The Path Forward

The Path Forward

First, find out what is going on. In patients suffering from recurrent UTI, I recommend the use of a PCR based test. I recommend Vero Diagnostics (https://verodx.com), Pathnostic’s Guidance test (https://www.pathnostics.com) or MicrogenDx’s Level 2 urine test (https://microgendx.com/patients/).

Vero Diagnostics is unique in that a patient can self-order the test and get recommendations from a pharm D specializing in UTI’s. Guidance looks at the PCR of over 45 different microorganisms but then offers Pooled Antibiotic Susceptibility Testing (P-AST). This is a unique way of looking at how the group of microorganisms respond to a variety of antibiotics. MicrogenDx’s test looks at a smaller group of PCR but then runs next gen sequencing (NGS). This can find pathologic bacteria and fungi who may have mutated and don’t show up on PCR. In my opinion the biggest downside of NGS is that we find the healthy bacteria too and it can be difficult to separate out what is pathologic.

Second, make sure there is nothing else going on. In patients who have not responded to standard treatments I recommend a kidney and bladder ultrasound and cystoscopy. This makes sure you don’t have something that is preventing you from getting rid of your infections. You may have kidney stones, outpouchings of the bladder or urethra, or a bladder that doesn’t empty.

Lastly, start treatment. My goal is ultimately to get patients off antibiotic but something that has taken years to build up may take months to years to treat. My philosophy is check, treat, recheck and maintain. Make sure you are doing the simple things like drinking lots of water and urinating after intercourse. In post-menopausal women without history of breast cancer I often recommend bioidentical vaginal estrogen. I’m also a fan of natural treatments, specifically proanthocyanidins (PAC) and d-Mannose (use link) which bind to bacteria and help prevent bacterial adhesion.

The goal is to get your life back. It may take work but you are worth it!