When the symptoms of interstitial cystitis and prostatitis virtually mimic that of a bladder infection, it’s only natural for patients and doctors to contemplate treating the urinary symptoms with an antibiotic. Go ahead! Admit it! You’ve probably raided your medicine cabinet in the middle of the night to take an antibiotic that you’ve saved. You might have even ordered antibiotics off of the internet. A desperate, burning bladder or prostate calls for desperate measures, right? Wrong! You should NOT self medicate with antibiotics. Here’s Why!

New  research has now found Lactobacillus Iners, a pathogenic bacteria, in the urine of some IC patients with bladder wall driven pain.(1) It was not found in patients with pelvic floor dysfunction. In a recent class on IC/BPS, researcher Dr. Anne Ackerman said “Lactobacillus Iners is unique because it is gram negative, it doesn’t behave like other lactobacillus to kill candida, produces minimal hydrogen peroxide and produces a toxin like gardnerella that damages cells.” She continued “Iners becomes highly enriched in the vaginal biome in patients using antibiotics.” It appears to be an opportunistic lactobacillus that grows rapidly and dominates the biome when antibiotics have killed the other good lactobacillus. Lactobacillus Iners has now been associated with a number of medical conditions, such as vulvovaginal candida  infections(2) and cervical cancer(3). In contrast, lactobacillus crispatus, a truly beneficial bacteria, have an anti-inflammatory effect.(4)

What else happens after antibiotic use? The good bacteria that normally keep fungi in check are destroyed, thus allowing fungus (candida) to grow. She said “Increased fungal levels are also found in IC/BPS and the levels go up when patients are having flares.” This was confirmed in an MAPP research study several years ago.(5) She continued “fungal signatures correlate with bladder pain. Specifically candida growth increases pain overall.” 

Still not convinced? Here are more reasons to contemplate:

#1 – Infection rarely causes IC or prostatitis flares –  Interstitial cystitis patients rarely test positive for infection.(6) The remaining 93% have other things going on in their pelvis, such as bladder wall injury, pelvic floor dysfunction, pudendal neuralgia, central sensitization, biomechanical stresses, etc. Experts state that antibiotics should only be prescribed AFTER a culture or Next Generation DNA testing are performed to verify not only the type of bacteria involved, the presence of antibiotic genes but also the most effective antibiotic to treat it with.

#2 – But they worked in the past – Don’t be fooled! Many antibiotics have an anti-inflammatory effect that can provide temporary relief but it won’t treat the underlying problem, such as Hunner’s lesions caused by viral infections, bladder wall irritation from a cup of coffee, estrogen atrophy, pelvic floor dysfunction, or widespread pain exacerbated by stress and anxiety. Be cautious of those who suggest long term antibiotic use, which can also lead to dangerous complications and should only be used under close medical supervision if an acute or chronic infection is present.

#3 – The Risk of C-Diff – Antibiotics disrupt the normal bacterial flora in the gut which can then lead to an overgrowth of another bacteria, Clostridium difficile. C. Diff can cause a terrible  inflammation of the colon (aka colitis) and is usually manifested in the form of bloody diarrhea. C. diff is responsible for more than 500,000 infections each year in the USA and nearly 48,000 deaths.(6) In recent years, it’s also become much more drug resistant and is now labelled a “superbug.” C. diff is highly contagious and can recur leading to life threatening complications.

#4 – Have you been floxed? – Some antibiotics are now associated with the risk of serious adverse events. Cipro and Levaquin, both fluoroquinolone medications, are no longer recommended for simple urinary tract infections with the FDA stating the risk of using these medications far out weigh the potential benefits, including the risk of aortic aneurysm.(7) If you have Cipro, Levaquin or any other medications of this type sitting in your drawers waiting for a flare, please discard them properly. They are no longer recommended for the treatment of simple urinary tract infections nor IC flares. Learn More!

