Woman 2 Woman - Urinary Tract Infections : Bane of a woman’s life

Posted on

24 July 2016

| Last updated on 17 August 2016

Urinary Tract Infections: Bane of a woman’s life

It is ironic that with my medical specialty being infections, I have been the longest sufferer of this infection. My personal experience with this malady started with ‘honeymoon cystitis’ and had I not been married to a physician who took charge of my infection that rapidly spread to make me so sick that I had to be hospitalized, I would’ve died on my honeymoon! Over the years, my life has become one long saga of living from one UTI to another, hospitalizations, investigations galore, one antibiotic to another and one prevention technique to another. I think I’ve probably tried every trick in the book from guzzling insane amounts of water every day to all possible homeopathic, ayurvedic tablets and even cranberry juice! No amount of knowledge or experience has helped in mitigating this scourge for me personally . At every conference , meeting , update in literature, I have thirsted for some clues that will help me understand and let alone the world, at least save me from the pain & suffering.

It is without doubt that urinary tract infections (UTIs) are one of the most common bacterial infections. The self-reported annual incidence of UTI in women is 12%, and by the age of 32 years, 50% of all women report having had at least one UTI. So I am not alone, but how does that help?

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To clarify the nitty-gritty of how bacteria get into the normally sterile urinary tract, they first step is the nasty bacteria sticking (colonization and adherence) to the urinary tract. Normally, bacteria can live around the urethra and colonize the urine, but are washed out while passing urine . Disturbances in this process as, for example, urogenital manipulations or medical interventions, even plain healthy normal sex sadly facilitate the movement of bacteria to the urethra and are therefore well known risk factors to develop a UTI.

Recently, two review papers in Current Opinion Infectious Diseases, provide very interesting new insights into the enigma of (recurrent) UTI. The studies help in some way to make clear that it is not only the bacteria sticking to the lining of urinary tract but more complex mechanisms that are in play in the way the microbes interact with the poor host. In the first report, the authors have tried to explain the differences in the way the body’s immune system reacts to the bugs. It may range from protecting the lining from infection or in some poor sufferers actually allow infection, based on their genetic make-up . Knew it was my genes that are to blame. It seems that different genetic mechanisms are present in the development of lower (bladder infections) and upper(affecting kidneys) UTIs.

They go on to say that molecular information is now available to improve diagnosis and to assess the risk for chronic problems. After having suffered for years, the threat of complications like kidney failure, high blood pressure ,dialysis and transplantation loom large on my horizon in my advancing age. For younger sufferers there is always the risk of spontaneous abortions and growth retarded babies with recurrent UTIs and asymptomatic bacteriuria, so under no circumstances can take these infections be treated as trivial no matter the age of the women.

In the second review, the investigators undertake to understand recurrent infections. Studies in animals show that chronic bladder swelling during prolonged bacterial infections actually causes changes in the lining of the bladder that sensitizes the poor host to a new infection. This is a very interesting concept, since many studies among young healthy women with lower UTI (cystitis) have shown that the infection recurs in 25% of women within 6 months after the first UTI. So , for me the culprit was that nasty first infection that ruined my honeymoon and ever since then it’s been a long saga long enough to fill a textbook on UTI. I have been on every antibiotic known and believe me I know many. Have been on every possible prophylactic regimen from long term 3 years of non-stop antibiotics to post-coital prophylaxis regimes. And yet the suffering continues.

Much work needs to be done towards understanding how the inherent immune responses vary in people and the changes in the urinary bladder lining that affect the easy entry of bugs into the lining to allow infection. Although the risk of a second UTI is strongly influenced by sexual behavior (abstinence is the only way out!), women with a first UTI caused by Escherichia coli are more likely than those with another causative microorganism of their first UTI to have a second UTI within 6 months. And my cultures initially were always E coli. After reading these reviews, I was tempted to share my thoughts, sadly only doubts but no firm answers.

It is clear that the pathogenesis of such a common infection as a UTI remains fascinating, and the results of such reports are very important in unraveling all the steps, because they might present new targets for saving women, many of whom suffer in silence. And certainly not force us poor worldly souls to become true ‘sanyasins’.