Chronic Urinary Tract Infections

Jim Shannon Excerpts

Wednesday 21st May 2025 Westminster Hall

[Dr Allison Gardner (Stoke-on-Trent South) (Lab)]

It is an honour to serve under your chairship, Sir Desmond. I am not well today for the very reason that we are here. I may need to sit down during my speech if that is okay. I am deeply grateful to the hon. Member for Sutton and Cheam (Luke Taylor) for securing this incredibly important debate. [Interruption.]

[Jim Shannon (Strangford) (DUP)]

This is a difficult subject for those who suffer from this condition. I will give an example in my speech, as one of my staff members suffers from it. We are deeply indebted to the hon. Member for Sutton and Cheam (Luke Taylor) for bringing this forward. It is important to hear personal stories from sufferers, such as the hon. Member for Stoke-on-Trent South (Dr Gardner), and that they are given the opportunity to express themselves on the importance of this issue to them personally and to all our constituents.

[Dr Gardner]

As hon. Members may have guessed, this debate is not only important to thousands of women across the country—according to the Chronic Urinary Tract Infection Campaign, about 1.7 million women suffer from chronic UTIs—but incredibly personal to me. I have suffered from UTIs as a result of menopause for more than 10 years, and received a diagnosis of chronic UTI in 2023.

I do not think many people realise how debilitating and excruciating chronic UTI can be. At my worst, I wondered how I could go on. I even changed from a beloved lecturing job to one at NICE because I wanted to change things from within, and it is why I am an MP now. I have tried almost everything; I was even considering—as a final step before the final, final step—having my bladder removed.

Although my NHS consultant gave me Hiprex—methenamine hippurate—thank God, which is life-changing for me, he finally shrugged his shoulders and said that I would just have to live with this condition. In desperation, I tracked down a specialist who worked in private practice. How lucky I was to have the money. I can confidently claim that Dr Catriona Anderson saved my life, which I do not say lightly.

Chronic UTIs can lead to hospitalisation—I have been twice—and sepsis and death. I have a long list of all the drugs that I am on, but I will not read it out. I believe this is another case of how women’s medical conditions continue to be misunderstood, under-researched and underfunded. To illustrate that point, there is a belief that UTIs are more serious in men than in women. I acknowledge that men’s physiology—men have a longer urethra than women—means that they are less likely to develop a UTI, although the possible presence of an enlarged prostate means that they may experience restrictive urine flows and develop a UTI. That is certainly the case in older men. Consequently, all men are recommended seven-day courses of antibiotics compared with the three-day courses that women are recommended. By the way, there are three antibiotics to treat UTIs. Trimethoprim and nitrofurantoin are the top ones, but I am allergic to them, so I am on cephalexin when I need it.

There is a lack of acknowledgement that poorly treated UTIs can lead to bacteria becoming embedded in bladders. Incidentally, a much shorter journey in women means that the diligence afforded to men is not afforded to women. In addition, women’s immune response to pathogenic bacteria in the bladder is oestrogen-dependent, and so it is also age-related. Lack of official recognition of chronic UTIs means that women do not receive treatment equal to what men. I am a molecular biologist, but I will not bore Members by setting out the different types of receptors in the urethral lining of the bladder.

I will further illustrate this point in simpler terms. A campaigner told me how her doctor, who repeatedly prescribed her three-day antibiotic courses for her chronic UTI, prescribed her husband, when he presented with a UTI for the first time, a month-long course, which would entirely clear the infection, of course, and minimise risk of recurrence. That says it all. Incidentally, chronic prostatitis is recognised by NICE.

As has been mentioned, for many women—approximately 70%—three-day courses will be sufficient, but for rest of women, three-day courses clear only some bacteria. Those that remain are relatively resistant; they then increase in population and there is recurrence. Essentially, repeated short courses establish a system of natural selection for resistant bacteria. It also means that the remaining bacteria then have time to invade the bladder and become embedded, finally leading to chronic UTIs. So, patients are stuck in a loop.