#5 – Drug Resistant Candida Infections. – Antibiotics kill the bacteria that normally keep fungus (i.e. candida/yeast) in check thus creating the perfect environment for fungal overgrowth and infection.  The MAPP Research Network discovered that many IC patients struggling with flares actually have candida in their urine strongly suggesting that fungal infection could be present in many of us.(8) The question is why? If there is one population of patients who have been overexposed to antibiotic therapy it’s the IC patient. Candida Auris – a potentially deadly yeast infection that spreads in health care facilities – has increased five fold in recent years and is often resistant to most anti-fungal medications. (9)

#6 – The Critical Problem of Antibiotic Resistance in UTI Antibiotic resistancy is now common. Kaiser Permanente Southern California reported that 57% of UTI’s weren’t susceptible to one or more antibiotics and 13% were resistant to at least three classes of medication. Subsequent infections increase the risk to 65% and 20%. (10) An estimated 2.8 million people in the USA  become infected with antibiotic resistant pathogens and at least 35,000 people die each year in the USA.(11) Taking antibiotics indiscriminately won’t kill all of the bacteria in the body. Those that survive are “resistant” and will reproduce yet more drug resistant bacteria.

Drug resistant infections cause more serious illnesses, deaths from previously treatable illnesses, prolonged recovery, more doctor visits, more invasive and expensive treatments. 

Conclusion

Could the antibiotics that we’ve all taken over our lifetimes have played a role in the development of IC/BPS? The discovery of lactobacillus iners suggests that it may. If there is any patient population over medicated with antibiotics, it is the lower urinary tract symptom patient. Now, of course, we know that tight pelvic floor muscles can also trigger urinary symptoms, aka myofascial frequency urgency syndrome.

In light of the serious risks now posed by the overuse of antibiotics, we must resist the temptation to ask for them “just in case we have an infection” nor should we self medicate with old antibiotics. We must do the work to verify that we have infection first!

References:

  1. Source: Quentin Clemens MD, Henry Lai MD, A. Lenore Ackerman  MD, Emerging Concepts in Interstitial Cystitis/Bladder Pain Syndrome. AUA 2024 149IC. May 5, 2024.
  2. Liang Y, et al. Highlight signatures of vaginal microbiota and metabolome contributed to the occurrence and recurrence of vulvovaginal candidiasis. Microbiol Spectr. 2024 Oct 30;12(12):e0152124.
  3. Liu Y, Cao L. Intratumoral Lactobacillus iners as a poor prognostic biomarker and potential therapeutic target for cervical cancer. Front Cell Infect Microbiol. 2024 Dec 20;14:1469924. doi: 10.3389/fcimb.2024.1469924. PMID: 39760093; PMCID: PMC11695224.
  4. Decout A, at al. Lactobacillus crispatus S-layer proteins modulate innate immune response and inflammation in the lower female reproductive tract. Nat Commun. 2024 Dec 30;15(1):10879.
  5. Nickel JC, et al. Assessment of the Lower Urinary Tract Microbiota during Symptom Flare in Women with Urologic Chronic Pelvic Pain Syndrome: A MAPP Network Study. J Urol. 2016 Feb;195(2):356-62Parsons CL. How does interstitial cystitis begin? Transl Androl Urol. 2015 Dec;4(6):605-10.
  6. Guh AY, Mu Y, Winston LG et al. N Engl J Med 2020;382:1320-30.
  7. Osborne J. The Dangers of Cipro and Levaquin – Have You Been Floxed? IC Network. February 3, 2019
  8. Osborne J. New Research Study Finds Higher Rates of Candida During IC Flares. IC Network. January 26, 2016
  9. Center for Disease Control. Antimicrobial Resistance Threats in the USA – 2021-2022. July 2024
  10. Jennifer H Ku, et al. Antibiotic Resistance of Urinary Tract Infection Recurrences in a Large Integrated US Healthcare System, The Journal of Infectious Diseases, Volume 230, Issue 6, 15 December 2024, Pages e1344–e1354,
  11. Center for Disease Control. Antimicrobial Resistance Facts and Stats – November 12, 2024

Updated: March 5, 2025 – JHO
Created: January 31, 2017