Treating UTIs—where to from here

The discovery that the bladder isn’t sterile has opened up new avenues of treatment for urinary tract infections (UTI).

Here, Imelda shares her story including why research is vital.  Below Dr Samuel Forster recaps his UTI research, where research needs to head next, and how further research could find a breakthrough treatment.

Imelda’s story

I have been suffering with urinary tract infections (UTIs) for over three decades.  Most women know how awful UTIs are because it is such a common infection. But unlike most women who are treated and fully recover, my UTI would always come back.  Each time I had a UTI, I would be in excruciating pain. I couldn’t think straight or function normally. My life would grind to a halt until I could get to a doctor and get the antibiotics I needed.

For people like me with chronic UTI, antibiotics help for a while, but the infection would return and you go through the whole cycle again. You are either living with the pain, or in continual fear of the pain returning. It is miserable and can feel very isolating.

Over the 30 years I have been dealing with UTIs, nothing much has changed in terms of treatment or understanding the behaviour of such a prevalent health condition. I have had mixed experiences with doctors both in Australia and France. Most have genuinely wanted to help, while others were dismissive and appeared disinterested. But still, no-one could ever tell me why these infections kept coming back.

At most appointments the doctor would send off a urine sample for testing. Over my many years of experience, I have randomly had tests come back negative despite having all the usual debilitating symptoms and signs. I could never understand how this could be. I am lucky that I have only occasionally been denied antibiotics based on a negative test, but I know not all UTI sufferers have the same experience.

At one point I was told I had an incurable inflammatory bladder condition. I was devastated, so I desperately tried many different treatments: Chinese medicine, acupuncture, faecal transplants, pelvic floor exercises, I even had surgery in France which did nothing to help. The faecal transplants reduced the pain significantly in the short-term, so I do believe gut health somehow plays an important role, but none of these treatments managed to eradicate my infections completely. Still, no doctors were any closer to understanding my condition.

Like many women, my UTIs are often triggered by sex. I am in a loving, 30-year relationship with my husband and this has been one of the biggest challenges we have had to face.  As you would expect, avoiding sex simply to avoid another acute flare can put pressure on even the most secure, loving relationships. This is something we have had to be conscious of.

Things improved when I learnt about a UTI clinician-researcher expert in England. I found a GP who agreed to treat me following the protocol developed for chronic UTI.  After just four weeks on a full dose of the right antibiotic, I was about 80 percent better. It hasn’t been a perfectly smooth road to recovery. However, after two years of focusing on this treatment, I am about 90 percent better. This means acute episodes are becoming less frequent and I am back to living a busy and fulfilling life. I can be a better mother to my kids. I am advancing in my career.  I am not forever visiting doctors. And I am not always exhausted from my body constantly dealing with an infection, or worried about when the next acute episode will hit. I have my joy and my energy back. It’s a wonderful feeling.

It is important that UTI research is supported in Australia. There are some wonderful researchers, both here and overseas, who know just how urgent it is to develop a better understanding of UTIs, and how to best diagnose and treat this condition so it doesn’t develop into a cruel, life-altering, chronic condition. I was surprised to learn there have been virtually no advancements in UTI diagnostics and treatment, on a clinical level, for the last 50 years.  With growing concerns that UTIs are becoming more resistant and harder to treat, and global fears over antimicrobial resistance in all infections, including UTIs, it is more important than ever that our researchers be given the resources they need to tackle this very serious public health issue.

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Learn more about chronic UTIs at Chronic UTI Australia.

Dr Samuel Forster recaps his UTI research, where research needs to head next, and how further research could find a breakthrough treatment.

Can you tell us about your UTI discovery?

I worked with scientists from the Wellcome Sanger Institute and the Loyola University of Chicago to use culturing and genomics to show the female bladder is home to a community of bacteria—similar to the gut microbiome—even in the absence of infection.

Dr Sam Forster with researchers

Historically, the female bladder has been considered sterile except in women with urinary tract infections (UTI). It was a finding that redefined the way we think about the treatment of UTIs.

What does this mean for those who are affected by a chronic UTI?

To diagnose a UTI, the standard process is to analyse urine in a pathology test to detect whether known pathogens, such as E. coli, are present in the bladder. This test considers a range of known pathogens and will determine the best antibiotic for treatment.

However, there is another section of the population, potentially 50–80 percent of UTI patients, who present with the symptoms of having a UTI, but the pathology test comes back negative. We don’t have any way to treat these people.

From our discovery, we now know there are many types of bacteria in the bladder and urinary tract—including bacteria that are believed to be harmless when found elsewhere in the body.

It is possible that for these patients, the infection is being caused by another strain or type of bacteria that we are not currently able to detect either due to limitations of the current testing or the location or behaviour of the bacteria.

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What are the next steps for furthering this research?

What we want to do next is test if the other untested bacteria present in the bladder of someone with an undiagnosable UTI could cause the infection. To do this we would use a combination of genomic sequencing and culturing of the bacterial communities present in people suffering with chronic UTIs.

If we could identify the exact bacteria causing these infections, we can find a targeted treatment for that bacteria.

There is a push to see less use of antibiotics. By looking to find a new antibiotic, or repurpose an existing one, to treat chronic UTI will this process lead to more antibiotic-resistant bugs?

It’s not that we shouldn’t be using antibiotics, it’s just that we should be considering our use of them, and seeing if we can come up with more targeted alternatives.

In instances where people have chronic UTI, they may well be taking antibiotics that aren’t targeted to the bacteria actually causing the infection. This is the kind of antibiotics use we need to avoid.

If we can identify the pathogen causing the infection the first time a patient visits the doctor, and can deliver a targeted, narrow spectrum antibiotic—this is a much better use of antibiotics. And it would actually reduce the use of unnecessary, non-targeted antibiotics. It would also prevent patients suffering with chronic undiagnosed infections.

Studies have shown some bacteria get inside the cells lining the bladder—which makes them difficult to both detect and treat. Will this work detect those bacteria?

Currently, detection is very difficult because we don’t know what we are looking for. We’re hoping with this study we will uncover more information on the location and behaviour of bacteria that cause chronic infections.

 

Research Group leading this work