Add UTIs to the List of Antibiotic-Resistant Scary Shit

UTIs are a common, hellish bacterial infection, as nearly anyone with a vagina can attest; nearly 50 percent of women will get one in their lifetime. The fact they’re so common would make you think doctors have figured out how to painlessly and expeditiously treat them, but the reality is that, according to a report from Elemental, Medium’s new health and wellness blog, the way they’re currently treated—by bombarding the infection with several different types of antibiotics when one treatment doesn’t work—may make things worse.

The report shares the story of a woman who showed symptoms of a UTI, and was prescribed increasingly stronger antibiotics, as earlier rounds failed to clear the infection. Even after several cycles of antibiotics she kept getting UTIs “every couple months for the next two years.” At one point, she showed signs of a kidney infection. One doctor, James Malone-Lee, who teaches nephrology at University College London, believes relying on rounds of antibiotic treatment may clear the way for resistant strains of bacteria:

The number one driver of resistance is antibiotic use itself, so by prescribing multiple types of antibiotics, her doctor may have inadvertently enabled several resistant strains to take hold, he says.

“In an environment where there’s resistance and you expose populations of microbes to antibiotics, many of them will be able to switch on genes that they’ve had for millennia which will prevent them from being affected by the antibiotic,” Malone-Lee says.

Antibiotic resistance is a growing problem around the world, beyond UTIs. But the bladder’s naturally rich microbiome often leads to signs of bacterial resistance showing up in urine cultures—leading doctors to up-the-ante by prescribing stronger drugs. (For the record, some doctors are starting to believe urine cultures are a terrible way to diagnose, because it’s nearly impossible to isolate good bacteria from infectious ones.)

Physicians are worried that an over-reliance on antibiotics will lead to a feedback cycle, where more patients present UTI symptoms that are resistant to antibiotics, and that their treatment options will dwindle as time goes on. Popular Science reported on the worst case scenario of one woman in the United States, who “was treated for a UTI, and the bacteria in her infection were found to be resistant to colistin—one of the strongest ‘last resort’ antibiotics we have.”

Malone-Lee has a solution. Instead of prescribing an increasingly severe antibiotics, Malone-Lee gives all of his UTI patients the same antibiotic—cephalexin—and keeps them on for longer periods of time it until they no longer show any signs of a UTI. Sometimes this could mean years of taking the drug. In July 2018, Malone-Lee and an number of other doctors and specialists published a study that showed positive results by treating patients in this way over the course of 10 years.

Until doctors uniformly adopt a method proven to protect the health of my uretha, I will be adopting constant vigilance: making sure to (continue) washing my hands, like, all the time and peeing after sex.