Transient microbiota exposures activate dormant Escherichia coli infection in the bladder and drive severe outcomes of recurrent disease
Fig 5
Model of Gardnerella vaginalis “covert pathogenesis.”
In women, approximately half of recurrent urinary tract infection (rUTI) episodes are caused by an E. coli strain identical to the strain that caused the initial infection. Here we present a model of one mechanism of rUTI: activation of latent intracellular E. coli reservoirs in the bladder. G. vaginalis urinary tract exposure, likely a consequence of sexual activity, results in exfoliation of the bladder epithelium and damage to the kidney. Subsequent to exfoliation, E. coli emerges from intracellular reservoirs into the bladder lumen, where it can ascend into the kidney, sometimes causing severe inflammation and systemic infection. Often E. coli rUTI occurs after G. vaginalis clearance from the urinary tract. These findings have important implications for our understanding of rUTI etiology and point to G. vaginalis colonization as a potentially important marker of rUTI risk.