Beyond better UTI testing
Even if your tests are negative, we do not advocate burying your head in the sand. Recently, more and more doctors are understanding that the urine testing dogma must be changed. Patients are gaining the tools to advocate for better UTI testing. Here are some steps to make UTI testing better.
What we currently know about the urinary microbiome is only the tip of the iceberg. Researchers know much more about the gut microbiome since projects like the human microbiome project (HMB) have been looking at the bugs in our gut for much longer. However, things are starting to change as more in the medical community are letting go of the old ‘urine is sterile’ dogma.
Researchers are able to find bacteria in about 75% of urine specimens but think that we just don’t have the techniques to discover the bacteria living in the other 25% of urine samples. Think how far much more we have to learn if we haven’t even discovered the bacteria, let alone figured out what they do in our bladder.
Nice to meet you, bacteria
Nowadays professional organizations like the American Society for Microbiology are at the forefront of this wave and are bringing together researchers who are passionate about understanding the urine microbiome. They have resources to get information out to everyone about the impact bacteria has on all of us.
One important objective is to harness good bacteria’s power to help decrease our overdependence on antibiotics. Medicine is shifting its resources from only researching pathological bacteria and instead also looking at how we can have a more mutually beneficial relationship with our resident bacteria.
With new information at our fingertips, we can become empowered to learn more about our own microbiome and figure out the steps to improve our own bladder health. We already know that optimizing our vaginal and gut microbiome has amazing benefits for the bladder. Simply changing our diet to one that promotes a healthy microbiome by eating prebiotics and choosing foods or supplements that contain these healthy bacteria we take our health into our own hands and build the strength of the bladder.
Better UTI Testing is Possible
We already know that OTC UTI tests kits aren’t an effective strategy to figure out if you have a UTI. Don’t put too much faith in them, especially if you have UTI symptoms or if you’ve had a lot of UTIs in the past.
Remember, while doctors may use a screening test that seems similar, they are more comprehensive and are also are bolstered by microscopy and other steps to better look for bacteria and infection.
There are also steps you can take right in your doctor’s office to get better UTI test results. For example, next time you get your UTI test results back from your doctor insist on more information no matter the result. You can ask:
- How many bacteria grew from your urine
- If your urine culture (not urinalysis) came back as “contaminated.” If it did, ask if you can repeat it or if the lab is able to identify the bacteria anyway. When labs think the urine is contaminated, they may ignore any bacteria that grows.
- How many types of bacteria grew. Similar to #2, if too many types of bacteria grow, the lab may ignore them or not list all of the different types.
Finding out this extra information, especially if your test comes back “negative” can help you and your doctor figure out the next steps for your treatment.
For example, you can ask your doctor:
- If the urine test could be cultured longer.
- Or if you could still have a UTI even if there were not up to 100,000 CFU of bacteria.
- If there are alternative tests or labs that could be used if you’re still experiencing UTI symptoms that just aren’t going away.
Remember you always have the opportunity to ask for a second opinion. This is especially important if you have recurrent or complicated UTIs and your symptoms are not going away.
DNA-Based UTI testing
Where to order better tests
If you’d like better testing, you can use the links to the lab listed below. The prices are listed as of July 2018 and, unfortunately, you might need to pay out of pocket even if you have an insurance.
The USA or international shipment:
• Broth-based UTI culture test
http://www.unitedmedicallab.com/ (Quote as of July 2018: $279 + shipment). A better alternative to a regular culture test.
• DNA-based UTI tests:
https://aperiomics.com/ (Quote as of July 2018: $1,000 (one thousand dollars) per sample plus $75 roundtrip shipping in the USA, 40-80% insurance reimbursement typically and also take Flexible Spending Accounts.) and takes about 10 days to produce results. The test can identify all known pathogens, world largest DB. Call them to see if they can bill your insurance. Your tests are sent to a doctor and Aperiomics CEO (Dr. Icenhour) who is a physician herself is always happy to jump on the phone and consult your physician about the test results.
https://microgendx.com/ (Quotes as of July 2018: $199 self-pay, $250 insurance. If you are not in the US then it’s a flat rate of$199.) Side by side comparison with Aperiometrics reports shows only 8-20 % of what Aperiomics can find so I’d rather save money or try to work with the insurance company but order a more precise test with Aperiomics instead.
A holistic approach to UTI
A final step is to prescribe a more holistic approach. We can’t just look at bacteria in isolation- they form a community on our bodies that are influenced by what we eat and our day to day habits. Doctors have to look at the whole patient- their background, their diet, and history of antibiotic use, not just the bacteria in a petri dish.
For example, a woman who is going through menopause and has been dealing with UTIs for decades is different from a twenty-something-year-old man with a UTI. We can’t treat these different people exactly the same and expect good results. We have to look at each person individually and come up with solutions that work for them.
In addition, doctors are starting to understand that antibiotics are not always the answer.
Some are advocating for alternative treatment, relying on the body’s natural bacteria fighting abilities, and not antibiotics to treat all infections. Whether you choose over the counter painkiller, an anti-inflammatory diet or antimicrobial herbs, there are alternatives to antibiotics. Of course, you must stay safe and talk to your doctor if your symptoms do not improve.
There is so much new information available that we really should feel hopeful about the changes coming to UTI testing and treatments. If we all take it upon ourselves to stay informed and continue to ask good questions, we will be well on our way to making UTI treatments as effective as they can be.
What are you doing right now that can improve your bladder health?
References:
- Christensen D, Orr J, Rao C, Wolfe A. Increasing Growth Yield and Decreasing Acetylation in Escherichia coli by Optimizing the Carbon-to-Magnesium Ratio in Peptide-Based Media. Appl Environ Microbiol. 2017 Mar 15; 83(6): e03034-16.
- Franz M, Horl W. Common errors in diagnosis and management of urinary tract infection. I: Pathophysiology and diagnostic techniques. Nephr Dialysis Transpl. 1999 Nov; 14(1): 2746–2753.
- Gágyor I, Bleidorn J, Kochen MM. Ibuprofen versus fosfomycin for uncomplicated urinary tract infection in women: randomized controlled trial. BMJ. 2015 Dec 23;351:h6544.
- Maloy S. Is Urine Sterile. ASM Live 114th General Meeting American Society for Microbiology. Retrieved at: https://www.youtube.com/watch?v=Vlt37Go04oM.
- Maskell R, Pead L, Allen J. The puzzle of “urethral syndrome”: a possible answer? Lancet. 1979 May 19;1(8125):1058-9.
- Pearce M, Zillox M, Thomas-white K. The Female Urinary Microbiota in Urgency Urinary Incontinence. Am J Obstet Gynecol. 2015 Sep; 213(3): 347.e1–347.e11.
- Price TK, Shaheen M, Kalesinskas L.Draft Genome Sequence of a Urinary Isolate of Lactobacillus crispatus. Genome Announc. 2016 Dec 1;4(6). pii: e01278-16.
- Thomas-White K, Brady M, Wolfe A, Mueller E, Elizabeth R. Mueller. The bladder is not sterile: History and current discoveries on the urinary microbiome. Curr Bladder Dysfunct Rep. 2016 Mar;11(1):18-24.
