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Chronic Urinary Tract Infection: Is Complete Elimination Possible?

Urinary tract infections (UTIs) are common conditions affecting women and men, with acute and chronic forms characterized by various causes and risk factors. Acute cystitis and urethritis are typical examples of quickly treatable infections requiring timely antibiotic intervention. In contrast, chronic infections like chronic cystitis and prostatitis can cause significant discomfort for patients and necessitate prolonged treatment. Biofilms often play a role in the development of such chronic infections.

What is a biofilm?

A biofilm is a group of bacteria that come together and produce a sticky substance known as an extracellular polymeric substance (EPS). This substance plays a crucial role in the formation and survival of the biofilm, aiding bacteria in attaching to surfaces such as the urinary tract and protecting them from the effects of antibiotics.

How do biofilms form?

The urinary tract provides a favourable environment for bacterial reproduction, with a constant flow of fluid passing through it and collecting in the bladder, creating conditions for bacterial growth. Biofilms form after inadequately treated acute infections and may be responsible for treatment difficulties and UTI recurrences.

Why is it challenging to eliminate biofilms?

While antibiotic treatment destroys some bacteria not part of the biofilm, the biofilm itself is resistant and can persist on the surfaces of the urinary tract. Subsequently, under certain conditions, it may detach, migrate, and trigger new infection flare-ups. This cycle can be challenging to interrupt, especially in the presence of resilient biofilms.

Now that we’ve discussed biofilms, let’s revisit the topic of urinary tract infections.

What is a urinary tract infection?

A urinary tract infection (UTI) is a condition affecting the bladder, kidneys, ureters, or urethra. It is the second most common ailment after the common cold. UTIs occur when bacteria enter the urinary tract, attach to the mucous membrane, and spread. Approximately 80% of cases are caused by the bacterium E. coli, which typically enters the urethra from the gastrointestinal tract.

We’ve covered biofilms, now let’s revisit the topic of urinary tract infections (UTIs).

What is a urinary tract infection?

A urinary tract infection (UTI) is a condition affecting the bladder, kidneys, ureters, or urethra. It is the second most common ailment after the common cold. UTIs occur when bacteria enter the urinary tract, attach to the mucous membrane, and spread. Approximately 80% of cases are caused by the bacterium E. coli, which typically enters the urethra from the gastrointestinal tract.

Urinary tract infections in women:

  • Acute cystitis:
    • Usually caused by bacteria such as Escherichia coli.
    • Characterized by pain during urination, frequent urination, and may be accompanied by lower abdominal pain.
    • Successfully treated with antibiotics.
  • Acute urethritis:
    • Can be caused by bacteria (e.g., Neisseria gonorrhoeae), viruses, or fungi.
    • Manifests as pain during urination and discharges from the urethra.
    • Successfully treated with antibiotics, antivirals, or antifungal drugs depending on the cause.

Chronic urinary tract infections in women:

  • Chronic cystitis:
    • May develop due to multiple episodes of acute infections.
    • Characterized by recurrent pain during urination and frequent urination.
    • Requires prolonged treatment and prevention of recurrences.
    • Resistant to antibiotic treatment.

Urinary tract infections in men:

  • Acute bacterial prostatitis:
    • Caused by bacteria, most commonly Escherichia coli.
    • Presents with pain in the perineal area, urination problems, and may be accompanied by fever.
    • Successfully treated with antibiotics.
  • Chronic prostatitis:
    • Can be bacterial or chronic non-bacterial.
    • Symptoms include pain in the perineal area and urination problems.
    • Treatment may involve antibiotics and other therapeutic methods, often prolonged due to biofilm presence.

What are chronic UTIs?

Let’s delve into chronic infections in more detail. If a UTI occurs more than twice in six months, it is considered chronic or recurrent UTI. One in every five women faces chronic UTIs during their lifetime.

The symptoms of UTIs are often painful. However, chronic UTIs can also lead to more serious problems, such as antibiotic resistance. Since antibiotics are the primary method of treating UTIs, their constant or improper use over time can lead to the body no longer responding to the medications. The reason for this, as you already know, is the presence of biofilms.

Most common symptoms of chronic UTIs:

  • Sudden urge to urinate (urgency) or constant urges to urinate.
  • Feeling like you need to urinate all the time (frequency).
  • Burning sensation during urination.
  • Cloudy/bloody appearance or a strange odour in the urine.
  • Pain in the lower back or abdomen.
  • Pain during sexual intercourse.

Moreover, if left untreated, a UTI can spread to the kidneys and cause serious health complications such as sepsis.

