. The frequency of H. pylori genes in mothers vaginal yeasts was significantly higher than in mothers oral yeasts. A significant correlation was found between the occurrence of H. pylori genes in vaginal yeasts and that in neonates’ oral yeasts, occurrence of H. pylori genes in mothers vaginal yeasts or neonates oral yeasts, and UBT+ results in mothers. Calbicans which colonizes the oral cavity of neonates through vaginal delivery or contact with environment or healthcare workers could be an important reservoir of H. pylori.

Vaginal yeasts are more potent in accommodating H. pylori than oral yeasts. Accordingly, vaginal yeast is proposed as the primary reservoir of H. pylori which facilitates H. pylori transmission to neonates [25].

Oral sex (fellatio) is a very common sexual activity. H. pylori is mainly a gastric organism, but studies have reported that infected individuals may permanently or transiently carry H. pylori in their mouth and saliva [25-27]. The existing studies support the hypothesis that H. pylori could be a causative agent of non-gonococcal urethritis. It is possible that H. pylori may be transmitted via the act of fellatio in the urethra. Further research is required to explore the role of H. pylori in sexually transmitted urethritis [28].

Conclusion

Since the evidence of oral H. pylori had been established, oral sex is a very common sexual activity. The risk of H. pylori infection transmitted sexual via oral contact, breast, prostate, vagina infection may exists.

References

  1. Minakami H, Hayashi M, Sato I. Does Helicobacter pylori colonize the vagina of pregnant women? J Infect. 2000; 41: 112-113.
  2. Morinaka S, Ichimiya M, Nakamura H. Detection of Helicobacter pylori in nasal and maxillary sinus specimens from patients with chronic sinusitis. Laryngoscope. 2003; 113: 1557-1563.
  3. Kowalski M. Hp infection in coronary artery disease: influence of Hp eradication on coronary artery lumen after percutaneous transluminal coronary angioplasty. The detection of Hp specific DNA in juman coronary atherosclerotic plaque. J Physiol Pharmacol. 2001; 52: 3-31.
  4. Yilmaz T, Ceylan M, Akyön Y, Ozçakýr O, Gürsel B. Helicobacter pylori: a possible association with otitis media with effusion. Otolaryngol Head Neck Surg. 2006; 134: 772-777.
  5. 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. 2007; 68: 1041-1046.
  6. Singh V, Trikha B, Vaiphei K, Nain CK, Thennarasu K, Singh K. Helicobacter pylori: evidence for spouse-to-spouse transmission. J Gastroenterol Hepatol. 1999; 14: 519-522.
  7. Schütze K, Hentschel E, Dragosics B, Hirschl AM. Helicobacter pylori reinfection with identical organisms: transmission by the patients' spouses. Gut. 1995; 36: 831-833.
  8. Zenilman JM. Ethnicity and sexually transmitted infections. Curr Opin Infect Dis. 1998; 11: 47-52.
  9. Mollison LC, Lecons RJ, Thein-Htut, Rajabalendaran N, Perera C. Upper gastrointestinal endoscopy in central Australian aborigines. Med J Aust. 1994; 160: 182-184.
  10. Eslick GD. Helicobacter pylori infection transmitted sexually via oral-genital contact: a hypothetical model. Sex Transm Infect. 2000; 76: 489-492.
  11. Blecker U, Lanciers S, Keppens E, Vandenplas Y. Evolution of Helicobacter pylori positivity in infants born from positive mothers. J Pediatr Gastroenterol Nutr. 1994; 19: 87-90.
  12. Yan P, Eslick GD, Xia HH-X. Association between Helicobacter pylori infection and fetal intrauterine growth retardation (IUGR). Gastroenterology. 2000; 118: 734.
  13. Mégraud F, Lehours P. Helicobacter pylori detection and antimicrobial susceptibility testing. Clin Microbiol Rev. 2007; 20: 280-322.
  14. Song Q, Zirnstein GW, Swaminathan B, Gold BD. Pretreatment with urea-hydrochloric acid enhances the isolation of Helicobacter pylori from contaminated specimens. J Clin Microbiol. 2001; 39: 1967-1968.
  15. Fujimura S, Kato S, Nagai K, Kawamura T, Iinuma K. Detection of Helicobacter pylori in the stools of newborn infants. Pediatr Infect Dis J. 2004; 23: 1055-1056.
  16. Kitagawa M, Natori M, Katoh M, Sugimoto K, Omi H, Akiyama Y, et al. Maternal transmission of Helicobacter pylori in the perinatal period. J Obstet Gynaecol Res. 2001; 27: 225-230.
  17. Dye BA, Kruszon-Moran D, McQuillan G. The relationship between periodontal disease attributes and Helicobacter pylori infection among adults in the United States. Am J Public Health. 2002; 92: 1809-1815
  18. Fernández-Tilapa G, Axinecuilteco-Hilera J, Giono-Cerezo S, Martínez-Carrillo DN, Illades-Aguiar B, Román-Román A. vacA genotypes in oral cavity and Helicobacter pylori seropositivity among adults without dyspepsia. Med Oral Patol Oral Cir Bucal. 2011; 16: 175-180.
  19. Nisha KJ, Nandakumar K, Shenoy KT, Janam P. Periodontal disease and Helicobacter pylori infection: a community-based study using serology and rapid urease test. J Investig Clin Dent. 2016; 7: 37-45.
  20. Tsami A, Petropoulou P, Kafritsa Y, Mentis YA, Roma-Giannikou E. The presence of Helicobacter pylori in dental plaque of children and their parents: is it related to their periodontal status and oral hygiene? Eur J Paediatr Dent. 2011; 12: 225-230.
  21. Hirsch C, Tegtmeyer N, Rohde M, Rowland M, Oyarzabal OA, Backert S. Live Helicobacter pylori in the root canal of endodontic-infected deciduous teeth. J Gastroenterol. 2012; 47: 936-940.
  22. Ogaya Y, Nomura R, Watanabe Y, Nakano K. Detection of Helicobacter pylori DNA in inflamed dental pulp specimens from Japanese children and adolescents. J Med Microbiol. 2015; 64: 117-123.
  23. Yee JK. Helicobacter pylori colonization of the oral cavity: A milestone discovery. World J Gastroenterol. 2016; 22: 641-648.
  24. Eslick GD. Non-gonococcal urethritis, Helicobacter pylori infection and fellatio: a new ménage à trois? Microbiology. 2004; 150: 520-522.
  25. Siavoshi F, Taghikhani A, Malekzadeh R, Sarrafnejad A, Kashanian M, Jamal AS, et al. The role of mother's oral and vaginal yeasts in transmission of Helicobacter pylori to neonates. Arch Iran Med. 2013; 16: 288-294.
  26. Yee KC, Wei MH, Yee HC, Everett KD, Yee HP, Hazeki-Talor N. A screening trial of Helicobacter pylori-specific antigen tests in saliva to identify an oral infection. Digestion. 2013; 87: 163-169.
  27. Wang XM, Yee KC, Hazeki-Taylor N, Li J, Fu HY, Huang ML, et al. Oral Helicobacter pylori, its relationship to successful eradication of gastric H. pylori and saliva culture confirmation. J Physiol Pharmacol. 2014; 65: 559-566.
  28. Dimitriadi D. Helicobacter pylori: a sexually transmitted bacterium? Cent European J Urol. 2014; 67: 407-409.

Citation: Yee JKC. Helicobacter pylori, A Sex Transmitted Bacteria?. Chronic Dis Int. 2016; 3(1): 1019.