The use of the useless urine dipstick test, which is no more accurate than the toss of a coin, and of the midstream urine test, which is even worse, means that infections go undetected. As a result, no antibiotics are prescribed until the infection gets worse and, finally, a short course of antibiotics is prescribed. However, the infection is still not fully cleared, so the loop starts again. The infection then becomes embedded in the bladder wall and chronic UTI develops.

Short-term antibiotic courses often do not treat chronic UTIs, because dormant populations of bacteria exist within the bladder wall. Your life revolves around desperately trying to convince doctors to prescribe a course that you know will work for you. I am due to move house soon and I am petrified of having to move GPs, which would mean again starting this battle of trying to convince a GP to take me seriously. I understand concerns around antibiotic resistance and the medical hesitancy in prescribing longer courses of antibiotics. However, the solution is not to minimise antibiotic use; it is to get the diagnosis right, treat thoroughly, recognise the existence of chronic UTIs and prevent their development.

I am concerned by the lack of research and guidelines for diagnosis and treatment of chronic UTIs. We could prevent them all together if we get things right. I am particularly excited by the UTI vaccine, which is not currently available in the UK. Prevention of UTIs would not only save the NHS countless hours and money, but save people from living miserable lives.

In April, the Minister for Care said in a response to a written question:

“there are no current plans to train GPs and urologists on recognising the symptoms of chronic UTIs”.

Also, current NICE guidelines do not contain guidance for chronic UTIs. This situation must change. Too many women are being left in unbearable pain without a proper diagnosis or appropriate medication.

I will be very quick now, Sir Desmond; you have been very patient with me. About 50% of all antibiotics are prescribed for UTIs. However, each year there are thousands of deaths from UTIs and approximately 200,000 A&E admissions are due to UTI-related illnesses. The cost of UTIs to the NHS, as well as to people’s lives, is huge.

This issue is personal for me. It is also personal for the millions living with the pain, frustration and isolation of chronic UTIs. Will the Minister meet me and others, including campaigners, to discuss how we can improve diagnostic tools, develop guidance and ensure that people suffering from this condition receive the care that they deserve?

Thank you for your indulgence, Sir Desmond.

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to serve under your chairship, Sir Desmond. I commend the hon. Member for Sutton and Cheam (Luke Taylor) on his presentation of this debate on subject matter that some, such as the hon. Member for Stoke-on-Trent South (Dr Gardner), have personal experience of. Others, including me, have staff members who have had this condition, and some have family members who have had it—I understand that my friend the hon. Member for North Down (Alex Easton) has experienced that.

This is an opportunity to speak on behalf of sufferers in my constituency of Strangford and across this great United Kingdom of Great Britain and Northern Ireland. The NHS estimates that some 14 million people in the UK experience some form of urinary incontinence. That figure is expected to rise because of an ageing population with often very complex health issues. That is a fact of life. Those of a certain age—I am one of them—find that their health issues are multiple. That is the nature of age; it takes its toll.

Inadequate continence care can lead to serious complications, with urinary tract infections among the most common and concerning outcomes. NHS data showed that there were more than 1.8 million hospital admissions involving UTIs between 2018-19 and 2022-23. The majority involved patients aged 65 or older. The admissions include both those directly caused by UTIs and those for other reasons but where a UTI was also present. As a leading cause of emergency admissions, UTIs place substantial strain on NHS resources, while diminishing patients’ dignity, experiences and outcomes.

I wish to highlight that this issue affects both men and women, as well as children. The hon. Member for Sutton and Cheam referred to a three-year-old girl, so children are affected by chronic UTIs. A member of my office staff, one of our young girls, came to work with me when she was 16. She has been there for a long time, so I must be doing something right; she has not left me to go elsewhere where the money is better. Perhaps the conditions and the time off are better as well.

