Breaking the Cycle: A New Hope for Recurrent UTIs

By Mr Ivo Dukic, Consultant Urological Surgeon

Recurrent urinary tract infections (rUTIs) are often extremely debilitating. The urgency, the pain on passing urine, the disruption to your daily life, and the anxiety of waiting for the next infection to strike—it is a burden that affects approximately 25–50% of women who experience an initial infection.

For many years, our main weapon in this fight has been antibiotics. We treat the infection, then perhaps put you on a low-dose "prophylactic" (preventative) antibiotic for a few months. While this often works in the short term, it is not a perfect solution. Antibiotics can disrupt your gut health, cause side effects, and, crucially, contribute to the global problem of antimicrobial resistance—where bacteria become harder to kill.

One of the most promising developments in recent years is an immunoprophylactic strategy (a way of using your own immune system to prevent disease) called Uromune (MV140).

What is Uromune?

Unlike a traditional injection, Uromune is a sublingual vaccine. This means it comes as a spray that you administer yourself, under your tongue.

It is a "polyvalent whole-cell vaccine," which is a medical way of saying it contains inactivated (dead) versions of the four most common bacteria that cause UTIs:

• Escherichia coli (E. coli)

• Klebsiella pneumoniae

• Proteus vulgaris

• Enterococcus faecalis

Together, these four bacteria are responsible for about 85% of all urinary tract infections.

The treatment consists of two sprays under the tongue, every day, for three months. Because the lining of your mouth is connected to the same immune system as your bladder (the mucosal immune system), the vaccine "trains" your body’s defence cells (dendritic cells) to recognise and fight these specific bacteria. It essentially puts your immune system on high alert, creating antibodies and killer cells ready to defend your bladder lining.

Does It Actually Work?

In medicine, we look for "Randomised Controlled Trials" (RCTs) to prove a treatment works. For Uromune (MV140), the landmark evidence was published in 2022 in a prestigious journal, NEJM Evidence.

This trial followed 240 women with recurrent UTIs. They were split into groups: some received the vaccine for three months, some for six months, and others received a placebo (a dummy spray). The results were striking.

Over a nine-month period:

• Women who took the placebo suffered a median of 3 infections.

• Women who took Uromune (MV140) (in both groups) had a median of zero infections.

• 56–58% of women who took the vaccine were completely UTI-free, compared to just 25% in the placebo group.

Even for those who did get an infection, the vaccine seemed to make it milder. Patients reported fewer symptoms, a better quality of life, and needed significantly fewer antibiotics.

Real-World Success

Clinical trials are great, but does it work in the "real world" outside of a controlled study? Again, the data is very encouraging.

Observational studies from Spain, the UK, and North America have reinforced the trial findings. For example, the first UK experience reported that 78% of women had no subsequent UTIs during a 12-month follow-up after their course of vaccination. A recent North American study showed a 75% reduction in the rate of infections.

Is It Safe?

This is a critical question. Across all studies, the safety profile of Uromune has been excellent. Adverse events (side effects) are rare, mild, and usually self-limiting. Because it is not a live bacteria and it is not an antibiotic, it avoids the thrush and gut issues often associated with long-term antibiotic use.

How Long Does It Last?

We are now seeing long-term data that answers the question of durability. A 10-year study from Spain showed that while the protection is excellent initially, it does gradually wane over time.

However, data presented recently from the Royal Berkshire Hospital gave us a 9-year view. They found that 54% of participants remained UTI-free for nearly five years on average. The key takeaway from this long-term data is that "booster" courses might be necessary. About 40% of the patients in that study received repeat vaccination courses every one to two years to maintain their protection.

Availability and Cost

In March 2023, the European Association of Urology (EAU) formally recognised MV140 in its guidelines, recommending it to reduce recurrent UTIs.

Currently, in the UK, Uromune is available on a "named-patient" basis. This means it is an unlicensed medication that must be specifically ordered for you by a specialist such as a urologist.

While there is a cost attached to the vaccine itself, a UK analysis showed it is actually cost-effective in the long run. By reducing GP visits by 68% and antibiotic costs by 70%, it saves money for the healthcare system—and more importantly, saves time and stress for you.

Summary

While we await further trials to fine-tune the perfect "booster" schedule, the current evidence suggests that Uromune (MV140) is a safe, well-tolerated, and effective game-changer for women struggling with recurrent UTIs. It offers a genuine alternative to taking regular antibiotics, using science and your own body defences to keep your bladder infection-free.

If you are struggling with recurrent infections, this is certainly a conversation worth having.

Mr Ivo Dukic
Consultant Urological Surgeon, Birmingham, UK

Mr Ivo Dukic is an experienced consultant urologist who offers personalised consultations in Birmingham, United Kingdom. Schedule an appointment with him for expert, bespoke advice through his Top Doctors profile or book an appointment through Harborne Hospital, HCA Healthcare, the Priory Hospital, Edgbaston, Circle Health Group or Droitwich Spa, Circle Health.