Risk Factors for Developing Chronic Genitourinary InfectionsTop of Form

Risk Factors for Developing Chronic Genitourinary Infections In Women

  1. Anatomical Features: In women, the bladder is close to the vagina and anus, facilitating the transfer of bacteria to the urinary tract.
  2. Physiological Changes: Pregnancy and menopause can alter the bacterial balance in the urinary tract, making it more susceptible to infections.
  3. Sexual Activity: Sex can change the vaginal microflora, increasing the risk of UTIs.
  4. Contraceptive Use: Certain contraceptive methods, such as diaphragms, may elevate the risk of UTIs.
  5. Genetic Factors: Some women may be genetically predisposed to more frequent UTIs.

Risk Factors for Developing Chronic Genitourinary Infections In Men:

  1. Prostatitis: Inflammation of the prostate gland can contribute to the development of chronic UTIs in men.
  2. Obstruction of Urinary Tract: Kidney stones, an enlarged prostate, or other urinary tract problems can create conditions for infections.
  3. Sexually Transmitted Infections (STIs): Some STIs can lead to chronic UTIs in men.
  4. Immune System Disorders: A weakened immune system can increase vulnerability to infections.
  5. Urolithiasis (Stone Disease): The presence of stones in the urinary tract can be a risk factor.
  6. Trauma to the Urethra: For instance, mechanical pressure from a bicycle seat on the perineum and urethra can cause irritation and trauma, creating conditions for bacterial penetration.

Additional Risk Factors for UTIs

This is a list of factors that can also influence the health of the urinary bladder and immunity:

  1. Diabetes Mellitus: Individuals with diabetes mellitus have an increased risk of developing urinary tract infections due to changes in the immune system and elevated sugar levels in the urine, promoting bacterial growth.
  2. Spondylosis of the lumbar spine: Problems with the lumbar spine can affect the function of the bladder and worsen urine drainage, increasing the risk of infections.
  3. Weakened Immune System: People with a weakened immune system, for example, due to immunocompromised conditions or the use of immunosuppressive drugs, are more susceptible to urinary tract infections.
  4. Dementia: Dementia, especially in later stages, can be a risk factor for various conditions, including urinary tract infections. In cases of dementia, changes in behaviour and body functions, including difficulties in self-care and alterations in the ability to control the urination process, are often observed.
  5. Vitamin D3 Deficiency: Vitamin D3 deficiency can have a general impact on the health of the urinary bladder and immunity.
  6. Lyme Disease: Pathogens causing Lyme disease can lead to issues with the urinary bladder.
  7. MTHFR Genetic Mutations: Genetic mutations in MTHFR (a1298c and c677t) may be associated with problems in the urinary bladder.
  8. Systemic Issues such as Candida: Systemic problems, such as Candida (fungal infection), can also influence the condition of the urogenital system.

Types of tests for diagnosing UTIs:

It is crucial to understand that various types of tests exist for checking urinary tract infections (UTIs).

For optimal results, most tests recommend using the first-morning urine. The longer the urine stays in the bladder, the better the sample for testing purposes. The term “clean-catch urine sample” means collecting a urine sample in the middle of the stream to avoid contamination from contact with your skin or other parts of your body.

UTI Test Strips:

These are the simplest office tests. The test strip is dipped into the urine sample, usually during a doctor’s visit. It is a quick and straightforward preliminary test that can detect leukocytes (white blood cells) and nitrites in the urine, indicating the presence of an infection.

It’s important to note that the nitrite test may not detect all types of bacteria, as it relies on the bacterial chemical reaction. There are bacteria incapable of converting nitrates to nitrites, leading to false-negative results. Leukocytes may not be visible enough if the urine is diluted due to increased water intake and more frequent urination.

In general, diet, supplements, medications, and other factors can influence the results of such a test.

Urinalysis (UA):

This is a laboratory analysis conducted on a urine sample, collected and sent for further analysis either on-site or in a separate laboratory. The analysis includes multiple tests consolidated into one report and is used to characterize potential UTIs based on various factors.

The urinalysis examines the physical, chemical, and microscopic aspects of urine. Parameters such as the colour of the urine sample, appearance, specific gravity, urine acidity level, and other factors are assessed as part of the analysis.

