Publication:

Recurrent acute uncomplicated urinary tract infections in women: an epidemiological review of incidence, pathogenesis and psychological burden

Recurrent acute uncomplicated urinary tract infections in women pose a serious health issue on the global agenda due to their high prevalence, high occurrence rate of recurrence, and dramatic clinical and psychosocial implications. Though recurrent urinary tract infections are historically viewed as harmless, they impose significant financial burden on health-service providers and significantly reduce the quality of life. Most of the episodes can be traced to uropathogenic Escherichia coli, the recurrence of which is caused by multifactorial interactions including host susceptibility, bacterial virulence factors, behavioural determinants, and increased antimicrobial resistance. Recent studies have highlighted the significance of the intracellular bacterial reservoirs, biofilm formation, and dysbiosis of urinary and vaginal microbiota as a factor in the maintenance of recurrence. Other than these biological processes, women with recurrent acute uncomplicated urinary tract infections suffer considerable psychological distress including anxiety, fear of recurrence, stigma and social restrictions that are often underacknowledged in a normal clinical practice. To this end, this review summarizes the modern facts about the epidemiology, pathogenesis, determinants of risk, and psychological burden of recurrent urinary tract infections in women. It advocates the use of multidisciplinary and patient-centred therapeutic models that combine antimicrobial treatment with preventive, behavioural, and mental-health interventions in order to reduce recurrence and improve the long-term outcomes.