Posted 1/3/2014 9:59 PM (GMT -6)
I came across this information related to a UC Davis researcher which is somewhat dated (2000), but nonetheless interesting. I'm surprised there hasn't been more research into menstrual hormones and lyme.
Marylynn Barkley, MD. PhD, UC
Davis Section of Neurobiology,
Physiology & Behavior,
a study on the relation of female
hormones to the waxing and waning of
Lyme disease symptoms. She has
observed an intensification of night
sweats (diaphoresis) in women with
Lyme disease immediately before and
during the menses. At the end of the menstrual cycle,
there is a precipitous decline in ovarian
steroid hormones which triggers the
shedding of the uterine lining. During
this period, recognition of Borrelia
antigen by the Lyme Urine Antigen
Test (LUAT) also reaches a peak, and
cytokine levels are above normal.
Night sweats are thought to reflect
activation of the immune system and
have historically been used to moitor
infections in patients with tuberculosis,
malaria, and other diseases. Dr.
Barkley discussed a patient whose
classical Lyme disease symptoms were
not recogni/.ed until 18 months after an
initial flulike illness. The patient.
initially seronegative, became positive
after an empiric trial of antibiotic
therapy. She experienced regularly
occurring night sweats which were
measured according to an objective
scale for intensity (level 4: most
intense, IOcc fluid could be wrung out
of garment, to level 1: only front of
garment was wet).
Data recorded over a two-year
period showed intensification of night
sweats (more level 4events) in a cyclic
pattern coinciding with the decline of
ovarian hormones and the onset of the
menses. Over time the intensity of the
night sweats lessened, suggesting
response to therapy.
Continuing her study with another
patient. Dr. Barkeley wanted to
discover whether there was an
objective relationship between
progestin levels and Bb antigen
activity. Using the LUAT. she
discovered an increased recognition of
Bb antigen as progesterone levels fell.
In a further study of 26 women, 21
reported night sweats, and of those
who kept records, the most intense
night sweats were in association with
menstruation. She also discovered a
significant correlation with intensifica-
tion of Lyme disease symptomatology
(arthralgia, myalgia, cognitive deficits,
fatigue) around the same time.
Dr. Barkeley concluded that there
is an interval of increased immune
activity during several days before and
after the onset of menses. She is
assuming that the night sweat activity
is proportional to the spirochete
abundance. She speculates that the
increase in immune response kills an
increased number of spirochetes during
this period, which leads to the intensi-
fied symptomatology and the increased
shedding of antigen.
One practical application of Dr.
Barkeley's work is to suggest an
optimal time for urine collection for
LUAT in menstruating women.
Collecting during the 3 days pro and
post onset of menses will maximi/e
the chance of a positive result.
Continued on back page
Another possibility is that the timing\
of a tick bite in the menstrual cycle
may also affect the likelihood of
infection or resistance to infection,
Dr. Barkeley made the interesting
observation that there are two peak
incidences of autoimmune illnes~ in
women; one is around the time of
puberty, the other is at menopause.
Evolutionary ecologists point out that
historically, women have not experi-
enced many recurrent menstural
cycles. The fact that many modem
women now do, may impinge upon
their immune systems and compro-
mise recognition of self. Dr. Barkeley
noted that many of the women
randomly included in her study got
their Lyme disease in their late 30s or
early 40s, leading her to wonder if
their immune systems had indeed
been compromised. But that is subject
for a further study.
In the question period. Dr.
Barkcley described three young
women who had tried birth control
pills to see if they would alleviate
some of their Lyme disease symp-
toms. Their symptoms intensified so
much they were unable to continue or
NUMBER 19 Education, Support, Advocacy. Research NOVEMBER-DECEMBER 1997
Presented at the 10th Annual International Conference on Lyme Borreliosis, NIH, Bethesda, Maryland
April 28-30, 1997
The Lyme Urine Antigen Test (LUAT) During Antibiotic Therapy in Women with Recurrent Menstrual Cycles
M. Barkley, MD, PhD, N Harris, PhD, and B Szantyr, MD
University of California at Davis, Davis, CA, IGeneX, Inc. Reference Laboratory, Palo Alto, CA and Lincoln, MA.
A previous study indicated that Lyme Disease (LD) symptoms were correlated with night sweat activity presumed to reflect immune system responsiveness to Borrelia burgdorferi (Bb) infection. Fluctuations in reproductive hormones appear to produce an immune response interval (IR) associated with altered Bb activity. We were interested in the possibility that monthly changes in neuroendocrine-immune ovarian activity might influence the appearance or availability of Bb antigens(s) in urine. Multiple urine samples from a single patient with LD were collected daily during 7 consecutive menstrual cycles while antibiotics were being administered. The portion of the menstrual cycle chosen for study included a 12-13 day period approximating the putative IR, including menses and the days immediately thereafter. Early morning (5-8am), mid-day (11am-3pm), evening (5-8pm) and late night (8-11pm) samples were collected and immediately transferred to BD Urine Vacutainers with preservative. Samples were
stored at -76°C. LUATs
were performed on each sample (N=285). Urinary metabolites of progesterone were measured by ELISA throughout three IR(s) selected at random. The case history is particularly interesting because initial LUAT(s), multiple PCR(s), IgG and IgM Western Blot analyses were negative following sample collection at times other than the IR. Positive LUAT(s) were obtained during the first and all but the second of the 7 IR analyzed. Menstrual cycle stage was significantly correlated with the level of Bb antigen detected in urine. Urines with a positive LUAT (P< 0.05) (N=56) were divided into Group A (collected during the late luteal phase, when urinary progesterone metabolites were highest and began to decline) (N=32) and Group B (collected on the first day of menses or thereafter, when urinary progesterone metabolites were decreased) (N=24). Excluding all negative LUAT results, mean positive LUAT values were lower prior to menses [41.94 ng/ml + 1.76(S.E.)] compared to mean positive LUAT values obtained on the first day
of menses and shortly thereafter [66.42 ng/ml + 6.36 (S.E.)]. This difference is highly significant P < 0.001 and suggests that neuroendocrine-immune-ovarian interaction may influence the availability of Bb antigen in urine. The results of this clinical study also demonstrate that collection of urine for LUAT determinations should include multiple samples obtained on the first day of menses and 3-4 days after that to optimize detection of urinary Bb antigen in women with recurrent menstrual cycles.