Urinary tract infection affects 50% of women and is poorly treated – 02/14/2023 – Equilibrium

For Melissa Wairimu, a video editor in Nairobi, Kenya, the symptoms started at age 21.

She had to urinate constantly and felt a burning sensation at this time. Her back hurt too.

A urine culture test confirmed the diagnosis of urinary tract infection (UTI). “I didn’t even know this existed,” she says.

She was prescribed a broad-spectrum antibiotic for seven days and told to drink plenty of water.

But the symptoms kept coming back, sometimes even stronger. Back pain spread to the abdomen.

Wairimu felt constantly tired, but found it uncomfortable to lie down.

“You get that feeling you need to go to the bathroom,” he explains.

It kept her awake. And the inability to sleep worsened the tiredness, making it difficult for her to stick to her busy work schedule.

Wairimu feels that the doctors have not heard her. They told her that her UTIs could be sex-related – even though she wasn’t having sex at the time.

Doctors seemed to be in a hurry to make assumptions and prescribe different antibiotics, but this did not solve the problem.

Wairimu sympathizes with the six doctors he has consulted over the years. She believes they didn’t have enough training in recurrent UTIs.

She then had to look for information on the internet, where she found stories of people in similar situations.

That took her to the group Live ICU Free (“Viva Livre de ITU”, in free translation), where she now works.

Frustration

Wairimu began changing her diet to see what would keep her symptoms under control. Four years later, the problem has not disappeared, but the discomfort has become milder.

Make medical appointments one after another. Not to be taken seriously. Being subjected to treatments that only work in the short term (if they work at all).

These are the experiences shared by Wairimu and other women who suffer from “complicated UTIs”, defined as those with the highest risk of treatment failure, with an estimated 250,000 cases per year in the United States alone (there are no Brazilian statistics on the subject).

Many patients, clinicians, and researchers are frustrated by the lack of progress in the fight against common and more complicated UTIs. But they hold out hope for changes in the future.

poorly understood infection

Symptoms of a UTI include painful or burning urination, frequent or sudden urges to pee, cloudy, bloody, or foul-smelling urine, pain in your back or lower abdomen, and fever or chills.

This is usually caused by the bacteria. Escherichia coli, or simply E coli.

Many other microorganisms can also be to blame for the condition, but there is little research on these and also on the even rarer strains of E coliaccording to researcher Jennifer Rohn, director of the Center for Urological Biology at University College London, in the United Kingdom.

A UTI can cause cystitis, an inflammation of the bladder, explains Chris Harding, a urologist at Freeman Hospital and Newcastle University, also in the UK.

There are other types of UTIs, but cystitis is the most common.

UTIs are extremely common, and affect at least half of all females at some point in their lives.

They are especially prevalent among young, sexually active women and those who are postmenopausal, contextualizes Rohn.

Genetics, hormones and anatomy all come into play. Women and girls are especially affected because they have shorter urethras than men. This makes it easier for bacteria to reach the bladder.

Although UTIs are classified as infectious diseases, they are not contagious. However, the bacteria responsible can be transmitted from person to person during sexual intercourse.

It is worth noting that men can also get a UTI, especially when they are older. In nursing homes, urinary tract infections are the most common type of condition caused by microorganisms.

Worldwide, UTIs affect an estimated 150 million people each year, but this already widespread problem is sure to become even more common as the world ages.

“And that’s a very important reason why seniors end up in the hospital,” explains Rohn.

Normal part of ‘being a woman’

Because UTIs are common and generally uncomplicated, many doctors view them as a normal part of being female.

This attitude, however, increases the risk of trivializing the most serious cases, which are countless.

One estimate is that, like Wairimu, 25% of women with at least one UTI will have recurrent episodes: at least two episodes every six months or three a year. Many have even more.

In addition to recurrent UTIs, there is increasing awareness of the chronic form of this disease, sometimes referred to as a long-term UTI.

Essentially, some people live with symptoms for several days without any relief. However, there is almost no official recognition of this condition, which drags on for longer.

Detection

Even relatively simple UTIs end up impaired at the time of diagnosis. Typical tests to detect the condition are urine tests and urine culture, but these methods are not sensitive enough to be reliable.

On the other hand, new generation molecular tests are almost too sensitive, and detect any pathogen, even if it is not related to the problem. In addition, this technology is much more expensive.

Traditional urine tests are inexpensive but often give misleading results. The urine culture test, which involves growing the bacteria in the laboratory from a pee sample, was developed in the 1950s with pregnant women who had kidney infections.

