Postmenopausal women taking estrogen therapy may be more resistant to recurrent urinary tract infections (UTI), according to new research presented at the European Association of Urology 2020 virtual congress.
Alterations in the genitourinary microbiome after UTI may lead to less bacterial diversity, thereby predisposing postmenopausal women to recurrent infections. To test this theory, investigators performed whole-genome metagenomic sequencing on clean-catch urine from 3 groups of 25 women: those who had no clinical history of UTI, a history of 3 or more UTIs annually but no current infection, and a recurrent UTI history with a current infection.
Women with current infection had less bacterial diversity in their genitourinary microbiome than the other groups, Nicole De Nisco, PhD, of the University of Texas at Dallas and colleagues reported. The “never UTI” and “remittent UTI” groups also displayed disparate levels of putatively protective (eg, Lactobacillus crispatus) and nonprotective (eg, L. inners) species.
In addition, women taking estrogen therapy had high levels of Lactobacilli in their urine, whereas women not taking exogenous estrogen or with naturally low estrogen had low or undetectable levels. Estrogen possibly supports the growth of Lactobacillus in the urogenital tract, Dr Nisco suggested. Women receiving hormone replacement therapy via a patch or pill had more Lactobacillus than those receiving it via vaginal cream, she reported.
“We now need to look more closely at whether managing the bacterial content of the urogenital system might affect susceptibility to infection,” Dr Nisco stated in a news release. Lactobacilli are known to play a protective role against vaginal infections, and this function may be conserved in the urogenital tract.
“If Lactobacillus really can help with UTIs, development of a probiotic to use in conjunction with [menopausal hormone therapy] may avoid antibiotic use in these women, but this needs to be tested.”
Neugent M, Hulyalkar N, Kumar A, et al. Metagenomic analysis of the genitourinary microbiome of postmenopausal women with recurrent UTI. Presented at: EAU20 Virtual Congress; July 17 to 19, 2020. Abstract 84.
Women taking menopausal hormone therapy may be more resistant to urine infections [press release]. Amsterdam, The Netherlands. Europa Uomo & European Association of Urology congress; July 18, 2020.