Health: Why do I always get urinary tract infections? And why are they so difficult to treat?

Urinary tract infections occur when bacteria enter the urinary system, causing pain and requiring frequent trips to the bathroom.

Recurrent UTIs go even further : they recur repeatedly or never completely disappear despite treatment. Recurrent UTIs are usually diagnosed when a person experiences two or more infections within six months or three or more within a year.

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How to avoid urinary tract infections this summer?

Heat, dehydration, conditions conducive to the proliferation of bacteria... Summer is here, and with it factors that promote urinary tract infections. "Caused by bacteria, they affect women more often than men because their urethra, the tube that connects the bladder to the outside world, is shorter. This makes it easier for bacteria to enter the bladder," recalls the Vidal medical dictionary.

(In France, the High Authority for Health speaks of “recurrent acute cystitis” when there are at least four episodes of cystitis or urinary tract infection over a period of 12 months, editor’s note.)

Anyone can be affected. But some people are more prone to them due to their constitution or certain hygiene habits. Women are more likely to get urinary tract infections than men , due to their shorter urethra and hormonal changes related to menopause, for example, which can reduce the protective layer of the urinary tract. Sexually active people are also at greater risk, as bacteria can be transferred to the genital area.

Up to 60% of women will experience at least one UTI in their lifetime. Although effective treatments are available, approximately 25% of women experience recurrent infections within six months. Approximately 20-30% of UTIs do not respond to conventional antibiotics . The challenge with chronic UTIs lies in the ability of bacteria to protect themselves against treatments.

Once considered simple infections treated with antibiotics, we now know that recurring urinary tract infections are complex. The cunning nature of the bacteria responsible for this condition allows them to hide in the bladder walls, beyond the reach of antibiotics.

Bacteria form biofilms, a kind of protective barrier that makes them almost impervious to standard antibiotic treatments.

This ability to evade treatment has led to a worrying increase in antibiotic resistance, a global health problem that renders some conventional treatments ineffective.

Antibiotics need to be refined to keep pace with evolving bacteria, just like the flu vaccine, which is updated annually to combat the latest strains of the flu virus. If we used the same flu vaccine year after year, its effectiveness would diminish, just as overused antibiotics lose their effectiveness against bacteria that have adapted.

But fighting antibiotic-resistant bacteria is much more difficult than updating the flu vaccine. Bacteria evolve in ways that are harder to predict, making it harder to develop new, effective antibiotics. It's like a never-ending game in which bacteria are always one step ahead.

Treatment for recurring urinary tract infections still relies heavily on antibiotics. But doctors are becoming ingenious, modifying medications or prescribing low doses for longer periods to outsmart the bacteria.

Physicians are also placing greater emphasis on thorough diagnostics to accurately identify recurring UTIs early on. By asking detailed questions about the duration and frequency of symptoms, healthcare professionals can more easily distinguish isolated episodes of UTI from chronic conditions.

The initial treatment approach can significantly influence the likelihood that a UTI will become chronic. Early and targeted treatment, based on the specific bacteria causing the infection and its sensitivity to antibiotics, can reduce the risk of recurrence.

For postmenopausal women, estrogen therapy has shown promise in reducing the risk of recurrent urinary tract infections. After menopause, declining estrogen levels can lead to changes in the urinary tract that make it more susceptible to infections. This treatment restores balance to the vaginal and urinary environments, reducing the risk of urinary tract infections.

Lifestyle changes, such as drinking more water and following certain hygiene rules, such as washing hands with soap after using the toilet and wiping from front to back, as women are advised to do, also play an important role.

Some people swear by cranberry juice or dietary supplements. But researchers are still evaluating the actual effectiveness of these remedies.

Scientists are currently working on new treatments for recurring UTIs. One promising avenue is the development of vaccines that would aim to prevent UTIs altogether, just as flu vaccines prepare our immune systems to fight the flu.

Another new method under study is called phage therapy. It uses special viruses called bacteriophages that attack only the bad bacteria that cause urinary tract infections and kill them, while leaving the body's good bacteria alone. This prevents the bacteria from becoming resistant to the treatment, which is a major advantage.

Researchers are also exploring the potential of probiotics. Probiotics introduce beneficial bacteria into the urinary tract to outcompete harmful pathogens. These good bacteria take up space and resources in the urinary tract, making it harder for harmful pathogens to establish themselves.

Probiotics can also produce substances that inhibit the growth of harmful bacteria and strengthen the body's immune response.

Recurrent UTIs are a significant challenge, but thanks to current treatments and promising research, we are getting closer to the day when they will be a thing of the past.