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per month. Slows. Full turns at mintmobile.com. It

1:14

can start with a suspicious

1:16

twinge. An urgent

1:19

need to pee. Tummy pain.

1:22

Then comes the burn. Anyone

1:29

who's had a urinary tract

1:31

infection knows how agonizing they

1:33

can be. Some infections go

1:36

away on their own. Many

1:38

need antibiotics. Simple.

1:41

Except beneath the surface

1:43

of this very common infection,

1:45

there's a lot of mystery,

1:48

unanswered questions, and

1:50

unnecessary suffering. And

1:52

it gets to the heart of

1:54

the challenge of tackling antimicrobial resistance.

1:58

Once you get a recurrent UTI, I'm afraid that the. chances

2:00

of getting another one are quite high. It's

2:02

almost as if you don't clobber it the

2:04

first time, it's more likely to get entrenched

2:06

and come back again and again. About

2:11

20 to 30% of all UTIs recur within

2:13

about six months. But

2:18

for some, they never go away.

2:21

I literally kept a record of how often I

2:23

was having to go to the loo. And

2:25

it was eight times in an hour, every

2:28

hour, every day. And of

2:30

course, when that happens to you, you withdraw

2:32

into your own world of pain. Chronic

2:38

UTIs also present another problem.

2:41

Often the infections don't show

2:43

up on tests. It

2:47

was like being slapped in the face, first of all. And

2:50

at the time, I was naive

2:52

enough to think, well, the doctors know best.

2:54

And if they're telling me there's no infection,

2:57

then, okay, it must be something else.

3:00

But as researchers learn more about

3:02

the problem bacteria, they're understanding why

3:04

our current tests and treatments just

3:06

aren't up to scratch. You know,

3:08

I know it's a terrifying and

3:10

awful thing, but it's also really

3:12

fascinating. And I have a lot

3:14

of respect for the bacteria because

3:16

they are tiny, tiny little things. They're

3:19

two microns. They're tiny little things. And

3:21

they can bring people to their knees.

3:23

And they have so many ways to

3:25

outmaneuver us. So

3:29

today we're asking, what's the

3:31

latest understanding of UTIs? What's

3:34

happening when someone gets a chronic

3:36

infection? And is there anything

3:38

on the horizon that could help

3:40

flush an infection without contributing

3:43

to our overuse of antibiotics?

3:48

From The Guardian, I'm Madeline Finley, and

3:50

this is Science Weekly. Dr

3:58

Jenny Rohn, your hair... of the

4:00

Centre for Urological Biology at University

4:02

College London. First of all, can

4:04

you explain what a UTI is

4:07

and who's most at risk of

4:09

one? A UTI is simply

4:11

an infection of the urinary tract,

4:13

which is basically your waterworks. That

4:15

can be your kidney, your

4:17

bladder, your urethra, which is the little tube

4:19

that connects the bladder to the outside world.

4:21

But usually when you hear the term UTI,

4:23

you're talking about a bladder infection. And

4:25

these are caused by bacteria. There are

4:28

a lot of bacteria living in your back passage, as we

4:30

all know. Most of them are friendly,

4:32

but some of them are not friendly. And

4:34

they can, in certain situations, can migrate into

4:36

the urethra and then up into the bladder

4:38

and cause problems. And although

4:40

anyone can get a UTI, it is

4:43

most common in women, probably because of

4:45

the anatomy. So our back passage is

4:47

much closer to the urethra than a man's back

4:50

passage. It can also be very

4:52

common in children and also in the elderly,

4:54

things start to equalize a bit and men

4:56

start getting UTI as much as women. But

4:58

by and large, this is a disease of

5:00

women and about one in two women will

5:02

get one in their lifetime. Right.

5:04

So bacteria that migrate from the

5:06

back passage to the urethra can

5:09

cause a UTI. But

5:11

how exactly does that happen? And how

5:13

does an infection then take hold? So

5:15

they get up there, they climb up

5:17

through the urethra and end up in

5:19

the bladder. So there's lots and lots

5:21

of urine and the urine is flowing

5:23

the wrong direction. It's trying to wash

5:25

out all the bacteria. But these uropathogens

5:27

or bacteria that cause UTI have

5:30

all sorts of tricks in order to cling

5:32

in in this inhospitable environment.

