What’s a CHRONIC UTI (cUTI)?
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A cUTI is similar to a normal UTI, but instead of the bacteria floating around freely in the urine, where they rapidly multiply and can be easily reached by antibiotics, the bacteria have embedded in the bladder wall where they can multiply more slowly and are much harder to reach.
It’s extremely common for a cUTI to develop after treatment for a normal UTI. For some reason (probably antibiotics that were given too late, or for too short a period, or at a low dose/prophylactic course, or maybe the wrong antibiotic altogether) some of the free-floating (planktonic) bacteria manage to escape and hide in the bladder lining. Here, in safety, they can rapidly form sophisticated self-defence mechanisms (known as biofilms) on the surface of, and inside, the bladder cells. This protects the bacteria from any further antibiotic penetration and immune attack and allows them to continue growing, multiplying and reinfecting new bladder wall cells, all the while causing on-going or periodic UTI symptoms.
Researchers are working to understand why this happens, but an estimated 20–30 percent of people treated for acute UTI will fail to respond to an initial course of antibiotics and go on to develop complications like this.
Once a UTI develops into a chronic state, it’s extremely difficult to diagnose using standard techniques,and even harder to treat. People with a cUTI will present to their doctors with obvious (and sometimes not so obvious) UTI symptoms, but will mostly return negative dipstick results. If a sample is sent to the lab for a mid-stream urine (MSU) culture, it will often come back with low levels of white blood cells (leukocytes), raised epithelial cells and no significant growth, mixed growth of no significance, or no growth. This is analysed by the lab as negative for infection, likely contamination and no further action required. These patients generally remain untreated and their infections are left to fester.
At some point, as symptoms worsen and sometimes new ones develop,the patient will be referred to a specialist to explore their on-going symptoms. They endure typical invasive procedures, such as cystoscopies, bladder biopsies, urethral and bladder stretches and various other imaging and urodynamic studies. It is common to then be diagnosed with a ‘syndrome’ or given a ‘diagnosis by exclusion’, such as ‘interstitial cystitis’ (IC) or ‘painful bladder syndrome’ (PBS). Other diagnoses include ‘over active bladder syndrome’ (OAB) or ‘recurrent UTI’ (rUTI). It is estimated that 12 million people in the UK suffer from a ‘bladder condition’, with around 500,000 diagnosed with the IC/PBS label—for which there is no effective treatment and no cure.
For those who are fortunate to receive a correct cUTI diagnosis, the only current available treatment is long-term, standard dose, oral antibiotic therapy. However, an innovative treatment for cUTI is currently in development in the UK which will potentially supersede the current reliance on long-term antibiotics.