The Tribune

By Dr Greggory Pinto

A belated Mother's Day gift for women in the Bahamas: a ray of hope for women who suffer from recurrent urinary tract infections. Many women are plagued with the pain and tremendous frustration of recurrent urinary tract infections (UTIs).

Recurrent UTIs can lead to many women being fearful to urinate due to the severe associated pain and having increased urinary frequency and urgency that dictates their lives. Bacteria in the urinary tract can lead to UTIs that are usually treated effectively by urinary culture directed antibiotic therapy.

At least half of all women will have one urinary tract infection (UTI) in their lifetime. Approximately 25 percent of women will have recurrent UTIs, defined as at least three UTIs per year or two UTIs in a six-month period.

Antibiotics eradicate one bacteria and predipose to another

A new study published May 2, 2022 in the scientific journal Nature Microbiology has suggested that women who suffer from recurrent UTIs may suffer in a vicious cycle whereby antibiotics eradicate one infection then predispose them to a new one. Researchers at the Washington University School of Medicine and the Broad Institute of Harvard and MIT determined that antibiotics eliminate bacteria in the urinary tract system but not bacteria in the intestines. Remaining bacteria in the intestines can then multiple and spread again to the urinary tract system and lead to another UTI.

Recurrent antibiotic therapy can negatively impact helpful bacteria that inhabit the intestines; termed gut microbiomes. The study found that women who received repeated antibiotics for recurrent UTIs had less important gut microbiomes. These gut microbiomes are linked to the immune system and they are important bacteria that aid in the control of inflammation.

The study has provided important insight into the link between gut microbiomes, antibiotics used to treat UTIs and levels of inflammation. Repeated courses of antibiotics for frustrating recurrent UTIs can make the situation worse.

Ground-breaking vaccine to help prevent UTIs

A scientific trial involving a potential E.coli vaccine is underway in the United Kingdom, conducted by researchers at the pharmaceutical firm Johnson & Johnson. The trial will involve individuals older than 60 who have had a history of urinary tract infections.

E. coli is the most common bacteria that causes UTIs. E. coli is present in human intestines where it is usually harmless, but it can lead to UTIs if this bacteria enters the bladder or kidneys.

This promising Johnson & Johnson vaccine is designed to prevent infections by training the recipients' immune system to recognize the 9 different strains of E. Coli bacteria and send antibodies to attack and destroy the bacteria. The trial is expected to recruit thousands of patients and end in 2025. It is hoped that an annual vaccine given to at risk patients would in the future considerably reduce the number of patients suffering from UTIs.

Antiseptic drug as effective as antibiotics against UTIs

A scientific trial published in the British Medical Journal in May proposes that the antiseptic drug methenamine hippurate is as effective as antibiotics in preventing urinary tract infections in women. Community resistance to many common antibiotics is a worsening problem throughout the world. The hopeful promise of an effective alternative prevention to urinary tract infections would provide potential relief to many recurrent UTI sufferers in the future.

Methenamine hippurate is a drug that sterilises urine and prevents the growth of bacteria responsible for UTIs. The scientific trial proved that this antiseptic drug provided equal protection to UTIs when compared to prophylatic broadspectrum antibiotics.

Numerous causes for recurrent UTIs

Women who suffer from recurrent urinary tract infections must be fully assessed and treated appropriately on an individual basis, as there are multiple potential causes for recurrent UTIs. Women who are poorly controlled diabetics or unknowingly diabetic, are at greater risk for repeated urinary tract infections due to an impaired immune system and are at risk of having diabetic cystopathy. Many women in the Bahamas suffer from diabetic cystopathy, which is a chronic complication of diabetes; characterised by poor bladder filling sensation, larger bladder capacity and impaired ability of the bladder to contract and fully empty. Incomplete bladder emptying puts women at risk for recurrent UTIs; and it can have obstructive and non-obstructive causes.

A common obstructive cause for incomplete bladder emptying in women would be a prolapsed bladder or uterus into the vaginal vault. Neurogenic bladders related to back spinal cord or nerve compression, is a non-obstructive cause for incomplete bladder emptying.

Women as they enter menopause are more likely to have urinary tract infections as a result of lower oestrogen levels, vaginal atrophy, weakening of the pelvic floor muscles and thinning of their urethra which allows bacteria to more easily enter the bladder.

Women who have bladder stones or kidney stones are at increased risk for urinary tract infections as bacteria cling to these stones.

Women, do not let recurrent urinary tract infections create misery and suffering in your life. Seek confidential, compassionate and comprehensive urological care.

• Dr Greggory Pinto is a board-certified Bahamian urologist and laparoscopic surgeon. He can be contacted at OakTree Medical Center #2 Fifth Terrace and Mount Royal Avenue, Nassau, Bahamas; Telephone – (242) 322-1145-7; email: welcome@urologycarebahamas.com or visit the website:www.urologycarebahamas.com