Covert Pathogenesis in the Urinary Tract

In a conversation with A. Lenore Ackerman, MD, PhD, Section Editor of the Next Generation Microbiome and Urologic Infection Learning Center on Grand Rounds in Urology, Nicole M. Gilbert, PhD, an instructor in the Department of Pediatrics at Washington University School of Medicine, discusses her research linking urogenital microbes to recurrent urinary tract infection (rUTI). Although the bladder was long regarded as sterile in the absence of overt infection, recent research suggests that there is a urinary microbiome and that two commonly found bacteria in the bladder are Gardnerella and Lactobacillus, both of which are also common in the vagina. Dr. Gilbert and her colleagues wanted to investigate how those urogenital microbes affect the bladder, and determined that Gardnerella vaginalis causes urothelial exfoliation, a condition that has been associated with rUTI. Because Gardnerella vaginalis appears able to trigger rUTI even when it is cleared out of the bladder within 12 hours, Dr. Gilbert calls it a covert pathogen, and suggests that further research is needed to find stable indicators of repeat exposure to Gardnerella.

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