5:34

So they have sticky appendages that

5:36

help them to latch on to

5:38

the bladder wall despite the urination.

5:41

And they also have ways of hiding

5:43

from the immune system and from antibiotics.

5:46

Two of these ways are one, they can actually

5:48

burrow into the bladder wall, which is kind of

5:50

horrific to think about. So they actually dive

5:53

into your cells and take up residence

5:55

inside them. It's nice and cozy. There's

5:58

plenty of nutrients in there. there's

6:00

no antibiotics, there's no

6:02

immune system. Another thing that

6:04

bacteria can do is they can form these slimy

6:07

communities known as biofilms on the inside of

6:09

the bladder wall. And these were also very

6:11

resistant to antibiotics in the immune system. Those

6:13

are two that I've mentioned, but there are

6:16

dozens and dozens of strategies they

6:18

have to get around our defenses and

6:20

our drugs. It's so impressive.

6:22

And I wonder, once you've got

6:25

this UTI, how do

6:27

they tend to be diagnosed and how

6:29

accurate is a diagnosis? How easy is

6:31

it to pick up that somebody has

6:33

got a UTI? Diagnosis

6:35

is definitely a problem. If

6:37

you have a really raging UTI, you don't really

6:39

need diagnosis. You'll be well aware

6:42

if you've had one that it's obvious,

6:44

right? Your urine is full of cloudy

6:46

pus, often blood. You've got terrible pain

6:48

when you urinate. Nevertheless, the GP

6:50

still wants to see some evidence that you've got

6:52

a UTI. And so what normally happens is you

6:54

get a dipstick, a little piece of paper is

6:57

dipped into your urine and it changes color if

6:59

you've got a UTI in theory. And

7:01

then if it looks like you've got a UTI

7:03

based on the dipstick, they'll send your urine

7:05

off for midstream culture. They try to

7:07

grow bacteria from your urine. Now, both

7:10

of these techniques are a

7:12

little bit flawed and they're very old fashioned. I

7:14

want to point out that the midstream urine culture

7:16

was pretty much invented by Alexander Fleming in the

7:18

1920s and things

7:20

like the dipstick, they don't work very

7:22

well. They're very insensitive. So imagine you've

7:24

got an infection and a lot

7:26

of the bugs are actually hiding in biofilms or

7:28

hiding in your bladder wall. Then the bugs won't

7:30

be in your urine or they'll be in your

7:32

urine at a very low level. So these tests

7:35

often fail to pick up a bona

7:37

fide UTI. It's kind of

7:39

like tossing a coin, whether you're going to test positive for

7:41

UTI if you have maybe a lower

7:43

grade infection that wouldn't show up in these very

7:46

old fashioned tests. A

7:51

2017 study found that

7:53

UTI diagnostic tests gave the wrong

7:55

result in at least a fifth

7:58

of cases. To people

8:00

with chronic UTIs, infections that

8:02

don't go away after a

8:04

typical course of antibiotics, this

8:07

can be a real problem and make

8:09

diagnosis very hard. As Carolyn

8:11

found, she was on a

8:13

trip up to Scotland in 2015 when

8:15

she was hit with an initial infection.

8:18

We got as far as Beric on Tweed

8:21

and I suddenly thought, God, I've got

8:23

UTI, how weird. Come out of nowhere.

8:26

And it got worse and worse and by the time we

8:28

got up to Edinburgh, I was rushing to

8:30

the loo, I was in pain, saw

8:32

a GP there and I

8:34

got a call two or three days later

8:36

to say the test had showed negative there

8:38

was no infection, which was really strange.

8:41

When her first course of antibiotics didn't clear

8:43

the infection, she went back to her GP

8:46

at home for more tests. My

8:48

own GP could not identify a

8:50

UTI. The test kept coming back

8:52

saying nothing abnormal

8:54

discovered or contaminated, simply

8:57

nothing. I was

9:00

starting to think I was going mad,

9:02

inventing it all in my head. So

9:04

while the tests weren't picking up

9:07

Carolyn's infection, she had

9:09

to suffer through months and months

9:11

of living with an unabated UTI.

