A new database has been launched to investigate the underlying causes of chronic urinary tract infections (UTIs) in children. This initiative aims to address a condition that affects millions of women and girls worldwide, often resisting treatment and challenging microbiologists.
Recent studies indicate that some persistent UTIs may be due to bacteria hiding deep within the bladder wall, making them difficult for both the immune system and standard treatments to eliminate. This process, called intracellular bacterial colonisation, has been observed before but is gaining renewed attention following a medical case study led by University of Sydney researchers and published by the American Society for Microbiology.
The case study described a child with chronic UTIs whose infection could not be cleared despite multiple long-term antibiotic regimens. The bacteria were found embedded in the bladder’s inner lining, or epithelium. According to the research, traditional clinical approaches—limited mainly to antibiotics and diathermy—are often ineffective. Diathermy, which uses electrical current to treat tissue, also carries an increased risk of cancer if used repeatedly.
Dr Arthika Manoharan from the Charles Perkins Centre and School of Medical Sciences led the research team. She noted that young girls as early as five years old have undergone years of antibiotic treatment only to relapse when medication stops.
In response to these findings, Dr Manoharan is developing a new database focused on children under 15 who experience chronic UTIs. The goal is to better understand why some individuals develop persistent infections while others do not. Dr Manoharan hopes this work will challenge longstanding assumptions linking UTIs primarily with sexual activity—a perspective she describes as a form of medical misogyny that downplays its impact on women and girls.
"Often people think of UTIs only affecting adult women who are sexually active, which is not the case. There are many cases where this issue starts in childhood, with no clear cause. This can have a huge impact to their quality of life at a time when they should be enjoying school, playing sports and simply being kids," said Dr Manoharan.
"The longer consequences of persistent UTIs can be severe. Some women see their employment affected due to chronic incontinence; others are unable to maintain a sexual relationship. Many echo the same sentiment: One minute you're fine, the next you're in agony and can't leave the house."
The research team plans for the database to help identify whether factors such as immune system evasion or genetic predisposition contribute to why some children develop chronic UTIs while others do not.
