Researchers are developing vaccines that could be a game-changing innovation for millions of women.
There’s nothing quite like the discomfort of a urinary tract infection: the stinging pain, the urgency, and the alternating fever and chills add up to a pretty unbearable feeling. If you’ve never had one, count yourself lucky: About half of women will get a UTI at some point in their lives, and of those women, about a quarter get them repeatedly. Sadly, you can’t age out of this condition; many older women are plagued by UTIs.
In the U.S. at least, there’s no long-term fix for recurrent UTIs. The only thing chronic sufferers here can do is pick up a course of antibiotics from an urgent-care clinic and hope it clears the infection. But in some European countries, they’ve developed a game-changing innovation that could have the potential to improve millions of women’s lives: a UTI vaccine. We’re taking a look at how those treatments work, and when one might be available here in the U.S.
What causes recurrent UTIs?
If you regularly get UTIs, you can do everything right — wear breathable underwear, always pee after sex, chug cranberry juice — and still wind up with an infection. It’s not “due to poor hygiene or something else that women have brought on themselves,” Kalpana Gupta, M.D., an infectious disease specialist, tells Harvard Health. “Some women are just prone to UTIs.” (Men, of course, also have a urinary tract, which can become infected, but it’s uncommon. Women are more susceptible because their urethras are much shorter and sit closer to the rectum, making it easier for bacteria to reach the urinary tract.)
Scientists aren’t sure what makes some women more likely to contract repeated infections, but they’re starting to understand how that occurs. It’s thought that the bacteria — typically E. coli — that causes a UTI can “hide within the layer of cells that line the bladder,” says Soman Abraham, Ph.D., a pathology professor at Duke. This is what’s called an embedded infection.
“The bacteria stays dormant for significant periods, and then for reasons that aren’t entirely clear, they emerge, get into the urine, multiply, and cause another flare-up,” he says. At that point, patients are forced to turn to antibiotics, which wipe out most of the bacteria — but not the ones that stay embedded in the walls of the bladder, allowing the cycle to repeat.
It may seem simple enough to just throw antibiotics at a UTI whenever one crops up, but researchers are starting to question this approach. Why? For one, the drugs can really mess with your gut microbiome — the vital community of bacteria, viruses, fungi, and other tiny organisms living in your digestive tract. Overusing antibiotics has also contributed to the growing issue of antibiotic resistance: Most UTIs used to be easily eradicated by antibiotics, but those drugs aren’t nearly as effective as they used to be, Dr. Abraham says. A 2019 study found that more than 92 percent of the bacteria that cause UTIs are resistant to at least one common drug, and about 80 percent are resistant to two. That’s why there’s a growing interest in UTI vaccines, says Melissa Kramer, the head of the patient advocacy group Live UTI Free.
“I think [vaccines are] hugely significant, judging from the response from the community,” says Kramer, who herself had recurrent UTIs for years. “It’s the one topic we’re constantly getting questions about.”
What to know about UTI vaccines
As we mentioned earlier, there are a few vaccines on the market in parts of Europe. According to Kramer, three popular options are StroVac, Uro-vaxom, and Uromune. Each contains a different formulation of inactive bacteria — strains which typically cause UTIs — but are administered in different ways. StroVac is the typical shot in the arm, given three times over six weeks, and is meant to prevent UTIs for about a year. Uro-vaxom is a pill that’s supposed to be taken daily for three months (or at least 10 straight days during an acute episode). And Uromune is a pineapple-flavored spray that’s misted under the tongue daily for three months. (Patients in the U.S. were able to import the spray up until this year, when the FDA updated its regulations, Kramer says.)
All three have proven to be moderately effective. A study of Uromune, for example, found that 56 percent of women who took the vaccine had no UTIs for nine months. Anecdotally too, Kramer says her organization’s heard plenty of success stories. But for a lot of people, the vaccine falls short, either because the bacteria causing the infection isn’t one of the strains targeted by the shot, spray, or pill — or because the treatment’s not potent enough to eradicate an embedded infection, Dr. Abraham says.
A new UTI vaccine is being developed in the U.S.
Dr. Abraham thinks he’s come up with a new, more effective vaccine strategy — although it’s not as convenient (or nearly as pleasant) as a fruit-flavored spray. His vaccine, which is still in development, would be given via catheter. The microbiologist believes that introducing the solution straight to the bladder — rather than shooting it into the arm, let’s say — is a crucial part of treating an embedded UTI.
He’s found that in mice, this method not only produced antibodies to fight off an infection but also produced special immune cells, called T-cells, capable of traveling to these reservoirs of bacteria hidden in the bladder walls and wiping them out. Dr. Abraham acknowledges that he may be a bit biased, but he believes that’s what sets his vaccine apart from the others currently available.
His lab’s received a grant from the National Institutes of Health to further study the vaccine, but Abraham tells us it’ll probably be at least five years before they can start a clinical trial. In the meantime, Kramer hopes the medical community pays more attention to recurrent UTI patients, who she says have been largely ignored. “The impact this has on the quality of life for so many women is huge: It affects their ability to socialize, to work, to have any sort of sex life at all,” she says. “This is a massive problem of mostly women not being taken seriously.”
