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Recurrent UTI

Updated: Apr 9

Recurrent #cystitis reportedly occurs in about 25% of women within months after a first episode, which far exceeds recurrences from other infections. Cystitis investigations reveal a worryingly high rate of associated #antimicrobial resistance (#AMR) compared with other common infections, suggesting bacteria survive our treatments, adapt and reinfect. Dead bacteria don’t do either, so despite clinical recovery, evidently many cystitis treatments, even uncomplicated ones, fail to eradicate the pathogens.

Evidence from mouse experiments indicates bacteria can find sanctuary intracellularly, but researchers report they haven’t found intracellular bacterial colonies in pig or human urothelium, despite looking for many years.

We can reliably test for resolution of other infections but not for cystitis. A post-treatment mid-stream test wouldn’t pick up bacteria adherent to urothelial cell membranes.

Symptom relief following cystitis treatment requires no special confirmatory test, but the ultimate test of efficacy must be infection resolution through uropathogen annihilation. Should we be satisfied that current treatments could cause these “downstream” complications, without investigating efficacy further? Should we be resigned to accepting it is beyond our ability to produce such a test and instead provide for increases in the number of recurrent and chronic cystitis clinics as patients return in misery in increasing numbers and AMR progresses relentlessly, demonstrating our failure with those patients and as guardians of the future of healthcare?

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