White blood cells seen under a microscope in a urine sample from a person with a urinary tract infection
Early intervention is key to preventing chronic UTI
Urinary tract infections accounts for 1-3% of all GP appointments. Even for simple infections rates of recurrence are high:
- Around 20-30% of patients don’t get better with initial antibiotic treatment
- Up to 70% experience another UTI within a year.
Up to 1.6 million women in Britain suffer from chronic lower urinary tract symptoms. A significant number of men and children also suffer. But NICE guidance does not exist for chronic UTI and there is no quality standard for recurrent UTI.
Negative dipstick tests and mid-stream specimens of urines and the failure of short courses of antibiotics are for many persistent UTI sufferers the first step to a diagnosis of interstitial cystitis, painful bladder syndrome, urethral syndrome or overactive bladder.
But numerous studies have shown dipsticks and MSUs to be unreliable.
Dipsticks detect only 40% of chronic infections (1, 2) and the MSU culture misses 90% of chronic infections (1, 2).
Burgeoning evidence suggests chronic lower urinary tract infections are caused by untreated bacterial infections – not inflammation.
Patients get stuck in a chronic UTI loop.
“I am seeing increasing numbers of women (and some men) affected by chronic and recurrent UTI, both in my work as a GP, and in the Community Urology clinics. Many have had symptoms for several months or even years, and due to negative urine tests have often been assured that no infection is present. We desperately need to build consensus, and work towards a better evidence base, on how to recognise and treat recurrent / chronic UTI.”
Chronic UTI factsheet for GPs
Our chronic UTI guide evidences the problems with testing and gives advice to medical professionals on how best to help patients.
All the information is based on the latest scientific research. We worked with specialists and GPs to make sure we got it right.
Chronic UTI factsheet for GPs (opens as PDF)
“Chronic and recurrent UTI are common conditions that profoundly affect sufferers’ health and wellbeing. Inaccurate diagnostic tests and inappropriate treatments result in many patients remaining undiagnosed, inadequately treated or even receiving an incorrect diagnosis. This is a travesty because if recognised, properly tested for and appropriately treated, patients can frequently have complete resolution of symptoms.”
Research into chronic urinary tract infections
Find the latest clinical research on chronic UTI. Some of the most important recent findings include:
The MSU culture test
Midstream urine culture (MSU) are still widely seen as the gold standard diagnostic test for acute UTIs. But this research found that MSUs
- miss a wide variety of bacteria
- can’t distinguish between infected patients from normal controls
Sathiananthamoorthy, S., Malone-Lee, J., Gill, K., Tymon, A., Nguyen, T.K., Gurung, S., Collins, L., Kupelian, A. S., Swamy, S., Khasriya, R., Spratt, D.A., Rohn, J. (2019). Reassessment of routine midstream culture in diagnosis of urinary tract infection. Journal of Clinical Microbiology, 57(3), e01452-18.
Successful treatment of chronic UTI with narrow-spectrum, first-generation antibiotics
An observational study in 2018 reported 10 year data from a specialist centre on 624 patients with CUTI treated successfully with long-term, full-dose, narrow-spectrum, first-generation antibiotics.
- The lengthy full-dose regime manages to suppress the bacterial activity as they emerge from the shed urothelium, thereby preventing reinfection of young and deeper cells.
- In this study, 84% of patients rated their condition as “much better” and of those, 64% rated their condition as “very much better.”
- On average it took 383 days of continuous treatment to achieve symptom resolution.
Swamy, S., Barcella, W., De Iorio, M., Gill, K., Khasriya, R., Kupelian, A. S., Rohn, J. L., & Malone-Lee, J. (2018). Recalcitrant chronic bladder pain and recurrent cystitis but negative urinalysis: What should we do?.
International Urogynecology Journal, 29(7), 1035–1043.
About the Chronic Urinary Tract Infection Campaign – CUTIC
We work closely with healthcare professionals to help people affected by chronic UTI get diagnosed and then receive the best treatment and care.
We believe that chronic UTI sufferers deserve better testing and treatment that works. These goals shape our work:
- Raising awareness about chronic urinary tract infection
- Challenging current tests which fail to diagnose about half of UTIs
- Gaining recognition and proper treatment guidelines for chronic UTI
- Challenging the diagnosis of interstitial cystitis, painful bladder syndrome and urethral syndrome
- Making effective specialist treatment for chronic UTI available to all.
If you’d like to get involved with our work or have feedback on our chronic UTI guide please email us at firstname.lastname@example.org
Please note we can’t answer emails about individual urinary tract health issues or recommend appropriate specialists, treatments or medications.
1. Sathiananthamoorthy, S., et al., Reassessment of Routine Midstream Culture in Diagnosis of Urinary Tract Infection. J Clin Microbiol, 2018
2. Gill, K., et al., A Blinded Observational Chort Study of the Microbiological Ecology Associated with Pyuria and Overactive Bladder Symptoms. Int Urogynecol J, 2018
"I was told that I had interstitial cystitis and that all they could do was manage my symptoms. This procedure made my condition far, far worse than I was able to cope with. In time, I lost my identity, my job and all of my confidence."
"This treatment, as clichéd as it sounds, has given me my life back. Having to plan trips and paths around toilet locations is incredibly draining, especially for somebody deemed to be in the prime of life."
“I had not experienced any particular bladder problems until the onset of this bladder condition three and a half years ago. Several urine tests taken in the GP surgery and samples sent to the laboratory came back as clear apart from three tests that registered as ‘mixed growth’ and were interpreted as contamination. I was...