Mythbusting Urinary tract infections

A urinary tract infection (UTI), it’s like trying to pee small needles. Most ladies have experienced it at least once in their life and are in fear it will return. Be afraid, be very afraid, because for many it will return.
I count myself lucky that I have only had the unpleasant experience twice in my life and only in a short period of two months. But oh my! Tears were running over my face and that was only because I just sat down and feared what would come. When the terror started it was excruciating to remain seated for five whole seconds. It took me to a new level of respect for the ladies with a recurrent UTI-experience.
What is it with this awful infection? Time for some facts and myths about UTI’s.

1. Fact: Women get infected more often than men

The whole mechanism behind the infection is a Tale of Two Holes. You get UTI’s mostly from bacteria that normally live and belong in your intestines. The most common cause is E. Coli, but there are many more that can make your pee burn. What they do is tiger-crawling from your anus to your bladder. Take a moment to imagine that please, and try not to move! Indeed, that’s quite a distance to cover from a bacterium point of view. And that’s a good thing. Pee before one of the bacteria reaches your bladder, and you wash him away. Yes him, I call this fucker a guy. For women this popular road is shorter than for men. As most of you know, men have a penis that adds about 10 cm to the tract (well, not all of them …) making the odds greater to be washed away. In this case: size does matter!

2. Myth: you can get UTI by sitting on a dirty toilet seat

Nope. Not true. Better yet, the ladies that squad to pee above a “contaminated” seat tend to not empty their bladder fully. Some of the pee stays inside, sometimes with a UTI bacterium that hung in there. Happy with his new fancy jacuzzi, called your bladder, it gladly multiplies, and you end up crying on the toilet seat once more. So please lovely ladies, sit down. Your thighs can hold the germs. Just don’t rub your vaginas on the whole seat, ok? And no, men, don’t go toilet slapping (either), because … well, it ain’t right.

3. Nobody knows for sure: Cranberries can prevent UTI

The idea behind the cranberries is that you change the sourness, the pH, of your urine making it more acidotic. In this acid the “legs” of the bacteria dissolve, making it impossible for them to keep crawling. It’s weird to imagine that something you eat can have an influence on the pH of your pee. A sour cranberry comes in contact with bile first and that is made to neutralize any acid that comes out of the stomach (pretty acid environment going on in your stomach). So this makes you wonder if you can change it enough to have an effect on bacteria. There are others who suggest cranberries work because of anti-oxidants. I tell patients that they can try it, if it doesn’t help, it’s still tasty.

4. Nobody knows for sure continues: peeing after sex, wiping method, drinking

Some things just make sense. If you have sex, all sorts of bacteria get moved from both your and your partners flora and fauna. Peeing afterwards could be a good idea. Wiping from back to front, is like giving the psychotic hitchhiking bacteria a free ride. I don’t know, why would anybody even consider that? And if you drink a lot of water, you pee more often, flushing away bacteria on the road. Don’t think about these thing, just do them.

5. Myth: you can get a UTI by wearing short skirts

My mother was wrong. Yet again. Had I only known sooner that most of the things parents tell their kids are not evidence based. No, a short skirt does not give you a UTI. However, a short skirt might lead to sex causing a UTI, might get you to a place where you refuse to sit down and pee properly … or might make you wipe from back to … nah, forget this last one.

6. Fact: you can die from a UTI

If the bacteria crawl all the way up to your kidneys, it can cause a kidney infection, Pyelonephritis. From here it can enter your bloodstream and make you septic. Sepsis can lead to death. But rest assured, before you die you will probably go to the doctor with fever, pain on your sides and pain while peeing. This will make the doctor give you antibiotics and voila, you don’t die any more. And if you didn’t go to the doctor, well then you are a masochist. I am not judging,… but you will die.

7. Myth: you always need antibiotics to cure from a UTI

For uncomplicated bladder infections, like the one I had, antibiotics are not needed. Even when I was peeing blood as an additional setting to the torture, I knew that all I needed to do was drink lots of fluids and hang – not literally, see 2. – in there. 
If you do want to get antibiotics make sure that your urine is cultured to test for susceptibilities. You might regret not doing it if the antibiotics don’t work and you get the fever and flank pain from your kidney’s.

Ladies – and men, I am still not judging – let’s promise ourselves to wear short skirts, wipe properly, drink a lot of water and have sex as long as we pee afterwards while sitting on the seat.

 

 

Picture:

Source Flood plain toilet
Author Jacob Levine

Malaria: the search for a vaccine

After my previous blog, we all understand the basics of malaria. It is the parasite that kills, not the bad air from swamps or your armpits. And although we have some medicine to cure Malaria, humanity still didn’t find a vaccine to prevent catching one of the biggest infectious diseases out there. And that isn’t because nobody is looking for it or nobody is investing money in the research. On the contrary, finding a Malaria vaccine is like finding a needle in a haystack and then try to learn that needle to do a trapeze act. In short, it’s hard work.

Why and who needs a vaccine?

Well, a vaccine is not primarily for the people with a bit of money that want to see the Big Five. As nice as it seems that you can travel without taking these often expensive, sometime hallucinating medications, we need to take a wider perspective. A vaccine is needed to prevent children deaths. That’s what counts in these countries. Especially now that more and more Malaria parasites turn out to be resistant to our anti malaria pills.

