Chronic UTI, Medical Misogyny and the System That Was Never Built for You

Chronic UTI affects hundreds of thousands of people in the UK. The majority are women. It has no formal medical definition, no specific treatment pathway, and a diagnostic threshold built on a study that was never designed for it. At some point that stops being an oversight and starts being a pattern.

This episode names that pattern directly and it does so with both the clinical authority and the human weight the subject deserves.

A Condition Without a Category

The most severe end of the UTI spectrum where recurrences are so frequent there are no gaps between episodes, where the condition has evolved into something that requires entirely different testing and longer treatment, currently has no medical category that triggers a different clinical response.

"It actually evolves into a completely different beast when it becomes like that. And what is needed in those situations are better testing and better treatment pathways. But to achieve that, we need to actually get a proper medical definition for chronic UTI." ~ Dr Cat

Without that definition, patients get routed through the same system that has already failed them. They get the same three-day course. They get the same negative dipstick result. And they get sent home again.

Medical Misogyny in Plain Sight

The antibiotic duration disparity is one of the clearest examples of medical misogyny in this space. Women with uncomplicated UTI receive three days. Men receive seven. The justification points to anatomical differences. But Cat notes that historically women used to receive five to seven days and that there has been more recurrent and chronic UTI since the move to shorter courses.

“Women are the creaky gates. They do suffer with quite a lot of stuff and almost they are expected to suffer with quite a lot of stuff. I hate to have to say it, there is misogyny in medicine as in the rest of society." ~ Dr Cat

Medical misogyny in chronic UTI care is not only about individual clinicians being dismissive. It is in the guidelines. It is in the prescribing practices. It is in the cultural assumption that women's pain is a baseline rather than a signal and that suffering is something to be managed rather than investigated.

The Weight of Not Being Believed

Cat shares a story from her third year of medical school that has never left her: a patient with an undiagnosed cancer who had spent months being told nothing was wrong. By the time the diagnosis came, the man was dying. His response was not devastation. It was relief. He finally had a reason. He was finally believed.

That story sits at the heart of what chronic UTI patients experience every day. The tick box culture Sula describes from her own research – the sense of being categorised rather than seen – is not a minor inconvenience. It has measurable psychological and physical consequences. Advocacy for better chronic UTI care is, at its core, advocacy for the right to be believed.

What is Changing

Cat has been part of the work to create a formal medical definition for chronic UTI. The December 2024 NICE update moved the guidelines towards symptom-based treatment. CUTIC continues to produce resources patients can take directly to their GP. And Neha's closing message that there is hope, there is a formula that works, and nobody is starting from a blank slate is not a platitude. It is the view from the other side of a very long and very difficult journey.

Listen to the full conversation with Dr Cat Anderson and Neha now.

Resources can be found here.