I lost my virginity when I was 17, and about a month later, I felt a burning pain when I peed. The pain led me to a doctor, who diagnosed me with a urinary tract infection, or UTI, and prescribed me antibiotics. But unlike most people who experience a UTI—the second most common infection that over half of women experience in their lifetimes—my infection never really stopped.
I continued getting infection after infection—chronic recurrent UTIs. I was plagued with burning urination, a feeling that I constantly had to pee, and the feeling when I finished peeing that I still had to go. I went through several male partners, and with all of them I continued to get infections, especially during the beginning of a relationship—something aptly called "honeymoon cystitis." The doctors all told me the same thing: Drink lots of water, pee before and after sex, wipe front to back, and stay clean. I did all those things and still got infections.
I was referred to a specialist—my urologist, Dr. Vasselli. Inside the waiting room, it was always a bunch of 80-year-old men, who often have issues with aging prostates, and me. Dr. Vasselli was warm and funny; he used to call my pee "liquid gold" when he asked me to give him my urine sample. Much to my relief, he told me we would be able to sort out my infections. For this I adored him and would look forward to the visits that meant the end, albeit temporary, to my latest suffering.
At first he did almost exactly what my other doctors had done when they prescribed antibiotics, thought he would test my urine to find out the specific type of bacteria that had caused the infection. We wound our way through many of the plethora of antibiotics useful for UTIs—Trimethoprim/sulfamethoxazole, Fosfomycin, Ciprofloxacin, Levofloxacin, Cephalexin, Ceftriaxone, Azithromycin, Doxycycline—and eventually I was prescribed Nitrofurantoin as a prophylactic antibiotic. I would take a small dose after sex and one the next morning to prevent infection.
Dr. Vasselli described to me in plain language what was happening to me on a biological level. Bacteria from my bowels would slowly crawl around and across my vulva and up my urethra (or be pushed up there during sex). When I peed, these bacteria would be flushed out, which is why it's so important to drink lots of water. If all the pee didn't leave my body, neither would the bacteria, which would breed and take over, causing an infection. Additionally, certain foods, drinks, and activities are naturally irritating to the urethra—coffee, black tea, spicy food, alcohol, sex, condoms—and these would leave the urethra raw and susceptible to infection. He told me to avoid all the aforementioned foods and drinks, and to add vitamin E and green tea to my diet, both of which are nourishing and healing to the urethra.
I managed these infections for over a decade, then started dating a new partner, and with it came a flood of UTIs. Often the pain from the infections make it hard to sleep, so I spent a lot of time scouring the internet for help with UTIs. I found a cranberry supplement that seemed promising, and used that for a while. It seemed to help prevent infections but couldn't correct one once it had started. (Recent research confirms that cranberry has disappointing results as a preventative measure.) Then I stumbled onto a barrage of product reviews from people swearing that D-mannose had solved their UTI problems once and for all.
D-mannose is the sugar that naturally occurs in cranberries and blueberries, the ingredient thought to prevent infections when people drink pure cranberry juice. There are a few promising studies examining D-mannose's effect. According to Jonathan Wright, a natural medicine specialist who's been using it for UTI treatment for twenty years, D-mannose helps rinse E. coli from the urinary tract by binding to E. coli's fingerlike projections (called fimbria), which normally allow it to stick to the urethral wall.
After reading endless online reviews for D-mannose, I decided to try it. I haven't had a single infection since. It's the only thing I've found that doesn't just prevent infections, but can also reverse an infection in the early stages. I take it after sex and the next morning. If I feel an infection coming on, I'll sometimes take it four times a day. Together, with preventative measures like drinking lots of water and practicing good hygiene, I've developed a routine that has allowed me to avoid infections altogether.
My experience isn't necessarily universal: Because D-mannose isn't supported by extensive studies, some doctors are reticent to suggest it to patients. Paul Auwaerter, professor of medicine at Johns Hopkins University School of Medicine, says he's "waiting for more definitive studies" before he recommends the treatment to his patients. But Mark Hyman, an MD who practices integrative medicine, says that when infections are caused by E. coli, D-mannose is "the most effective treatment that I've found for a urinary tract infection," adding that a high-fiber diet with plenty of plant foods and few processed sugars can help as well.
Aviva Romm, an integrative physician and herbalist, also affirms my experience, saying that she has found great success with patients using D-mannose and probiotics together for prevention. She suggests a probiotic combination of lactobaccilus reuteri and lactobacillus rhamnosus, both known for treating vaginal flora disruption. For treatment of infections that have already taken hold, if they are in early stages, she says it's worth trying natural treatments—cranberry, D-mannose, or the herbs uva ursi, which becomes antibacterial after the body processes it, and marshmallow root, which helps soothe the urethral lining and reduce inflammation.
For chronic recurrent UTIs, new infections continue to pop up because they are triggered by something. Often this can simply be sex, but for older women, lower estrogen levels contribute to susceptibility. Food allergies, such as in Celiac disease, can trigger infections, and in older men, chronic prostatitis can contribute. Romm also says that if people have anal sex before vaginal, this can trigger infections, as can lubricants, soaps, or other hygiene products. If a trigger can be identified and eliminated or addressed, this can aid the struggle to rid patients of chronic recurrent infections.
The prolific use of antibiotics in western medicine—most people in the US have taken 20 rounds of antibiotics by age 18, and another ten by age 30—has wreaked havoc on most people's populations of good bacteria like lactobacillus and allowed harmful bacteria like E. coli to thrive, Romm says. This could be a contributing factor to why so many of us have had UTIs. "The bugs in our gut determine more about your health and your emotional and mental well-being than you ever imagined," Hyman adds.
I thought I would struggle with UTIs for the rest of my life, and perhaps they will return in the future, but for now, I'm grateful for the respite.