Role of abnormal vaginal microbiota in the pathogenesis of recurrent lower urinary tract infection: a modern view of the problem


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Abstract

The review is devoted to the problem of recurrent urinary tract infections (RUTIs) in women. It considers risk factors for RUTIs and the role of abnormal vaginal microbiota in this disease. E. coli have special virulence factors that cause urinary tract infection and colonization by adhesion to urothelial cells: the pronounced virulence of Type 1 factor (or Type 1 pili), which triggers an inflammatory response by attracting neutrophils to the bladder. Despite the fact that RUTIs are not considered a life threatening disease, they have a significant impact on quality of life, disabling effects on women's health, intimate and social relationships, self-rating and work ability, and also lead to irritability, fatigue, and inability to concentrate until depression develops. There are modern views on bacterial vaginosis and the associated new pathogenesis of RUTIs. The existing relationship between the factors of RUTIs, sexual practice, and the composition of the vaginal microbiome requires correction of the composition of the vaginal flora and the implementation of preventive measures and non-antimicrobial treatment. The major mechanisms of RUTI development are reinfection and bacterial persistence. Female RUTIs are associated with a steady upward entrance of the microflora from the periurethral region. Antibiotics are the most common treatment regimen for urinary tract infections (UTIs), at the same time they are becoming increasingly ineffective due to the emergence of antibiotic-resistant microorganisms. The global emergence of multidrug-resistant UPEC strains over the past decade highlights the need for alternative therapeutic and preventive strategies to combat UTIs. Conclusion. Thus, a vicious circle is formed: the patient takes antibiotics often or even continuously for the treatment of cystitis, which leads to the development of vaginal dysbiosis, bacterial vaginosis, candidiasis, and vulvar and urethral discomfort. The presented results of clinical trials have confirmed the rationale, efficiency, and safety of taking vitamin D, D-mannose, and proanthocyanidins in the treatment, prevention, and rehabilitation of patients with UTIs.

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About the authors

A. V Zaitsev

A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia

Email: zaitcevandrew@mail.ru
Dr. Med. Sci., Professor at the Department of Urology 127473, Russia, Moscow, Delegatskaya str., 20/1

I. A Apolikhina

V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia

MD, PhD, professor, Head of the Department of Aesthetic gynecology and Rehabilitation, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia; Professor of the Department of Obstetrics, Gynecology, Perinatology and Reproductology, Institute of Professional Education, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia; President of Association of Aesthetic Gynecology Specialists (AAGS), President of European Association for Genital Aesthetic Medicine and Plastic Surgery (EAGAMPS) 117997, Russia, Moscow, Akademika Oparina str., 4

L. A Khodyreva

Research Institute for the Organization of Healthcare and Medical Management, Moscow Department of Healthcare

Email: khodyreva60@mail.ru
Ph.D, Head of the Department of organizational and methodical support for the urology 115088, Russia, Moscow, Sharikopodshipnikovskaya str., 9

A. N Bernikov

A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia

Email: bernikov@mac.com
PhD, Associate professor at the Department of Urology 127473, Russia, Moscow, Delegatskaya str., 20/1

Yu. A Kupriyanov

A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia

Email: dr.kupriyanov@mail.ru
PhD, MD, assistant at the Department of Urology 127473, Russia, Moscow, Delegatskaya str., 20/1

R. V Stroganov

A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia

PhD, assistant at the Department of Urology 127473, Russia, Moscow, Delegatskaya str., 20/1

O. A Arefyeva

A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia

PhD, assistant at the Department of Urology 127473, Russia, Moscow, Delegatskaya str., 20/1

T. A Teterina

V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: t_teterina@oparina4.ru
D, PhD, gynecologist of the Department of Aesthetic Gynecology and Rehabilitation 117997, Russia, Moscow, Akademika Oparina str., 4

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