9:14

Obviously at that point, you're thinking, well, how

9:16

am I going to live like this? You

9:19

know, I love to go to the theatre, I

9:21

love to do all sorts of things. I couldn't

9:23

go anywhere. Your sex life is

9:26

an impossibility like if you're in

9:28

that much pain. My life had

9:30

become so tiny. When

9:32

you don't know if you're going to get any

9:34

better, it is just

9:36

horrific and depression

9:38

kicks in. My greatest salvation

9:40

was finding a group

9:43

that I could work with and talk

9:45

to of other women who had similar things and

9:47

we'd have lunch in a local pub and everybody

9:49

would talk about it and help each other. Then

9:53

Carolyn found Professor James Malone

9:55

Lee, who was pioneering research

9:57

and treatment for chronic UTIs.

10:00

including the long-term use of

10:02

antibiotics. I was on antibiotics for

10:04

three and a half years and gradually,

10:07

gradually my symptoms started to get

10:09

better and I started to have

10:12

the odd good day. Today,

10:15

Carolyn is UTI free.

10:18

But despite her success, the

10:20

long-term use of antibiotics is

10:22

a fine balance. It

10:25

doesn't come with outside effects

10:27

and the risk of antimicrobial

10:29

resistance. Currently, the guidelines

10:31

state that men should be prescribed

10:33

five to seven days of antibiotics,

10:35

whereas women are typically given a

10:38

three-day course. Campaigners like

10:40

Carolyn argue that this often

10:42

isn't enough to clobber that

10:44

initial infection and prevent UTIs

10:46

coming back. But

10:49

if we don't tackle antimicrobial

10:51

resistance, we won't have

10:53

anything to treat UTIs with. Back

10:55

to Jenny. Antimicrobial resistance has been

10:57

on the rise for the past century. The

11:00

number one resistant bug at

11:02

the moment, according to the

11:04

WHO and a few other studies, is E.

11:07

coli. So E. coli is the most common

11:09

UTI bug. It's also the one that's the

11:11

most resistant. It's really a problem. So the

11:13

more antibiotics humans take and animals, the

11:16

more drugs are out there in the environment, in the

11:18

water supply, in the soil, and then

11:20

every time a bacteria encounters an antibiotic, those

11:23

that can resist will survive and

11:25

those that will die will die. So that

11:27

just selects evolutionarily for

11:30

bacteria that are resistant. And then they love spreading

11:32

these resistance genes around. They spread on little things

11:34

called plasmids, little bits of DNA, and they're like

11:36

business cards. The bacteria can pass them from one

11:39

to the next, say, hey, I've got this really

11:41

useful bit that allows me to resist

11:43

penicillin. Would you like it? If

11:45

you don't do something about it, pretty soon we'll

11:47

be back to an era where you can't have an

11:49

operation, even a routine operation, because it will be too

11:52

risky. That's obviously terrifying.

11:54

So is there anything else

11:56

that can help treat UTIs

11:58

or other... non-antibiotic treatment options

12:01

that are on the horizon.

12:03

There are some pretty good studies with D-manus. D-manus

12:05

is a sugar you can buy over the counter.

12:08

It prevents certain bacteria from binding to the

12:10

bladder wall. It's got some pretty good data.

12:12

There's a little bit of controversy. And

12:14

equally, cranberry extract, again, people go back and forth

12:17

about whether this is useful. But by and large,

12:19

the studies suggest that it can help a little

12:21

bit. But these are very sort of modest

12:24

weapons against UTI. I would consider using

12:26

them, but they're not going to be

12:28

as good as antibiotics when antibiotics work.

12:31

As far as the future, there are a

12:33

few things on the horizon. Disappointingly few, I

12:35

would say. This whole area has been neglected

12:37

for decades. There isn't a lot of research.

12:40

There isn't a lot of drug development, most

12:42

likely because it's a women's disease. People aren't

12:44

interested in it. And it's not necessarily going

12:46

to be a blockbuster drug. And

12:49

maybe there's no profit margin in it.

12:51

But there's a few things on the

12:53

line. There's an interesting new vaccine called

12:55

Uramune, which has been reporting some excellent

12:57

findings. I should also mention probiotics. People

12:59

are looking at using our good bacteria to

13:01

fight the bad bacteria. And I think that's

13:04

a very promising strategy. Jenny,

13:06

this infection is so common.

13:08

It affects 400 million people

13:11

every year worldwide. And yet we're

13:13

nowhere near the kinds of tests

13:15

and treatments that we need. What

13:17

needs to happen, do you think?

