Medical leaders call for treatment and testing overhaul of urinary tract infection

The nation’s medical leaders have united to call for the recognition of chronic urinary tract infection amid widespread evidence that thousands of women are being misdiagnosed and undertreated.

Thousands of women are being misdiagnosed as medical leaders call for Australia to recognise chronic UTI.

The nation’s medical leaders have called for the recognition of chronic urinary tract infection amid widespread evidence thousands of women are being misdiagnosed and undertreated.

Urological Society of Australia president Helen O’Connell, Australian Medical Association president Steve Robson, Royal College of General Practitioners primary care guidelines expert Magdalena Simonis and Westmead pediatrics professor of urology Ani Deshpande have penned an article in the Medical Journal of Australia InSight journal calling on the medical profession to recognise chronic UTI is an infection embedded in the wall of the bladder – as first reported by The Australian in a major series of articles this year.

Professor Helen O'Connell

Many doctors believe the infection is simply recurrent, not embedded or chronic. The professors state “it is evident that some infections can be chronic or persistent” and “this is an important paradigm shift imparting practice and policy implications”. They call for Australia to recognise chronic UTI as has the National Health Service in the UK.

The doctors state “chronic UTI has caused unremitting suffering in many women and their physical pain has often been compounded by a lack of understanding of the condition”. They note a substantial body of evidence now suggests our diagnostic criteria are neither sensitive nor specific enough to detect many cases of chronic UTI, and have called for a pathology testing overhaul. UTI is the most common reason for the prescription of antibiotics but midstream urine testing is so flawed that up to 50 per cent of cases of infection are missed.

“Many clinicians remain unfamiliar with the diagnosis of chronic urinary tract infection, leaving many women and girls to suffer without the right support,” the article says. “Studies suggest that as many as one-third of patients treated according to current clinical guidelines fail to respond to treatment. Chronic UTI has caused unremitting suffering in many women and their physical pain has often been compounded by a lack of understanding of the condition.”

Moves are under way within the pathology profession to re-examine the thresholds for the detection of bacterial growth in midstream urine sample testing, with many sufferers routinely failing to culture bacteria in the petri dish despite having active infection. And the presence of white blood cells and epithelial cells in these patients’ urine samples is often dismissed as sample contamination when in fact it likely indicates infection.

The article notes many women are denied antibiotics when in need because of a misunderstanding of chronic UTI.

“Many specialists – gynaecologists, urologists, infectious disease physicians and GPs – remain unfamiliar with the diagnosis of cUTI and the failings inherent in our current interpretation of investigations. The time has come to recognise a condition that has been a source of misery for many women and girls. Clinical awareness followed by treatment aimed at eliminating chronic bladder wall colonisation of pathogens may lead to complete recovery.”

Natasha Robinson was a co-author of the MJA InSight article