Can Bacterial Vaginosis Cause Sepsis?
Bacterial vaginosis itself does not directly cause sepsis, but the anaerobic bacteria associated with BV can ascend to the upper genital tract and cause serious pelvic infections that may lead to septic complications, particularly in the context of pregnancy, surgical procedures, or immunocompromised states.
Understanding the Infection Pathway
BV represents a polymicrobial condition where normal protective lactobacilli are replaced by high concentrations of anaerobic bacteria including Prevotella, Bacteroides, Peptostreptococcus, Gardnerella vaginalis, and Mycoplasma hominis 1. While BV itself is confined to the vagina and is not an invasive infection, these organisms have pathogenic potential when they gain access to normally sterile sites 2.
High-Risk Clinical Scenarios for Serious Infection
Obstetric Complications
- BV during pregnancy is associated with chorioamnionitis, amniotic fluid infections, postpartum endometritis, and postabortal pelvic inflammatory disease 3, 4, 5.
- The bacteria can ascend through the cervix to infect the uterus, fallopian tubes, and amniotic cavity, potentially leading to systemic infection 1, 2.
- Pregnant women with BV have increased risk of preterm delivery and premature rupture of membranes, which can create portals for bacterial invasion 3, 5.
Surgical and Procedural Risks
- Treatment before surgical abortion procedures substantially reduces post-abortion pelvic inflammatory disease 3.
- BV increases the risk of post-hysterectomy infections including vaginal cuff cellulitis, pelvic cellulitis, and pelvic abscess 5.
- Women with BV undergoing gynecological surgeries face elevated risk of postoperative infectious complications and should be treated prophylactically 3, 5.
Pelvic Inflammatory Disease Pathway
- The same anaerobic organisms found in BV are frequently isolated from the upper genital tracts of women with acute pelvic inflammatory disease 1.
- BV has been suggested as an antecedent to lower genital tract infection that leads to polymicrobial acute PID 1.
- PID results from direct canalicular spread of organisms from the endocervix to the endometrial and fallopian tube mucosa 1.
- These upper tract infections can progress to tubo-ovarian abscess and, if untreated, can rupture leading to peritonitis and sepsis 1.
Immunocompromised Considerations
While the evidence does not specifically address immunocompromised hosts, the general principles of infectious disease suggest that:
- Immunocompromised individuals have impaired ability to contain localized infections [@general medical knowledge].
- The anaerobic bacteria associated with BV are opportunistic pathogens that can cause more severe disease in immunosuppressed states [@general medical knowledge].
- Any breach in mucosal barriers (surgical, obstetric, or spontaneous) poses greater risk in immunocompromised patients [@general medical knowledge].
Critical Clinical Pitfall
The major danger is not BV itself, but the failure to recognize and treat BV before high-risk procedures or in pregnant women, allowing the BV-associated flora to cause ascending infection [@3@, 5]. More than 50% of women with BV are asymptomatic, meaning they harbor potentially pathogenic bacteria without knowing it [@1@, @6@, @7@].
Prevention Strategy
- Screen and treat BV before elective gynecological procedures, particularly hysterectomy and abortion [@3@, 5].
- Consider screening high-risk pregnant women with history of preterm delivery [@3@].
- Treat symptomatic BV promptly with metronidazole 500 mg orally twice daily for 7 days [3, @4@].
- Ensure patients avoid alcohol during and for 24 hours after metronidazole treatment to prevent disulfiram-like reactions [@3