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There is finally hope for people who suffer from chronic urinary tract infections (UTIs) after years spent in debilitating pain and “medical misogyny”.
Several exciting scientific developments are underway, from a new antibiotic that could change the trajectory of treatment to novel methods of delivering game-changing drugs directly to the bladder.
Evidence is building to suggest infections are not always fully cleared by the standard three-day course of antibiotics.
Without proper treatment, bacteria becomes embedded into the bladder lining, triggering a chronic infection. The symptoms can leave people bedbound, unable to work, sleep, leave the house or socialise.
But the political and medical tide is turning, with a new All-Party Parliamentary Group (APPG) for chronic UTI forming and a group of experts finally set to agree upon an official definition in 2026, which could overhaul NHS diagnosis and treatment guidelines.
Labour MP Dr Allison Gardner, co-chair of the APPG, said chronic UTI is a “classic example of medical misogyny”, with a lack of research into the condition and limited treatment guidelines leading to misunderstanding by doctors.
But after a history of resistance by the medical community and a refusal to recognise that chronic UTI exists as a distinct condition by the UK health authorities, the future looks promising.
Here are the top scientific breakthroughs expected over the next year, and the difference they could make.
First new antibiotic in decades
The first new antibiotic for UTIs in nearly 30 years has been approved by regulators.
Gepotidacin, also known as Blujepa, is “first-in-its-class”, which means it uses a unique mechanism to treat UTIs, and could pave the way for new formulations.
“That means, fingers crossed, there’s going to be more in its class,” said Rajvinder Khasriya, a leading consultant urogynaecologist at University College London Hospital. “That’s important because we are facing antimicrobial resistance as a crisis.”
The oral antibiotic has been approved by the Medicines and Healthcare products Regulatory Agency (Mhra) for treating uncomplicated UTIs in women and girls above the age of 12.
Khasriya said it “has the capacity to change the trajectory for a lot of people who’ve been struggling with very long courses of antibiotics”.
Doctors are waiting to hear whether it will be approved for NHS use by the National Institute for Health and Care Excellence (Nice), which provides clinical guidelines and decisions on whether the new drugs are financially viable.
The drug works by targeting and blocking two bacterial enzymes which bacteria need to copy their DNA and multiply. Because it inhibits these enzymes using a novel mechanism, it is effective against strains resistant to older antibiotics, helping to combat antimicrobial resistance.
Dr Cat Anderson, a GP specialising in challenging UTI cases, warned the drug is “expensive”, so Nice is only likely to approve it for patients shown to suffer from antibiotic-resistant infections.
The UTI vaccine
A vaccine used for the prevention of UTIs is showing promise, but it is still awaiting approval by the UK health authorities.
Uromune is a mouth spray that has been proven in clinical trials to prevent recurrent UTIs from returning for up to nine years.
Bob Yang, a consultant urologist at the Royal Berkshire NHS Foundation Trust, who co-led the research, said the vaccine could be a “game-changer” for UTI prevention if offered widely, while also reducing the need for antibiotics.
“Many of our participants told us that having the vaccine restored their quality of life,” he said.
Uromune, which was developed by the Spanish pharmaceutical company Immunotek, is still awaiting approval from the Mhra and Nice – so it could be years until it is widely available on the NHS.
It is already accessible via private clinics in the UK, but costs hundreds of pounds.
Bacteria-eating viruses could be the answer
Viruses that essentially eat the bacteria that causes chronic UTIs could be on the horizon as a non-antibiotic treatment.
In what is known as phage therapy, viruses – or bacteriophages – are used to destroy harmful UTI bacteria. Over the summer, the Mhra published the UK’s first official guidance to support its development, which Khasriya said “opens the gate” for more research.
In the US, researchers are already looking at how phage therapies can be used to target strains of bacteria that commonly cause UTIs. There are currently no licensed phage medicines in the UK market.
Though it is not yet a clinically viable option, research demonstrates it could be effective in targeting drug-resistant microorganisms that stick to the bladder wall and make infections hard to treat with antibiotics.
Long-term antibiotics for more sufferers
Treatment provided by the UK’s only dedicated NHS chronic UTI clinic could become more widely available following a clinical trial into the efficacy of long-term, high-dose antibiotic courses.
The i Paper previously reported the wait list for the Lower Urinary Tract Symptoms (LUTS) Service at the Whittington Hospital, in north London, is over a year long, with patients travelling long distances for specialist treatment.
A trial, led by Khasriya, is investigating whether extended, high-dose antibiotic treatment, combined with a urinary antiseptic called Hiprex, is more effective for chronic UTI patients than the current standard of care.
The phase two clinical trial received funding from the Medical Research Council (MRC) and will start recruiting patients at the end of January.
If it shows the efficacy of long-term antibiotics, it means “other centres will be more confident to give it”, said Khasriya.
The antiseptic Hiprex was approved for NHS use last December and has led to “much better control of recurrent and chronic UTI” and “much better outcomes in terms of quality of life”, said Dr Anderson.
Backlash over three-day antibiotic prescription
A three-day course of antibiotics is not long enough to treat an acute UTI, and could trigger a chronic infection, according to a growing body of evidence.
Many patients have polymicrobial infections, meaning there is more than one bug growing in the urine, according to research by Professor Jenny Rohn, a microbiologist at University College London (UCL).
New research, which Prof Rohn hopes will appear in a peer-reviewed journal in 2026, suggests these bugs “work together to make your UTI worse” – suggesting they are more difficult to treat with short courses of antibiotics.
Previously, it was thought that other bugs in urine samples could have come from cross-contamination.
Prof Rhon said the research “really strongly suggests that you need a longer course to clear the infection” and that lengthening the three-day course of antibiotics is likely to “get better results”.
This is important because Nice needs new evidence to prompt a review into changing treatment guidelines.
Race to develop new treatments
New ways of delivering drugs directly to the bladder, to make UTI treatments more targeted, are under development.
One locally administered therapy involves an antimicrobial polymer called Nanocin, which kills bacteria, and an analgesic drug, which provides pain relief. The formulation is still being finalised, but it is likely to be delivered directly into the bladder via catheter, which would need to be instilled once per week.
It is being developed by nanotechnology firm Tecrea, in partnership with the Bladder Infection and Immunity Group (BIIG) at UCL.
Separately, Prof Rohn is developing CapFuran, an encapsulated antibiotic designed to go directly into the bladder, also administered via catheterisation.
She is currently applying for a research grant and said a clinical trial could start over the next year if investment is secured.
With both treatments in the early stages of development, it will be years before either becomes available on the NHS.
New diagnostic tests in the works
Some health experts have said current testing methods are outdated and can miss chronic infections, including the dipsticks many sufferers are likely to have used.
In March 2023, Nice recommended further research into tests that can give “faster and more accurate results compared with current testing”.
One of these is called Lodestar DX, which is being developed by Dr Emma Hayhurst, a microbiologist at Llusern Scientific.
She explained doctors can insert urine into this handheld device without needing to send a sample off to a lab. It can detect which of the six most common bacterial pathogens is causing the infection within 25 minutes.
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The new test has regulatory approval and is being used in some private urology clinics, but it is yet to be approved for NHS use.
A Department of Health and Social Care spokesperson said: “Living with a chronic UTI can be extremely debilitating and patients should receive compassionate care and support from the NHS.
“We are funding research to improve the diagnosis and unlock new treatments such as these for patients. The medicine regulator recently approved the first new type of antibiotic for this condition in nearly 30 years.
“We’re also renewing the Women’s Health Strategy, cutting waiting lists for gynaecological services and bringing care closer to home with Neighbourhood Health Centres delivering personalised support.”
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