  • pH Level: The optimal pH level is 7.2 (either too acidic or too alkaline is suboptimal). This parameter can help determine the type of infection in the urine but is influenced by food and other factors.
  • Red Blood Cells (RBC): Checked for the presence of visible and microscopic blood. In women during menstruation, this parameter may be inconclusive, as the test does not distinguish where the blood in the sample originated.
  • Glucose: The amount of sugar in the urine. Elevated sugar levels may predispose to the development of urogenital infections.
  • Protein: The presence of protein may indicate a UTI, dehydration, kidney problems, or other systemic issues.
  • Ketones: The presence of ketones usually indicates that the body is not receiving enough sugar or carbohydrates. In some cases, it may indicate sepsis.
  • Specific Gravity: Evaluates the body’s water balance and urine concentration. This indicator may be low with excessive fluid intake.

This test may yield false-negative results in the case of chronic infections, so a broad context is essential for its interpretation.

Urinary Culture:

Urinary culture is an essential diagnostic method that detects gram-negative bacteria. The procedure involves collecting a urine sample, which is then sent to the laboratory for culture over 2-3 days. The bacterial growth is analyzed to identify “normal” and abnormal test results.

A normal result suggests a low quantity of bacteria, indicating no infection. However, a low value may be due to the presence of biofilm, making the test falsely negative for chronic infection.

Positive results indicate bacterial or yeast growth in the sample, likely indicating an infection. The test can also identify one or several bacteria.

The urinary culture report includes sensitivity to different antibiotics, presented in a rating of their effectiveness against the detected bacteria.


The urinary tract infection (UTI) test from CirrusDx, including UTIP™ and polyMIC™, is designed to detect and quantitatively determine infectious bacteria, providing information on their sensitivity to antibiotics. This test ensures accurate diagnoses and corresponding prescriptions within one day, detecting both fast-growing gram-negative pathogens and slow-growing gram-positive and tricky bacteria. The test addresses difficulties in clean sample collection, showing all infections in the sample regardless of their quantity and the amount of each type of infection detected.

This test allows for the detection of the problem even when all previously mentioned tests come back falsely negative.

Approach to the Treatment of Chronic Genitourinary Infections

Chronic genitourinary infections may require comprehensive and prolonged treatment for effective resolution of the problem. Here are some approaches to treating this type of infection:

  1. Biofilm Disruption: The use of agents aimed at disrupting the biofilm can improve the effectiveness of antibiotics. These agents include substances that contribute to the breakdown of the bacterial layer.
  2. Antimicrobial Agents: The use of antibiotics may be necessary if natural antimicrobial agents cannot address the problem even after biofilm disruption. Bacteria within biofilms may be more resistant to antibiotics, so testing for their susceptibility to natural antimicrobial agents and antibiotics, as well as the use of prolonged and/or combination treatment, may be considered.
  3. Immunotherapy: In some cases, methods aimed at boosting the patient’s immune system may be employed to enhance its ability to combat the infection.
  4. Treatment of Underlying Conditions: If chronic infection is associated with other medical conditions, such as bladder stones or structural abnormalities, treating the underlying condition may be necessary for complete healing.
  5. Prevention of Genitourinary Infections: It is important not only to cure the current disease but also to prevent its recurrence. Preventive measures may include regular medical check-ups, adherence to hygiene norms, lifestyle regulation, and the use of probiotics to maintain a healthy microflora.

The Ways to Prevent Biofilm Formation

Biofilm formation can be prevented by taking some measures to care for the health of the genitourinary tract. Here are a few tips:

  1. Hydration: Drink an adequate amount of water. The more fluid passes through the genitourinary tract, the more bacteria are flushed out through urine. Regular hydration helps prevent fluid retention, which can contribute to biofilm formation.
  2. Urination Before and After Sexual Contact: Bacteria can easily enter the genitourinary tract during sexual contact. Urinating before and after sex helps remove potentially harmful microbes and prevents their retention in the urethra.
  3. Hygienic Practices: When cleaning the perineum, move from front to back. This helps prevent the transfer of bacteria from the anus directly into the urethra, reducing the risk of infection.
  4. Use of Supplements and Foods: Including cranberry juice, products with lactobacilli, and enzymes in the diet can help maintain a healthy microflora in the genitourinary tract and prevent biofilm formation.

By following these recommendations, the risk of infections can be reduced, promoting optimal health of the genitourinary tract.


Chronic genitourinary infections are a serious condition. Understanding risk factors, diagnostic methods, and treatment approaches plays a crucial role in effectively combating these diseases. In the presence of symptoms of chronic infection, especially with risk factors, seeking help from a specialist is recommended. Thorough diagnostics and a treatment plan considering research results and responses to previous treatment methods are essential. Special attention should be given to identifying and treating the underlying condition that led to chronic infections, with the aim of preventing the formation of new biofilms.