In other words, a standard test for UTIs is derived from outdated research that wasn’t even specific for this disease in the past.

delayed education

As with testing, medical education remains outdated. Harding learned as a medical student that the bladder was a sterile environment (ie, where there are no microorganisms).

This misconception has led to confusion about how to interpret the evidence for bacteria living in that organ.

To this day, Rohn lectures to medical students who incorrectly believe that urine is a sterile liquid.

While researchers are aware of the lack of adequate evidence, the latest information “does not seep into clinical practice,” says Carolyn Andrew, director of the Campaign on Chronic Urinary Tract Infections (Cutic), a UK-based patient advocacy group United.

wrong diagnosis

Like many people who suffer from chronic UTIs, Andrew also received the wrong opinion.

Upon developing the first symptoms, UTI tests came back negative and she was diagnosed with interstitial cystitis (IC), or bladder pain syndrome.

IC treatments were painful and only made things worse.

The following year, when Andrew saw a specialist, she was finally treated for the chronic UTIs.

“Thank God someone is listening to me,” she remembers thinking. The treatment would take nearly four years to clear the infection, but Andrew is grateful for the end result.

She believes that a diagnosis based on symptoms, rather than ineffective tests, would have given some more effective answers.

Rohn points out that diagnosis based on symptoms has become common sense for people with recurrent UTIs, since the patients themselves can recognize and report the typical discomforts of the condition.

“We should start taking women and their symptoms more seriously,” suggests Rohn.

‘Perfect Storm’

Rohn believes that a “perfect storm” of signs and perceptions explains why UTIs have been so overlooked: “It’s a female disease. It affects the elderly too. And it’s down there. [na lista de prioridades]”, it says.

“The painting is also perceived as a minor thing”, Rohn reckons.

As UTIs are generally not fatal, they do not attract the same levels of funding and attention as other pathogen-related conditions.

But urinary tract infections can cause death from sepsis or kidney damage.

“People don’t realize that bacterial infections are very dangerous if not treated properly,” explains Rohn.

These infections can be not only threatening from a health point of view, but profoundly harm personal and professional life.

Andrew lived with constant pain and pressure on his bladder before finally receiving treatment for a chronic UTI.

In her work with the Cutic group, she saw people so desperate that they asked for their own bladders to be removed.

The antibiotic dilemma

For those women lucky enough to be accurately diagnosed, treatment can be a minefield.

In Kenya, Wairimu was given antibiotics virtually indiscriminately.

In the UK, the standard course of antibiotics for treating urinary tract infections in women is three days. For men, whose cases are automatically considered complicated, the deadline is seven days.

The disparity is frustrating for some patients.

Rohn believes that the three-day treatment period, with the limited list of antibiotics available, is not enough for many of the women.

One of the main reasons for the limited duration of treatment is concerns about antimicrobial resistance (where bacteria and other microorganisms develop ways to survive drugs).

That’s justified, but too often concerns about antimicrobial stewardship overlook people who are suffering, argues Rohn.

A paradox is that first-line treatment of UTIs can cause these infections to become chronic or recurrent, with hidden bacteria that evade medicine.

In these cases, more antibiotics may be needed.

For recurrent UTIs, patients are usually treated with antibiotics for longer periods. This happened to Andrew, who was torn between public and private health before finding relief.

Many others lack the resources or level of education to persist in their quest for better care.

Change perspectives

Several efforts are underway to improve the diagnosis and treatment of UTIs.

In response to the loss of effectiveness of antibiotics, researchers are trying to redirect existing drugs or increase their effectiveness in the tissues where they are needed.

Last year, pharmaceutical company GSK also reported promising test results for a new oral antibiotic. If approved, it would be the first developed in over two decades to treat uncomplicated UTIs.

Given the huge problem of drug-resistant superbugs, alternatives to antibiotics are also needed.

Harding offers patients vaginal estrogen supplements as a non-antibiotic option, but there are promising signs that antiseptics may also work. In addition, there are some vaccines against UTIs in development.

Basic research also plays an important role in understanding the urinary tract.

Rohn says “mouse models reigned supreme” in UTI research for many years, even though rodents have different urinary functions than humans.

Unlike us, these animals do not store urine for a long time. And they don’t even get UTIs naturally.

Rather than relying solely on mouse-based experiments, Rohn and his colleagues designed a 3D model of a human bladder that can mimic the flow of urine in a real organ to make studies and projections.

“It’s very exciting to be at a time when these human modeling techniques are entering a renaissance,” enthuses the expert.

In the meantime, greater awareness of UTIs and a willingness to take them seriously could help alleviate the suffering of women like Wairimu and Andrew, who have struggled for years to find answers.

This article was published in BBC Future. Click here to read the original version (in English).

This text was originally published here