The Current

Diagnosing UTIs is 'a dog's breakfast,' and that's affecting women

It's time to rethink how urinary tract infections are diagnosed, says Dr. James Malone-Lee, because some tests are false negative and patients are not getting necessary treatment.
Symptoms of urinary tract infections can be acute and sometimes, debilitating. People have difficulty with urination, lower back and pelvic pain and extreme fatigue. (Shutterstock )

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Toronto mom Liz McDonald has struggled with upwards of 20 urinary tract infections a year since she was 15 years old. 

She lost hope finding an explanation for the recurring issue as doctors only advise her to,"Wear cotton underwear. Pee before and after sex. Drink a lot of water," she says.

"I think I've been in almost every single walk-in clinic in the city once or twice to deal with it and only one person took me seriously and referred me to a urologist. Everyone else just sent me on my way," the 22-year-old told The Current's Anna Maria Tremonti, adding that no relief came out of the urologist appointment. 

Symptoms of urinary tract infections can be acute and sometimes, debilitating. People have difficulty with urination, lower back and pelvic pain and extreme fatigue. 

After seeing several doctors, McDonald says she still doesn't know why she gets at least 20 UTIs a year. She says she's just told women are more prone to UTIs.

Diagnosing UTIs 'a dog's breakfast' 

Dr. James Malone-Lee, a professor emeritus of medicine at the University College London, is critical of how UTIs are diagnosed and treated.

"The diagnosis of a urine infection is a dog's breakfast. Most patients presenting to the primary care sector will have their urine tested with a dipstick test and that is grossly insensitive."

He says the dipstick test is not sophisticated enough to detect any nuances or variances in the bacteria. 

"The sensitivity is so weak that you cannot possibly make a judgment of disease on that evidence."

With the potential of cultures demonstrating false negatives or wrong information, Malone-Lee says he decided to ban his medical staff from issuing this test for diagnosis.

"As a result of that we found that we can manage our patients on very simple … first-generation antibiotics."

But urologist Dr. J. Curtis Nickel isn't keen on the use of antibiotics because patients can develop "a disharmony of the bacterial populations" in the bladder, urethra, vagina and gut, which could result in future illnesses, including recurrent urinary tract infections.

He argues physicians are led to believe antibiotics are the only answer to treat the infection.

"That's sort of like carpet bombing during a war, where you figure you're winning the battle but you're actually losing the war," says Nickel, who is also the Canada Research Chair in Urologic Pain and Inflammation.

Cranberries are fruit with natural antibiotic qualities. Dr. J. Curtis Nickel says in the case of UTI's you'd need to drink two litres a day to be able to make a difference. He suggests taking cranberry extracts with good concentration, instead. (Eric Foss/CBC)

Nickel suggests antibiotics should only be used strategically. He lists some natural approaches to confront UTIs, such as taking supplements of cranberry extract or considering probiotics that have lactobacilli like in different types of yogurt.

"Diet is extremely important. Environment reduction and stress and anxiety all reduce your propensity for this."

In the future, he hopes a vaccine will be able to prevent UTIs.

"We've been actually working on vaccines now for 25 years and the bacteria continue to outsmart us, but we think we have an opportunity now using more modern vaccine technology to be able to develop a mucosal vaccine."

Listen to the full conversation at the top of this page, where you can also share this article across email, Facebook, Twitter and other platforms.

This segment was produced by The Current's Alison Masemann, Samira Mohyeddin and Danielle Carr.