13:20

This would all start with awareness that

13:22

it is a serious problem. We need

13:25

better education at the medical school curriculum.

13:28

So I teach medical students as my job as a

13:30

professor. And most of them have

13:32

absolutely no idea that UTI is a complex

13:35

disease in the textbooks, all as well. It's

13:37

just a trivial disease. You

13:39

diagnose it this way and you treat it this way.

13:41

The students have no idea. This

13:46

lack of knowledge around UTI's

13:48

and chronic infections, not

13:50

just amongst medical students but

13:52

doctors and even sufferers, was

13:55

something Carolyn and her support group were

13:57

keen to tackle themselves. up

14:00

a not-for-profit company called

14:02

Chronic Urinary Tract Infection Campaign,

14:05

CUTIC. What we'd

14:07

really like is to see the

14:09

women's health strategy expanded to include

14:12

chronic UTI. And if

14:14

we get a change of government, we

14:16

would like the new health minister, whoever that's

14:18

going to be, to actually

14:20

take notice of chronic UTI and

14:23

be prepared to talk to us and the specialist

14:25

doctors to have a look at how we can

14:27

get to the bottom of this disease In

14:30

five years from 2018 to 2023, there have been over 1.8 million

14:32

admissions for UTI. And

14:38

these are NHS England's own statistics.

14:41

And the NHS mortality rate for

14:43

UTI is 4%. So

14:46

four people in every hundred will

14:49

die of UTI. And

14:51

chronic UTI is still not taken

14:53

seriously. Finally,

14:58

Jenny, what advice would you give

15:01

to maybe somebody listening today who

15:03

might want to protect

15:05

themselves from a UTI or

15:07

perhaps thinks that they have a UTI

15:10

but isn't getting the treatment that they

15:12

feel they need? Well, protection

15:14

from UTI, there's no simple

15:17

answer, but it is widely

15:19

understood that you do need

15:21

to have good hygiene. Of course, if

15:23

you produce feces, you should wipe from

15:25

front to back. People say it's useful

15:28

to urinate before and after sex, and

15:30

you can understand why because you can

15:32

sort of flush out the waterworks. Drinking

15:35

lots of water is important. The more you

15:37

urinate, the more you'll be sort of

15:40

facilitating that natural flushing process.

15:42

Don't hold your urine in because it's

15:44

known that retaining urine will

15:47

then set up a situation where you're sort

15:49

of fermenting the urine in there. It should

15:51

be being flushed out constantly. So don't hold

15:53

your urine. As far as if you think you

15:55

have a UTI and you're not sure

15:57

and you go to your GP and they fob you

15:59

off. Say, listen, I've got

16:01

these symptoms. I know that

16:03

the diagnostic tests are a

16:05

little bit insensitive. I would like

16:07

to insist on a second opinion or I would

16:09

like you to take the test again. And if

16:12

the test come back negative, I'd like

16:14

to have a course of antibiotics. And if

16:16

then it clears up, I know that I had one. I

16:19

don't know how successful you'll be because

16:21

of antimicrobial resistance. Most GPs

16:23

are under orders not to give unnecessary antibiotics. So you

16:25

might have a fight on your hands. But

16:27

I know a lot of patients are successful

16:29

just by advocating for themselves and being quite

16:31

verbal. So maybe don't take no for

16:34

an answer. A

16:36

big thanks to Dr. Jenny Rohn and

16:38

to Carolyn. You can

16:40

find out more about Carolyn's campaign, CUTIC,

16:43

at cutic.co.uk. And

16:48

we've put a link to that in the show description. And

16:51

if you've been following our general

16:53

election coverage on the Politics Weekly

16:55

podcast, you might have

16:58

noticed that you haven't heard from

17:00

our political editor Pippa Creira and

17:02

correspondent Kieran Stacy yet this week.

17:06

Well, they've been busy on the campaign

17:08

trail and they're going to be back

17:10

on Thursday with all their insight and

17:13

a late night analysis of the

17:15

twists and turns of the last

17:17

TV debate before the election. So

17:20

just search for Politics Weekly UK

17:22

wherever you listen to your podcasts.

17:27

And that's it for today. This

17:29

episode was produced by me, Madeline

17:32

Finley and Holly Fisher. It was

17:34

sound designed by Joel Cox and

17:36

the executive producer is Ellie Burey.

17:39

We'll be back on Thursday. See you then. Here's

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