The new world of the urinary microbiota in women

It's always been believed that urine is sterile. Even soldiers during WW1/WW2 were told to wash their eating utensils in their own urine if they had no access to good water. However, recent research from the US and the UK now finds this to be untrue and that the urinary tract has it's very own bacterial communities. UK research has recently found up to 450 different bacterial species in a healthy bladder .

Since our current lab testing is based on the assumption that urine is sterile, and infection is defined by the PURE growth of a SINGLE KNOWN urinary pathogen, which also has to meet the standard threshold of >10*5 colony-forming units per ml, researchers are saying our gold standard testing methods are missing up to 80 percent of infections.

Given these recent findings, do you think our current testing methods for UTIs need to be re-evaluated?

https://www.researchgate.net/publication/277027063_The_New_World_of_the_Urinary_Microbiome_in_Women

http://www.europeanurology.com/article/S0302-2838%2815%2900206-7/fulltext/-sterile-urine-and-the-presence-of-bacteria

Just wondering if you will be able to test for PCR Level 2 bacteria in the bladder and around the vulva ? and also fungal issues ?

What is the PCR Level 2 testing I see people here mentioning? Is this the urine testing offered through PathoGenius in Texas? http://www.pathogenius.com/

Yes there are 2 labs in the US I think the one in Texas is the one used by Ruth Kris which is the link you have provided. It must be Level 2 not level 1. Level 2 picks up 25,000 different bacteria and all types of fungi. The main ones being found are Microplasma and ureaplasma these dont show up in the standard test carried out here in Aus.

Andi2016 wrote:

It's always been believed that urine is sterile.  Even soldiers during WW1/WW2 were told to wash their eating utensils in their own urine if they had no access to good water.   However, recent research from the US and the UK now finds this to be untrue and that the urinary tract has it's very own bacterial communities.  UK research has recently found up to 450 different bacterial species in a healthy bladder .

Since our current lab testing is based on the assumption that urine is sterile, and infection is defined by the PURE growth of a SINGLE KNOWN urinary pathogen, which also has to meet the standard threshold of >10*5 colony-forming units per ml, researchers are saying our gold standard testing methods are missing up to 80 percent of infections.

Given these recent findings, do you think our current testing methods for UTIs need to be re-evaluated?

https://www.researchgate.net/publication/277027063_The_New_World_of_the_Urinary_Microbiome_in_Women

http://www.europeanurology.com/article/S0302-2838%2815%2900206-7/fulltext/-sterile-urine-and-the-presence-of-bacteria

I have read through the 2 links provided, is this the same as PCR Level 2 testing ? I note that samples of urine taken from the bladder are taken using a catheter, are samples then taken from the vulva area again to carry out PCR Level 2 testing for embedded bacteria in that area ? Is this your line of research - embedded bacteria ? Thank you for all your work.

I must have spoken to every lab in the uk about this but the majority are saying the same thing. It can be done but does not give conclusive results because it is so sensitive it would always show some bacteria. I am desperately trying to find someone to listen to me to go at least look down this route but finding it very challenging.

Strandsidemol wrote:

I must have spoken to every lab in the uk about this but the majority are saying the same thing.  It can be done but does not give conclusive results because it is so sensitive it would always show some bacteria.  I am desperately trying to find someone to listen to me to go at least look down this route but finding it very challenging.

I cant work out how to send a PM can you PM me so I can reply ?

I believe that my BPS symptoms are primarily caused by some sort of infection, primarily because what has helped me the most are a combination of antibiotics, including hiprex and antifungals. This is despite regular negative urine cultures. I just don't believe they are sensitive enough to pick up whatever is causing this pain.

I have so many questions regarding this.

Is it possible for some sort of bacteria to live within the cell walls of the human bladder as it has been shown to in mice?

(Rosen, D. A., Hooton, T. M., Stamm, W. E., Humphrey, P. A., & Hultgren, S. J. (2007). Detection of Intracellular Bacterial Communities in Human Urinary Tract Infection: e329. PLoS Medicine U6)

Is it possible for a different, more virulent strain of what is considered a commensal bacteria to cause symptoms?

"certain increasing indications that specific Lactobacillus spp are of pathogenic relevance and may be involved in urinary tract infections"

(Siddiqui, H., Lagesen, K., Nederbragt, A. J., Jeansson, S. L., & Jakobsen, K. S. (2012). Alterations of microbiota in urine from women with interstitial cystitis. BMC Microbiology, 12(1), 205. doi: 10.1186/1471-2180-12-205)

Is it possible for a species of nanobacteria to cause ICBPS symptoms?

"NB levels decreased dramatically after tetracycline treatment, and they reported significant reduction in the severity of IC/PBS symptoms. A high prevalence of NB was observed in female IC/PBS, and anti-NB treatment effectively improved the symptoms, which suggest that NB may cause some cases of IC/PBS."

