Microbiome and Dysbiosis Video #7: Dysbiosis by Location—Genitourinary Tract

Urine is a broth of nutrients and hormones, making excellent fertilizer for a wide range of bacteria and fungi; overgrowth of microbes in the genitourinary tract can trigger systemic inflammation.

When I first studied (and later taught) Clinical Laboratory Medicine¹ at the graduate/doctorate level, I remember our professor telling us that urine is an excellent culture media for bacterial growth. Stated slightly differently: Urine is a broth of nutrients and hormones, making excellent fertilizer for a wide range of bacteria and fungi. Overgrowth of microbes in the genitourinary tract can trigger/cocreate systemic inflammation and autoimmune diseases. We have classic examples of this.

Reactive arthritis is a general term that describes any chronic inflammatory multi-joint disease (polyarthritis) that is attributable to an infection or microbial colonization at a different location. Obviously, this is not the same as joint infection (septic arthritis) which typically affects only one joint (not several joints) and is typically acute (intense and short-term, not chronic).

The classic prototype of Reactive Arthritis was previously termed Reiter's Syndrome, which describes polyarthritis (inflammation of many joints), oligoarthritis (inflammation of a few joints), spondylitis (inflammation of the spine) or sacroiliitis (inflammation of the pelvis), in response to a genitourinary infection, typically chlamydia. The infection does not have to be localized to the genitourinary tract, although Reiter syndrome implies this; the infection or colonzation can occur in the gastrointestinal tract for example with Giardia parasite colonization or Salmonella or Shigella infection.

No-one in medicine denies the existence of reactive arthritis; it is considered rare, but is obviously very real. But it is not really obvious. Most clinicians can make the diagnosis of reactive arthritis if they are presented with the classic presentation of a young man/woman presenting with the combination of a new sexually transmitted infection plus joint pain, especially in the low-back, pelvis, hips, knees and/or ankles. You’d expect that case presentation on medical licensing exams.

“Reactive arthritis, also called Reiter's syndrome, is the most common type of inflammatory polyarthritis in young men. It is sometimes the first manifestation of human immunodeficiency virus infection. An HLA-B27 genotype is a predisposing factor in over two thirds of patients with reactive arthritis. The syndrome most frequently follows genitourinary infection with Chlamydia trachomatis, but other organisms have also been implicated. Treatment with doxycycline or its analogs sometimes shortens the course or aborts the onset of the arthritis. Reactive arthritis may also follow enteric [gastrointestinal] infections with some strains of Salmonella or Shigella, but use of antibiotics in these patients has not been shown to be effective. Reactive arthritis should always be considered in young men who present with polyarthritis.” American Family Physician 1999

The question/issue becomes who among which doctors can diagnose a nonclassic clinical presentation, a more complex case, perhaps complicating the appreciation of the relationship by labeling the patient with some official (yet largely meaningless) diagnostic tag such as:

• Rheumatoid arthritis (RA)

• Psoriasis, psoriatic arthritis (PsA)

• Ankylosing spondylitis (AS), spondylitis

Peer-reviewed (independently published) articles related to this material provided by Dr Vasquez:

1. Nutritional and Botanical Treatments Against Silent Infections and Gastrointestinal Dysbiosis Commonly Overlooked Causes of Neuromusculoskeletal Inflammation and Chronic Health Problems. Nutritional Perspectives 2006 academia.edu/39481031

2. Mitochondrial Medicine Arrives to Prime Time in Clinical Care: Nutritional Biochemistry and Mitochondrial Hyperpermeability ("Leaky Mitochondria") Meet Disease Pathogenesis and Clinical Interventions. Integr Med (Encinitas) 2014 Aug;13(4):44-9 pubmed.ncbi.nlm.nih.gov/26770108

3. Reply to "role of Western diet in inflammatory autoimmune diseases" by Manzel et al. In current allergy and asthma reports (volume 14, issue 1, January 2014). Curr Allergy Asthma Rep 2014 Aug;14(8):454. doi: 10.1007/s11882-014-0454-4 pubmed.ncbi.nlm.nih.gov/24947682

4. Neuroinflammation in fibromyalgia and CRPS is multifactorial. Nat Rev Rheumatol 2016 Apr;12(4):242. doi: 10.1038/nrrheum.2016.25 pubmed.ncbi.nlm.nih.gov/26935282

5. Biological plausibility of the gut-brain axis in autism. Ann N Y Acad Sci 2017 Nov;1408(1):5-6. doi: 10.1111/nyas.13516 pubmed.ncbi.nlm.nih.gov/29090837

6. Correspondence regarding Cutshall, Bergstrom, Kalish's "Evaluation of a functional medicine approach to treating fatigue, stress, and digestive issues in women" in Complement Ther Clin Pract 2016 May. Complement Ther Clin Pract 2018 May;31:332-333 doi: 10.1016/j.ctcp.2016.10.001 pubmed.ncbi.nlm.nih.gov/27814977

Video #7 (57 minutes) Dysbiosis by Location—Genitourinary Tract

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