A clinical trial that actually defines chronic UTI and tests a treatment protocol designed around it has been a long time coming. In this episode of the Live UTI Free podcast, host Melissa Kramer sits down with Dr. Kiran Gill and Dr. Harry Horsley to talk through the ETAP trial, a new UK-based phase 2 randomised controlled trial investigating extended full-dose antibiotics combined with methenamine hippurate (Hiprex) for chronic UTI. Dr. Kiran Gill is a consultant urogynaecologist at the Whittington Hospital and a clinical academic at University College London, and co-chief investigator on ETAP alongside Professor Rajvinder Khasriya. Dr. Harry Horsley is principal investigator and scientific lead, and co-leads the Bladder Infection and Immunity Group (BIIG) at UCL, where he has been researching recurrent and chronic UTI for over 15 years.

Together, Melissa, Kiran, and Harry walk through how recurrent UTI and chronic UTI are defined, and why the lack of NHS guidelines for chronic UTI leaves patients getting misdiagnosed with conditions like painful bladder syndrome (interstitial cystitis), overactive bladder, or the genitourinary syndrome of menopause. The conversation also covers the two trial arms, with extended full-dose antibiotics plus methenamine hippurate compared against the current NICE-recommended low-dose prophylaxis informed by the ULTA study. They explain why fresh urine microscopy is being used as the primary endpoint instead of standard MSU culture alone, the perineal swab approach to tracking antimicrobial resistance, who is eligible for the trial, and how to access screening at the five UK trial sites (Whittington, UCLH, Guy’s and St Thomas’, Manchester St Mary’s, and Newcastle). Recruitment closes August 2027, with first results expected in early 2028.

Key Takeaways

1. ETAP is the first RCT built around a clinical definition of chronic UTI. It defines the condition as continuous daily urinary symptoms lasting more than three months, with acute flares in between.
2. The trial looks at the host response, not just the bacteria. Fresh urine microscopy checks for white blood cells as a sign of an immune response, giving same-day results instead of a two-to-three-day wait for culture.
3. The design reflects what patients actually need. Clinicians choose the antibiotic based on tolerability and history. D-mannose, cranberry, and vaginal oestrogen are allowed, flares are managed with rescue therapy, and travel is reimbursed up to £45.

Links and Resources Mentioned

• Learn more about EAT-UP Trial:https://www.isrctn.com/ISRCTN17592593
• Get in touch with the research team: whh-tr.researchanddevelopment@nhs.net 
• Watch our previous interview with Dr. Harry Horsley: https://www.youtube.com/watch?v=pq1K1zBt7Ho
• More on the science behind chronic urinary tract infection:https://liveutifree.com/chronic-urinary-tract-infection/