Microbial Dysregulation in Recurrent Urinary Tract Infection: Gut and Vaginal Microbiome Profiling

Abstract Background Almost 50% of women experience a UTI, 10–20% develop recurrent episodes. Beyond sexual intercourse and pelvic floor dysfunction, alterations in gut and vaginal microbiota have been proposed as contributing factors. Methods We compared gut and vaginal microbiomes of women with and without rUTIs and assessed factors potentially influencing microbial composition. Results Women with rUTIs exhibited marked dysbiosis: lower gut alpha diversity and higher vaginal alpha diversity relative to controls. Compositional overlap between gut and vaginal communities was greater in rUTI cases, supported by detection of gut-associated taxa in vaginal samples and reciprocal findings. Uropathogens such as Citrobacter spp., Staphylococcus haemolyticus, Enterobacter spp., and Proteus spp. were more prevalent. Sexual activity correlated with increased gut-vagina similarity, whereas compromised pelvic floor health was linked specifically to Proteus spp. Conclusions Greater similarity between gut and vaginal microbiomes may contribute to rUTI pathogenesis through cross-site microbial exchange.