Why you get a keep getting a UTI after sex

Being scared to have sex because every time you do, the resultant urinary tract infection is unbearable, is a disaster for your sex life. But, there is a reason why this keeps happening, and it’s not because your body is broken.

The way urinary tract infections work is that the bacteria live on your epithelial cells – the most outward-facing cells in the urethra. But, when your body sheds these cells (normal programmed cell death, apoptosis), the bacteria get kicked off, along with their now dead cell, by the immune system.

They realise they’ve been jibbed, and jump off the cell. They then procreate like crazy and make many, many more of themselves. These new bacteria then attach to the fresh epithelial cells underneath.

Bacteria can also hide, dormant, inside your urethral epithelial cells, biding their time. This means you may feel ok after successful treatment for a UTI, but then get flare-ups regularly. The same thing happens when you have sex, but in a more mechanical way.

The epithelial cells shed more during friction, like sex, and the same process occurs. If you are prone to UTIs, the reason you get a seemingly new infection is because the bacteria have just been sitting around waiting to pounce.

It’s not that new after all, just your colonisers doing their thing. When you have chronic UTIs, the tests may come back negative. This is an error, and the wrong testing is being done.

What we know about diagnosing chronic UTI infections

• Dipstick tests are not an effective diagnostic tool
• An active infection may not show anything on culture
• A culture may show normal growth of pathogens and healthy flora, even when you are in the throes of agony
• Urine may not have many white blood cells (pus cells), despite you still having symptoms
• Bacteria can embed themselves in epithelial cells, remaining dormant
• Urine samples that have delayed testing are ineffective at detecting white blood cells in urine, since white blood cells lyse (break up) after 45 minutes in a jar

If you have recurrent UTIs, there are very limited treatments available for you. The latest and greatest is a treatment program devised by Professor James Malone-Lee and his United Kingdom team.

If you are suffering and nobody can help you with recurrent UTI, speak to your urologist, gynaecologist or doctor about completing his treatment program.

It involves lots of antibiotics, for a longer period of time than is normally recommended, and using methenamine (Hiprex). His team’s success rates at clearing up chronic UTI have been phenomenal.

References

• Khasriya R, Khan S, Lunawat R, Bishara S, Bignal J, Malone-Lee M, et al. The Inadequacy of Urinary Dipstick and Microscopy as Surrogate Markers of Urinary Tract Infection in Urological Outpatients With Lower Urinary Tract Symptoms Without Acute Frequency and Dysuria. JUrol. 2010;183(5):1843-7.
• Kupelian AS, Horsley H, Khasriya R, Amussah RT, Badiani R, Courtney AM, et al. Discrediting microscopic pyuria and leucocyte esterase as diagnostic surrogates for infection in patients with lower urinary tract symptoms: results from a clinical and laboratory evaluation. BJU Int. 2013;112(2):231-8. doi: 10.1111/j.1464-410X.2012.11694.x. PubMed PMID: 23305196.
• Brubaker L, Wolfe AJ. The Female Urinary Microbiota/Microbiome: Clinical and Research Implications. Rambam Maimonides medical journal. 2017;8(2). Epub 2017/05/04. doi: 10.5041/rmmj.10292. PubMed PMID: 28467757; PubMed Central PMCID: PMCPMC5415361.
• Gill K, Kang R, Sathiananthamoorthy S, Khasriya R, Malone-Lee, J. A blinded observational cohort study of the microbiological ecology associated with pyuria and overactive bladder symptoms. Int Urogynecol J. 2018. Epub 2018/02/20. doi: 1007/s00192-018-3558-x. PubMed PMID: 29455238.