Breakthrough research set to change treatment of chronic UTIs

As someone who is neither a doctor nor a woman, I cannot claim to have any great knowledge of urinary tract infections (UTIs). But having been the partner of someone who has, I know it can be a very uncomfortable experience. For those with chronic UTIs, it’s debilitating.

And so it is with great delight I have learnt of scientific breakthroughs that could provide much-needed relief. What’s more, those breakthroughs have occurred in Australia.

Chronic UTIs – past and present attitudes and treatment

As delighted as I am about these breakthroughs, I am sure women will be much more so. Especially those who have suffered chronically from UTIs because, historically, they have been shamefully ignored.

Why have chronic UTI sufferers been ignored? The following fact probably provides the biggest clue: women get UTIs up to 30 times more often than men.

Though the balance has certainly changed in recent decades, medicine and medical science has traditionally been the domain of men. With so few men experiencing UTIs, it’s easy to see that as a major factor in minimising their potential impact.

In fact, many women have stated that doctors have not simply minimised but trivialised their often very painful experiences.

Mother of four Lisa George, who had chronic UTIs for decades, provides one example. “I was told it was all in my head and I needed better hygiene. I was told to take antidepressants. I’ve had a specialist say to me, ‘The only thing I can do now is remove your bladder’.”

Sadly, Ms George’s experience is not rare. Imagine, though, if the ratio of infection had been reversed – with men 30 times more likely to get a UTI. One suspects that earlier progress in this area of medicine may have been achieved.

Big breakthroughs

Two scientific breakthroughs that could reshape the diagnosis and treatment of UTIs focuses very much on chronic cases. First, data suggests that four in 10 women with a UTI will get at least one more within six months.

But this data has been almost certainly misleading. It has now been demonstrated that these are not recurrent infections at all. They are, in fact, a single chronic infection the body has been unable to eradicate. This revelation has huge implications for treatment strategies.

Second, scientists have now found that the bladder epithelium is not exactly what they thought it was. The epithelium is the bladder’s initial layer of cells, and it has long been characterised as impermeable.

However, a discovery at the Children’s Hospital at Westmead has exploded that characterisation as a myth. Westmead paediatric urologist Ani Deshpande examined a bladder tissue sample taken from a 10-year-old patient. In that sample, he found the presence of colonies of ‘embedded’ bacteria within the girl’s bladder cells.

This discovery reinforces the new notion of a single chronic UTI as opposed to multiple episodes. Previous theories had posited that some UTIs will go on to become chronic because bacteria penetrates the bladder lining.

It then establishes colonies of pathological bugs within the cells of the bladder wall. The bacteria are then released into the bladder periodically. In turn this causes a re-emergence of UTI symptoms, creating the false impression of a ‘new’ infection.

Rethinking chronic UTI treatment

This mischaracterisation of a chronic UTI as separate infections has led to patients being prescribed a short course of antibiotics. It now appears that this common practice – a standard three-day course – fails in severe cases.

Urologists now say particularly severe infections require 10 days to two weeks of antibiotic treatment. This longer course would likely ward off the risk of infections becoming chronic.

President of the Urological Society of Australia and New Zealand Professor Helen O’Connell is now calling for change. She says the latest breakthroughs require updated national therapeutic guidelines to address the issue of chronic UTIs.

Have you suffered from recurrent UTIs? Do you believe they may have been a single chronic episode? Let us know via the comments section below.

Also read: Australia ‘losing the war’ against drug-resistant infection

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