Cystitis is a major health concern for women in particular and it is estimated that approximately 40% of women have had a UTI at some time in their lives. Many women associate these problems with sexual activity and tell us that their intimate lives are overshadowed and badly affected by a fear of further infection.
Women develop cystitis within a day or so after having sex for several reasons. Vigorous movement during sex can push bacteria from the perineum up into the bladder and may cause some damage to the urethra, which is thought to enable bacteria to take hold and thrive. All of these circumstances will be exacerbated if the vagina is dry during sex, so it may be wise to use lubricant. The most prevalent bacterium that causes bladder infections associated with sexual activity is Escherichia coli (E.Coli) though any coliform can potentially cause problems. Oral sex can also introduce Streptococcus (Strep) from the mouth.
When these attacks of cystitis keep occurring they are usually referred to as complicated UTIs. The dangers of recurrent UTIs range from painful cystitis to serious kidney infections and life threatening sepsis. We have become used to these episodes being dealt with effectively by antibiotic therapy and recent awareness of bacterial resistance suggests we dare not become complacent. The truth is that bacteria are survivors and have mutated in response to repeated courses of antibiotics: they have got stronger and acquired resistance and burrowed deeper in to the bladder wall where they lay dormant, protected from further attack by biofilms. These biofilms are currently estimated to be responsible for over 65% of nosocomial infections and 80% of all microbial infections. A nosocomial infection is contracted because of an infection that exists in a certain location, such as a hospital but not limited to. People now also refer to HAIs (hospital-acquired infections). For an HAI to be correctly assigned the infection must have not preceded medical care.
Bacteria can colonise layers of the bladder epithelium and bury themselves deep within the bladder wall. The ability of bacteria to create and survive behind biofilms is worrying.
It is more accepted now that sex related cystitis is not always about reintroduction of bacteria but also about embedded bacteria coming to the surface where they attach to mannose in bladder cells and proliferate, causing the same infection to reappear and grow stronger.
As a result doctors are increasingly, and quite rightly, reluctant to over-prescribe antibiotics unless a kidney infection is a factor as the understanding increases that although antibiotics kill off unwanted bacteria, they also kill off "friendly" bacteria living in the gastrointestinal (GI) tract, causing unwanted side effects. If enough friendly bacteria are killed, an overgrowth of the not-so-friendly yeasts, moulds, and bacteria, all of which produce unwanted toxins, can occur. Most women who have problems with cystitis will report a cycle of infection, antibiotics, candida, being well, then reinfection.
But perhaps our reliance on antibiotics is concerning for another reason, and that is that antibiotic-resistant bacteria (superbugs) are emerging that are resistant to all known antibiotic drugs.
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