(Zhang, Q.-h., Shen, X.-c., Zhou, Z.-s., Chen, Z.-w., Lu, G.-s., & Song, B. (2010). Decreased nanobacteria levels and symptoms of nanobacteria-associated interstitial cystitis/painful bladder syndrome after tetracycline treatment. International Urogynecology Journal, 21(1), 103-109. doi: 10.1007/s00192-009-0994-7)

What do you think?

summerley, I have had this wretched thing for close to 25 years now. Taking it in the simpelist form, symptoms are the same as in any normal UTI yet Urine Test come back negative, and if given anti biotics they dont work, SO, my theory is the tests are missing "something" and until we find out what that "something" is we cant fix it.
SO, as they say God helps them who help themselves so I am going down the road of sending samples to the US to see what comes back. At least that way I will know if levels are "normal" or if levels are raised, or if there is something there that is causing all my symptoms.

I've had consult with Ruth Kriz and Fry laboratories. First result came back my urine was clean.. Ruth Kriz suggested Lyme disease and I take Plaquenil long term. I saw my Doctors here in Australia who would not support me if I took Plaquenil. Therefore I went quiet for a month or so whilst weighing up my options. Then miraculously I had another lab report come back that they had made a mistake with my initial results and that I did I fact have a bacteria present (I'd have to look up my emails to fine the name). Whole situation did not sit well with me also the fact I'd spent around $2,500.00 for Ruth consult , freighting samples to USA and lab charges. If possibly IC/BPS is autoimmune problem then that would explain why Ruth Kriz by her own admissions says she can cure IC because Plaquenil is a treatment used for Arthritis which is an autoimmune disease (my mother in law takes it for this reason). If it were me I would save my money and wait and see what this team can determine in their research.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3744036/

This is an interesting article with regards the bladder microbiome. It says “data is suggestive of the existence of a “core” bladder microbiome” that changes with ageing. Maybe this ‘core’ is disrupted in BPS. It would be amazing if probiotics could substitute antibiotics. Does your team consider this a potential area of research?

Good question, Jill1947. What an exciting direction. I hope someone answers you.

Jill1947 wrote:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3744036/

This is an interesting article with regards the bladder microbiome.  It says “data is suggestive of the existence of a “core” bladder microbiome” that changes with ageing.     Maybe this ‘core’ is disrupted in BPS. It would be amazing if probiotics could substitute antibiotics.   Does your team consider this a potential area of research?

Following along the same thought. On the website it says "This technology harnesses the bacterium’s unique immune regulatory properties for the development of products that are easily and safely administered for improved management of allergic, and potentially other chronic inflammatory, diseases":
http://www.abc.net.au/catalyst/stories/4099320.htm?site=%28none%29&topic=%28none%29&listaction=unsubscribe

although this sounds like a wonderful simple answer, probiotics make me flare, and there are others who also flare, are there differenct types of probiotics that target different issues ?

Tina2, I wonder if there could be a clue in this 2012 study as to why probiotics cause you to flare? I've heard plenty of people reporting the same and I've been suspicious with myself at times.

This team looked at the urinary microbiota in women with IC and compared it to the urinary microbiota in healthy women. They found women with IC had reduced urinary microbial diversity and richness, with a higher abundance of bacterial genus Lactobacillus.

So if what Alan's Wolfe's team at the Loyola University turns out to be correct, along with Professor James Malone-Lee's team at the UCL, then we are talking about distinct urinary microbiome imbalances causing symptoms. It could make sense that introducing more probiotic Lactobacillus to an already imbalanced microbiotia, could make things worse. Makes your mind tick, doesn't it?

http://bmcmicrobiol.biomedcentral.com/articles/10.1186/1471-2180-12-205

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Alterations of microbiota in urine from women with interstitial cystitis
Huma Siddiqui, Karin Lagesen, Alexander J Nederbragt, Stig L Jeansson and Kjetill S Jakobsen
Oslo, Sweden 2012

Abstract
Background

Interstitial Cystitis (IC) is a chronic inflammatory condition of the bladder with unknown etiology. The aim of this study was to characterize the microbial community present in the urine from IC female patients by 454 high throughput sequencing of the 16S variable regions V1V2 and V6. The taxonomical composition, richness and diversity of the IC microbiota were determined and compared to the microbial profile of asymptomatic healthy female (HF) urine.
Results

The composition and distribution of bacterial sequences differed between the urine microbiota of IC patients and HFs. Reduced sequence richness and diversity were found in IC patient urine, and a significant difference in the community structure of IC urine in relation to HF urine was observed. More than 90% of the IC sequence reads were identified as belonging to the bacterial genus Lactobacillus, a marked increase compared to 60% in HF urine.
Conclusion

The 16S rDNA sequence data demonstrates a shift in the composition of the bacterial community in IC urine. The reduced microbial diversity and richness is accompanied by a higher abundance of the bacterial genus Lactobacillus, compared to HF urine. This study demonstrates that high throughput sequencing analysis of urine microbiota in IC patients is a powerful tool towards a better understanding of this enigmatic disease.

Andi2016 that is a very interesting thought, because many women say there IC either gets worse or improves depending on hormonal changes in there monthly cycle and when falling pregnant. So do hormons effect the bacterial chages also ?

Yes, I know others say that ... some say they flare when high in oestrogen and some say they flare when high in progesterone. I haven't found any pattern with me. But I hope it's something they'll explore and be able to tell us. Some women's symptoms go into remission during pregnancy, others not. I do know some research into the FUM does define 'non pregnant women', so there must be something significant about the female body when pregnant (hormones, as you say).