Management of uncomplicated recurrent urinary tract infections

Abstract

To discuss optimal management of recurrent urinary tract infections (UTIs) in women. About every second woman experiences at least one UTI in her lifetime, of those 30% experience another UTI, and 3% further recurrences. Especially young healthy women without underlying anatomical deficiencies suffer from recurrent UTIs (rUTI), which are associated with significant morbidity and reduction in quality of life. MethodsThis is a narrative review, investigating publications dealing with recurrent UTI in women. Risk factors and options for management are discussed. ResultsThe increased susceptibility of women to rUTI is based on the female anatomy in addition to behavioural, genetic, and urological factors. However, why some women are more likely than others to develop and maintain rUTI remains to be clarified. Invasive characteristics of certain uropathogenic Escherichia coli that are able to form extra-and intracellular biofilms and may therefore cause delayed release of bacteria into the bladder, may play a role in this setting. Treatment recommendations for an acute episode of rUTI do not differ from those for isolated episodes. Given the nature of rUTI, different prophylactic approaches also play an important role. Women with rUTI should first be counselled to use nonantibiotic strategies including behavioural changes, anti-adhesive treatments, antiseptics, and immunomodulation, before antibiotic prophylaxis is considered. In addition to the traditional treatment and prophylactic therapies, new experimental strategies are emerging and show promising effects, such as faecal microbiota transfer (FMT), a treatment option that transfers microorganisms and metabolites of a healthy donor's faecal matter to patients using oral capsules, enemas, or endoscopy. Initial findings suggest that FMT might be a promising treatment approach to interrupt the cycle of rUTI. Furthermore, bacteriophages, infecting and replicating in bacteria, have been clinically trialled for UTIs. ConclusionDue to the limitation of available data, novel treatment options require further clinical research to objectify the potential in treating bacterial infections, particularly UTIs.

Association of Cervical Dysbacteriosis, HPV Oncogene Expression, and Cervical Lesion Progression

“…Previous mechanistic studies have shown that, through inhibiting the expression of the HPV E6/E7 oncogene, suppressing the proliferation and metastasis of the cancer cells, and promoting the apoptosis, Lactobacillus or Lactobacillus supernatant could significantly inhibit the progression of cervical cancer in vitro and in vivo ( 18 – 20 ). Furthermore, through producing antimicrobial agents, competitively inhibiting the adhesion of pathogenic bacteria and viruses, and maintaining a low pH and local anti-inflammatory microenvironment ( 21 ), the dominant Lactobacillus community state types (CST I, CST II, and CST III) could effectively maintain a healthy vaginal environment, which could exert a vital role in the elimination of HPV infection ( 22 , 23 ). Furthermore, a recent study using transgenic mice showed that HPV oncoproteins can greatly inhibit the expression of host defense peptides, which were the source of essential amino acids for the survival of vaginal commensal Lactobacillus , downregulating these innate immune molecules that ultimately lead to dysbiosis of the vaginal microbiota ( 24 ).…”

The Role of Biofilms in the Pathogenesis of Animal Bacterial Infections

“…Following infection, different scenarios may occur depending on the infective agent, host immune defense, and site affected. The cells in biofilms may remain hidden from the body’s immune system due to the protection of the matrix or due to intracellular biofilm formation [ 13 , 14 ], which will permit chronic subclinical infections to occur. Activation of both the innate and adaptive immune systems may also ensue, leading to a longstanding inflammation, mainly with polymorphonuclear neutrophils (PMNs).…”

Emerging Non-Antibiotic Options Targeting Uropathogenic Mechanisms for Recurrent Uncomplicated Urinary Tract Infection

“…Therefore, rUTIs may present as either relapsing infections due to an incomplete clearance of uropathogens within two weeks of the treatment course or reinfection, which occurs two weeks after treatment completion. The majority of rUTIs are clinically categorized as reinfections [ 7 ]. On the other hand, women are vulnerable to UTIs because of their anatomical structure [ 8 ], including the fact that women have (1) a short distance between the urethral meatus and non-sterile anus, which allows for easier access for uropathogens to the lower urinary tract, and (2) a short urethral length without a complex structure, which facilitates the entry of uropathogens into the bladder.…”