2024-02-27 16:14:15
Dealing with recurrent urinary infections (also called recurrent, chronic or repeated cystitis, editor’s note), it’s dealing with more than occasional discomfort. It’s as if we find ourselves in an endless battle against an invisible adversary who transforms simple everyday activities into challenges.
UTIs occur when bacteria sneaks into the urinary system, causing pain and requiring frequent trips to the bathroom.
Recurrent urinary infections go even further: they reappear several times or never completely disappear despite treatment. Recurrent UTIs are usually diagnosed when a person experiences two or more infections within six months or three or more within a year.
(In France, the High Authority for Health speaks of “acute recurrent cystitis” when faced with, at least, four episodes of cystitis or urinary infection during a period of 12 months, editor’s note.)
Everyone can be affected. But some people are more prone to it because of their constitution or certain hygiene habits. Women are more likely to get UTIs than men, due to their shorter urethra and hormonal changes related to menopause, for example, which can diminish the protective layer of the urinary tract. Sexually active people are also at greater risk, as bacteria can be transferred to the genital area.
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Up to 60% of women will have at least one urinary tract infection in their lifetime. Although there are effective treatments, around 25% of women experience recurrent infections within six months. About 20-30% of urinary infections do not respond to standard antibiotics. The challenge with chronic UTIs lies in the bacteria’s ability to protect itself against treatment.
Why are recurrent UTIs so difficult to treat?
Formerly considered simple infections treated with antibiotics, we now know that recurrent urinary infections are complex. The cunning nature of the bacteria that causes this condition allows them to hide in the walls of the bladder, out of reach of antibiotics.
Bacteria form biofilms, a sort of protective barrier that makes them almost impervious to standard antibiotic treatments.
This ability to evade treatment has led to a worrying increase in antibiotic resistance, a global health problem that renders some conventional treatments ineffective.
Some antibiotics are no longer effective against urinary infections. Michael Ebardt/Shutterstock
Antibiotics need to be refined to keep up with changing bacteria, just like the flu vaccine, which is updated every year to combat the latest strains of the flu virus. If we used the same flu vaccine year after year, its effectiveness would decrease, in the same way that overused antibiotics lose their effectiveness against bacteria that have adapted.
But fighting antibiotic-resistant bacteria is much more difficult than keeping the flu vaccine up to date. Bacteria evolve in ways that are more difficult to predict, making it more difficult to develop effective new antibiotics. It’s like an endless game in which bacteria are always one step ahead.
The treatment of recurrent urinary infections still largely relies on antibiotics. But doctors are getting ingenious, changing medications or prescribing low doses over a longer period of time to thwart the bacteria.
Doctors are also placing more emphasis on thorough diagnostics to accurately identify recurrent UTIs early on. By asking detailed questions about the duration and frequency of symptoms, healthcare professionals can more easily distinguish isolated episodes of UTI from chronic conditions.
The approach to initial treatment can significantly influence the likelihood that a UTI will become chronic. Early, targeted treatment, based on the specific bacteria causing the infection and its sensitivity to antibiotics, can reduce the risk of recurrence.
For postmenopausal women, estrogen therapy has shown promise in reducing the risk of recurrent UTIs. After menopause, decreasing estrogen levels can lead to changes in the urinary tract that make it more susceptible to infections. This treatment restores balance to the vaginal and urinary environments, reducing the risk of urinary tract infections.
Lifestyle changes, such as drinking more water and following certain hygiene rules, such as washing hands with soap after using the toilet and wiping back and forth, as recommended for women to do so, also play an important role.
Some people swear by cranberry juice or dietary supplements. But researchers are still evaluating the real effectiveness of these remedies.
What treatments could be developed in the future?
Scientists are currently working on new treatments for recurrent urinary tract infections. A promising avenue is the development of vaccines that would aim to prevent urinary tract infections in general, just as flu vaccines prepare our immune system to fight the flu.
New treatments could help eliminate recurring UTIs. guys_who_shoot/Shutterstock
Another new method being studied is called phage therapy. It uses special viruses called bacteriophages that only attack and kill the bad bacteria that cause UTIs, while leaving the body’s good bacteria alone. This way the bacteria do not become resistant to the treatment, which is a great advantage.
Researchers are also exploring the potential of probiotics. Probiotics introduce beneficial bacteria into the urinary tract to outcompete harmful pathogens. These good bacteria take up space and resources in the urinary tract, making it more difficult for harmful pathogens to establish themselves.
Probiotics can also produce substances that inhibit the growth of harmful bacteria and strengthen the body’s immune response.
Recurrent UTIs represent a significant challenge, but with current treatments and promising research, we are getting closer to the day when they will be a thing of the past.
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