I understood the chronic pain that my staff member had, but also the need to be flexible at times—whenever she was not well, she obviously needed time off. She attended a fair few hospital appointments for a chronic UTI, and it was a very difficult time. She was on antibiotics for six months. I wondered, “Is that possible?” But in this case it was, because the infection was so chronic. Ultimately it cleared. Also, on 1 January this year she got married, so her life is going in the right direction now—thank goodness for that. The issue was exacerbated at the time by the difficulty of getting GP appointments and specialist referrals. The chronic pain just seemed to exist forever, even with the help of antibiotics. Eventually she got to the end of that six-month period and she is now in much better health.

I want to mention what we are doing in Northern Ireland, because obviously that will be part of any debate in which I speak. In Northern Ireland we have something, and perhaps the Minister will say to me in a few minutes, once I tell her what it is about, “Well, we’re already doing that.” If they are, that is good. I was very relieved when Northern Ireland rolled out the Pharmacy First scheme, especially as the scheme covers advice and treatment for uncomplicated urinary tract infections in the local pharmacy, so without having to wait for a GP appointment. If the Minister tells me that the Government have not done that yet, can I say that it is another Northern Ireland first? And if the Minister is not aware of it, may I say, to be helpful in this debate, that perhaps it should be done here as well?

The pharmacist may test the patient’s urine to help to determine whether a UTI is present. How does the scheme work? What happens when a person goes to their local pharmacy in Northern Ireland? In some cases, self-care advice may be all that is necessary. In other words, they will get a bit of advice. The pharmacist will find out what the symptoms are and explain the situation to the person, and perhaps will be able to respond fairly quickly. As I said, in some cases self-care advice may be all that is necessary, but the community pharmacist is also able to supply the patient with medicines to relieve pain—in some cases there can be chronic pain—and, if applicable, antibiotics. In all cases, women will be advised on what to do if their symptoms worsen or do not resolve.

The Pharmacy First UTI service means that women can be assessed and treated much sooner, without having to wait for a GP appointment—like the young girl in my office—for a month, two months, six weeks or whatever the case may be. Not only will patients not need an appointment, but community pharmacies are more likely to be open after normal working hours, at weekends and on bank holidays. Newtownards, my major town, has a number of pharmacies, which take turns staying open at the weekend; there is always access to a pharmacy in Newtownards and, indeed, other major towns in the Province.

The UTI management service expanded to more than 400 community pharmacies in 2024-25, following positive evaluation of the pilot, which involved 60 pharmacies and started in July 2021. That success convinced the Northern Ireland Department of Health to make the pilot bigger and showed that we could do more. Between March 2022 and April 2023, 3,500 women in Northern Ireland used the pilot service. Following assessment, more than 85% were diagnosed with a UTI and received appropriate advice and treatment from a pharmacist.

That is positive, but for those with chronic UTIs, like the hon. Member for Stoke-on-Trent South, the pharmacy does not cut it and the GP can only do so much. There are different levels of response: community pharmacies in Northern Ireland provide an automatic response to those who have a urinary infection, rather than a chronic UTI, but sometimes things are much more complicated.

The waiting list to be seen for a UTI in Northern Ireland is long, and the average waiting time for urology appointments varies significantly, depending on the health and social care trust and the urgency of the case. For example, in the Belfast health and social care trust, the wait in a red flag case—the most urgent—might be nine weeks, which is more than two months and far too long; a non-urgent case could wait 76 weeks, and a routine case could wait 180 weeks. Those are horrendous and completely unacceptable waiting times.

Throughout the United Kingdom of Great Britain and Northern Ireland, there needs to be access to specialised care, innovation, new and modern technology, and new ideas, rather than a six-month course of antibiotics and a hope for the best. Men, women and children need more, and it must be provided.

I look forward to the Minister’s response. She responded positively to last week’s debate, and I am sure that today she will again indicate her wish to make lives better. This debate gives her the opportunity to do so, and to help those who have been waiting so long for an end to their health issue. We can do better—and we must.