Cystitis: the burning need for new treatments
Urinary tract infections are the frontline of the war against bad bacteria. So why has it taken so long to develop new treatments?

Ask a woman to write down a list of the most painful health conditions she has ever experienced and it is highly likely that cystitis will appear somewhere towards the top. Just over half of all women will suffer from the world’s most common urinary tract infection (UTI) at some point in their lives.

About one in four will go on to suffer from recurrent episodes, classified as three times within one year, or two within six months. Chief among the symptoms are a sudden and frequent desire to urinate, followed by a painful, burning and stinging sensation when doing so.

Cystitis is particularly common among young, sexually active, or post-menopausal women. Yet despite its ubiquity, treatments have barely changed in decades and diagnosis still relies on lab analysis that can take days and often misses half of all infections.  

Many researchers attribute this to the fact that cystitis is largely a female condition and women’s diseases have historically not attracted the same level funding that men’s have. But the good news is that change is coming, not least because certain bacterial strains have become resistant to the frontline antibiotics used to treat them.

Why do women get more UTIs?

Women are 30 times more likely than men to get one. The main reason relates to anatomy. Women have shorter urethras than men, making it easier for bacteria to reach the bladder and inflame it.

Female urethras are also much closer to their rectums, causing infections from bacteria in faecal matter. The most common culprit is E.coli: one 2018 study found 12 separate strains that had found their way from chicken the women had consumed, through their faecal matter to a UTI infection.

Other factors increasing the likelihood of an infection include being diabetic: this puts sufferers at risk of klebsiella and group G streptococci-based UTIs. Scientists believe this is either because high glucose levels in urine speed up bacterial growth, or nerve damage impacts the bladder’s ability to sense the presence of urine and need for urination.

Post-menopausal women are also at higher risk because of changing hormones. Declining oestrogen levels prompts a reduction in the amount of beneficial bacteria (lactobacillus) in the vaginal flora, making room for bad bacteria instead. One option to rectify this is a vaginal oestrogen cream

A new antibiotic on the horizon

Cystitis sufferers often want instant relief rather than waiting an agonising few days for lab tests to determine what strain of bacteria has caused the infection. But this makes it far harder for doctors to prescribe the right antibiotic to kill it.

For many years, the mainstay in combating cystitis was ampicillin until some bacteria became resistant to it. Certain strains have also become harder to kill after learning to develop a biofilm (protective armour), which antibiotics cannot penetrate.

In 2013, the US government responded to the need for more antibiotics of all kinds by setting up the Biomedical Advanced Research and Development Authority (BARDA). One partnership with the pharmaceutical giant GSK has led to the first new prospective oral antibiotic for cystitis in two decades: gepotidacin.

GSK is planning to submit an application for the drug this spring after stopping trials early because the drug was so effective. It works by blocking enzymes the bacteria need to replicate.

Alternative treatments to antibiotics

Recent studies have also pinpointed alternative treatments.

In 2021, UK researchers suggested that the antiseptic methenamine hippurate works well against some UTI strains. It acts as an antimicrobial by sterilising urine. However, women who take it need to avoid dairy products, fruit and other foods that make their urine less acidic.

And there is cranberry juice, often the first port of call at the first sign of an infection. Supporters believe that one of its compounds, tannin, stops UTI-causing bacteria sticking to the urinary tract lining.

A 2017 study suggested that it reduced the risk for women with a history of cystitis by 26% . Yet other studies have found inconclusive evidence and the FDA’s latest guidance concludes that there is: “limited and inconsistent credible scientific evidence” of its efficacy.

However, increasing fluid intake when infected can make a difference because it helps to flush bad bacteria out.

What else can women do prevent cystitis. Here are a few tips:

  • Clean the genital area before and after sex and urinate as soon as possible afterwards
  • Completely empty your bladder
  • Wipe from front to back after using the toilet
  • Avoid spermicidal contraceptives, diaphragms and vaginal douching
  • Increase probiotic intake by eating more fermented products such as yoghurt, kimchi and sauerkraut

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