UTI and Prostatitis – Related Conditions

What is UTI?

A Urinary Tract Infection, or UTI, is an infection of the urethra, bladder or kidneys. This infection is often bacterial in nature. Bacteria from the rectum or anal area commonly cause UTIs by entering the urethra and travelling up the urinary tract. A UTI can also be hospital-acquired, and can be caused by the use of urinary catheters. Any exposure to and build up of a pathogenic or opportunistic bacteria can cause UTI in both men and women.

To diagnose a UTI, the recommended tests are urine microscopy – to check the white blood cell (leukocyte) count, and a urine culture – to identify the bacteria that is in a state of overgrowth. PCR or DNA sequencing tests are also used to identify the bacterial load and presence in urine samples.

Correlation of UTI with Prostatitis

UTI in men is a condition that often correlates with prostatitis. They are both infections of the male urogenital tract. For some prostatitis sufferers, their condition starts as a UTI before the bacteria travels up the urethra and invades and colonizes the prostate gland, which is located at the base of the urethra. This eventually develops into prostatitis.

For other sufferers, their chronic prostatitis can cause recurrent UTIs. This happens when bacteria from the prostate gland release into the urinary tract and flow down the urethra, causing a UTI.

The symptoms of UTI and prostatitis tend to be very similar – painful urination (dysuria), frequent night-time urination (nocturia), urethral burning during urination, urinary urgency, and often, a fever.

Why is UTI difficult to treat with antibiotics?
Antibiotic Resistance

Bacteria commonly associated with UTIs are gram negatives like Escherichia coli (E. coli), Klebsiella pneumoniae, Proteus mirabilis, and gram positives like Enterococcus faecalis and the Staphylococcus species. Many of these are considered ‘priority pathogens‘ by the World Health Organisation, against which antibiotics no longer provide successful eradication due to the increase in antibiotic resistance amongst these bacteria. This makes their treatment with antibiotics difficult.

Another reason why a UTI can be difficult to treat is because it is often hospital-acquired. Patients who have been hospitalised and put on urinary catheters can easily develop a UTI from catheterisation. The challenge with hospital-acquired UTIs is that the offending bacteria tend to be resistant to multiple types of antibiotics. These are referred to as Multi-Drug Resistant (MDR) infections.

For MDR UTIs, very few options of antibiotics remain available for treatment. Often, these antibiotics are the last resort drugs available for treating infections. Some of the strongest antibiotics such as Colistin, which were banned for human use because of their toxic effects on the body, are now being brought back into use because safer antibiotics are becoming less useful. And if such MDR bacteria ascend up the urethra to cause a prostate infection, that makes a bad situation worse, because the categories of antibiotics available for treating prostatitis are limited to begin with.

Chronic UTI and Bacterial Biofilms

If a UTI persists for more than 3 months, it is usually referred to as a chronic UTI. A chronic UTI can also take the form of a recurrent UTI, which subsides when taking an antibiotic course, only to resurface once the course finishes. As is the case with most chronic or recurrent infections, the presence of bacterial biofilms makes the infection persistent. Biofilms harbour the bacterial colony, and protect it from antibiotics and from the body’s immune system. Antibiotics are largely ineffective against bacterial biofilms, and struggle to eradicate them.

A biofilm can be home to not just one, but different bacterial species. Within the biofilm, one bacterial strain can even transfer antibiotic resistance genes to other bacterial strains present in the biofilm.

Biofilms don’t just form inside the human body. They can form anywhere where bacteria can create a hold, even medical equipment like urinary catheters. All these factors together stack the odds against antibiotics as effective infection control drugs for chronic UTIs.

Phage Therapy – Treatment for UTI

Phage therapy can be an effective treatment option for this difficult condition. A bacteria that is multi-drug resistant or even extremely drug resistant can still be sensitive to phage preparations made of up multiple phages, called a phage cocktail. A phage cocktail has many different phages that attack their specific target bacteria. It can be targeted to one specific bacterial strain, or it can be made to attack different bacterial strains at the same time.

With antibiotics, a few evolutionary cycles of the bacteria are usually enough to develop resistance to an antibiotic drug. Bacteria find it much more difficult to develop resistance to phage cocktails as compared to antibiotics. As the bacteria evolve to evade phages, phages are also able to adapt to remain active against the bacteria. And in the rare case when a bacteria develops resistance to a phage cocktail, a new customized phage can be prepared within a matter of weeks against that particular strain of bacteria. This is obviously not possible with antibiotics. 

For chronic or recurrent UTIs, phage therapy offers the advantage of being able to penetrate, attack and clear bacterial biofilms. Of course, it is vital to follow extremely careful and experienced pre-treatment protocols before undertaking such a treatment – the phage cocktails need to be purified and prepared to remove endotoxins; the correct kind of phages need to be selected for the phage cocktail; careful diagnostic testing needs to be carried out to check for sensitivity of the bacteria to the phage cocktail; the optimum phage dosage amounts and administration guidelines need to be established and closely followed; and importantly, patience is required as treatment can go on for a few months before a chronic infection and its associated biofilms are cleared completely. But it does offer a proven and highly effective way of treating antibiotic resistant infections.

Have you experienced a UTI along with your prostatitis? Did the UTI precede the onset of prostatitis, or does the prostatitis give you recurrent UTIs? And have you found treatments or supplements that help you deal with the UTI once antibiotics don’t help? Do share your experience in the comments below. 

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