A new database targeting chronic urinary tract infections (UTIs) – a long-overlooked condition that may begin in childhood – is set to help researchers uncover why millions of women and girls worldwide suffer from infections that defy treatment and stump microbiologists.
A growing body of research suggests that persistent, antibiotic-resistant UTIs may be caused by bacteria that embed deep within the bladder wall, potentially evading both the immune system and conventional treatments.
This phenomenon, known as intracellular bacterial colonisation, is not new, but a medical case study of a child with chronic infections, published by the American Society for Microbiology and led by University of Sydney researchers, could reveal just how underestimated its long-term impact may be.
The case study showed that no antibiotic regimen, even aggressive long-term courses, was able to eliminate the infection because the bacteria were embedded inside the inner lining of the bladder, known scientifically as the epithelium. The patient's samples showed no improvement despite years of treatment, raising concerns about current clinical approaches, which remain limited to antibiotic therapy and diathermy – a surgical technique that uses heat from an electrical current to cut or coagulate the bladder lining – and which carries an increased risk of cancer development if performed repeatedly.
Lead researcher Dr Arthika Manoharan from the Charles Perkins Centre and the School of Medical Sciences said there are cases of girls as young as five being treated with antibiotics for years, often relapsing the moment treatment stops.
As a result of the published case study, children under 15 will be the focus of the new database built by Dr Manoharan, which seeks to understand why some people develop chronic UTIs. She hopes it will help remove the long-held assumption that UTIs are linked to sexual activity, exposing a form of medical misogyny that has long minimised the condition's impact on women and girls.
"Often people think of UTIs only affecting adult women who are sexually active, which is not the case. There are many cases where this issue starts in childhood, with no clear cause. This can have a huge impact to their quality of life at a time when they should be enjoying school, playing sports and simply being kids," said Dr Manoharan.
"The longer consequences of persistent UTIs can be severe. Some women see their employment affected due to chronic incontinence; others are unable to maintain a sexual relationship. Many echo the same sentiment: One minute you're fine, the next you're in agony and can't leave the house."
The research team hopes the new database will help them explore whether immune system evasion or genetic predisposition could explain why some children develop chronic UTIs while others don't.