How to train your dragon… uh, no, how to train your immune system step 1

In Nijmegen, the Netherlands, years ago, a research group found a couple of students to participate in their “can we train our immune system to recognize Malaria” study. They treated them with anti malaria pills and deliberately infected them with Malaria a couple of times. Then they stopped the medication. Now the real challenge began, without any prophylactic therapy all subjects were exposed to the Malaria once again. Just to see if the immune system had actually seen the parasite previously under treatment. Turns out: your immune system rocks! Even with the anti malaria pills it was able to get a good look at Malaria and remember what it looked like. The unfortunate thing was that this memory didn’t last very long. But it was a promising start.

How to train your immune system step 2

Now that we knew the immune system could be trained, researchers wanted to train it with a vaccine, a RTS,S vaccine. It took about 30 years to develop, but eventually they could test this vaccine in African children. They had really nice results, preventing serious Malaria in about 30% of the children. In a world where previously all malaria infected person died, this was good news! But, just like the Nijmegen group, they found that the immune systems memory weaned and the immune system needed to be exposed to the vaccine, and thus to malaria, in order to keep it working. Better than nothing, but not the holy grail humanity was looking for.

How to train your immune system step 3

Now the Dutch are hitting the news again. A new vaccine is made and is being tested in, amongst other countries, the Netherlands. The problem with the other vaccines appears to be that in the vaccine only some of the Malaria particles are used to train the immune system. But this is not good enough. The immune system needs more to ensure a long-lasting recognition. The new vaccine is supposed to be made from an inactivated whole parasite. Yes, you read it correctly, a whole Malaria parasite that has been modified to not go into hiding in your liver and not invade your blood cells. Pretty impressive right? Could work. Hopefully this vaccine wont take 30 years to get past all the safety and effectiveness tests!

So there you have it, the long long long search for a Malaria vaccine and the training of an immune system. Remaining questions that we want to get the answer to these coming years are: 1. Will this new vaccine give long lasting protection for the people that need it the most? 2. Will it help for all types of Malaria?

For now, don’t wait for this vaccine and do travel to Africa and see the animals, I can highly recommend it. Just take your prophylactic malaria pills.

Mal’aria? I don’t smell anything.

Some researchers state that humanity is on the verge to invent a vaccine against malaria. That would be great news, because Malaria is a notorious disease. In 2015 it infected roughly 121 million people with an estimated 429.000 death, most of which were children.

Time to shine a light on this disease in my blog. First some history and basics, next time we’ll learn about the search for that vaccine in a particular study in the Netherlands.

Although Malaria is a well-known disease, most Western people are only confronted with it when they travel to far away countries around the equator and they are going through their usual list of questions: 1. Do I need a special adapter to charge my phone? 2. Do I need a visa and by the way where is my passport? 3. Do I need to take a precautionary medicine for malaria or not?

But actually, not too long ago, this disease was also endemic (read my previous blog if you don’t know what that means) in Europe and in the USA. During World War II for example, approximately 500,000 men became infected with Malaria in Europe. Bet you didn’t know that.

Swamps and Miasma

Our very own granddad of medicine, Hippocrates, has described a disease with fever that would come after draining swamps and lakes. He was a believer of the “Miasma” theory, most people believed that you actually could get sick from bad air. In this case that the fumes from the swamps were the cause of the illness. Malaria even has its name derived from this Miasma theory; Mal Aria means Bad Air in Italian.

You might say: oh, stupid people, what were you thinking in 400 BC? Understand however that the Miasma theory has had an impact on the profession of medicine well into the 19th century.
But rest assured, you don’t need to shower, Malaria really has nothing to do with (your) bad air. It is all about the water where the mosquitos live. Without the mosquito: no Malaria! To be even more precise: malaria is caused by a parasite, Plasmodium, that specific mosquitos carry and inject humans with. At this moment there are 5 different Malaria species known of which P. Falciparum is the most famous one, but please don’t ask him for his signature.

Hide and Sick

Malaria can give you a lot of symptoms, but fever is for sure the numbero uno give-away. Unfortunately, the parasite can be a practical joker. It lives in different stages. Some of these stages are in your blood which are easily targeted by treatment, in other stages the parasite looks for a quiet place in the liver and can actually hide there for years before you get sick, resulting in a different treatment strategy.

Sometimes, natural medicine rocks

Now as a medical doctor, I’m not the biggest fan of traditional medicine. I’ve seen many times how the “traditional doctor” did not know the actual cause of the symptoms and just did some vague Magician Act. However, this does not mean that I don’t believe that nature has most of the answers to our problems. We’ve seen this for example with the discovery of Penicillin from a fungus, and yes, also in the treatment of Malaria, nature saved our asses again: the two most effective treatments for Malaria are both nature based.
The first effective treatment for malaria came from the bark of the cinchona tree, which contains quinine. The second drug is Artimisinine, which is a Chinese herb. It was used in China for many years to treat fever and hemorrhoids (love that combination).
Both of these drugs are used to make new variations to treat Malaria. But we need to go the extra mile. There is an actual danger for Resistance against these medicines. Here we go again. 

In summary: Bad air is difficult to breathe in, but does not actually cause Malaria … or hemorrhoids.

Next week: vaccination time