Urinary tract infections, or UTIs, are some of the most common infections in the world. Today, they are becoming increasingly difficult to treat.
In the US alone, UTIs account for more than 8 million office visits and one million emergency department visits annually. For decades, these painful and inconvenient infections have been stopped in their tracks by a routine course of antibiotics, but it appears the prescriptions have begun to falter in recent years.
As UTI-causing bacteria grow more resistant to antibiotics, some women have no choice but to live with intolerable discomfort, year in and year out.
A recent clinical case study details one elderly woman's struggle with UTIs that lasted for more than 40 years. Nanell Mann began getting these uncomfortable infections after a hysterectomy in 1971, but no matter how many times she was treated, the ailment just kept coming back.
With each recurrence, it became harder to find an antibiotic that would work. Her doctors were at a loss.
"They kind of give up on you because they don't know what to do," Mann told The Atlantic.
Mann is not alone in feeling this way. Data on UTIs and antibiotic resistance is still scarce, but initial results, combined with a growing number of hospitalisations, suggest there's something ominous going on.
Last year, a study in the United Kingdom found a third of all UTIs are now resistant to key antibiotics. This year, a recent paper by the New York City Department of Health showed that a third of UTIs, caused by the most common type of bacteria, E. coli, were resistant to one of the most widely used drugs.
What's more, the researchers found at least one fifth of these infections were resistant to five other common treatments.
"This is crazy. This is shocking," Lance Price, who researches antibiotic resistance but who was not involved in these studies, told The New York Times.
Shortly after their article ran, The New York Times received interest from nearly 600 people, both men and women, who wanted to share their experiences with recurrent UTIs.
Cece Turner, age 30, told reporters she did whatever her doctors told her to do, taking drug after drug to cure her recurrent UTIs.
"I ended up being severely ill with a multi-drug resistant infection," she wrote. "Having tried 6+ different courses of antibiotics over the course of 4 months, my UTI was eventually 'cured' in July by a 2 week course of antibiotics."
Less than a year later, she got a second infection and she demanded a culture immediately.
Nowadays, the only way to tell if a bacterial infection is resistant to a drug is to culture it. This practice, however, takes time and money, and it can't be done for everybody.
It's much easier for doctors to just prescribe antibiotics and be done with it. But in an era of antibiotic resistance, with few other approved alternatives, such practices will need to change.
"There are various reasons for this rising antimicrobial resistance," explains a 2018 paper.
"Overuse and abuse of these drugs are very common, especially in those parts of the world where over-the-counter sales are allowed. Furthermore, antibiotics are often prescribed without indications. Even in the USA, up to 60 [percent] of antimicrobial prescriptions in the ICU are found to be inappropriate or suboptimal."
The need to explore new strategies for treatment is clear, but such research is still in its infancy.
Postmenopausal women, women who are sexually active and those who are in their child-bearing years are at the most risk of UTIs, and they need to be aware that antibiotic resistance is on the rise when they seek medical help.
"Increasingly, experts tell us that you should ask for a culture when you go in for a UTI treatment, even if you get an immediate prescription," New York Times writer Matt Richtel wrote recently.
"The culture will allow a doctor to change the drug if the first one does not work."
The risk of that happening might be on the rise.