Do I still need to see my regular GP?

Yes. We work alongside your GP. Functional and integrative medicine is complementary — we don't replace your primary care relationship.

My results keep coming back normal. Can you actually help?

Yes. Standard blood tests typically look for overt disease. We run broader panels — reverse T3, fasting insulin, inflammatory markers, microbiome analysis, provoked urine testing for heavy metals — that pick up patterns standard testing misses.

Will I need a lot of testing?

It depends on your case. Your first appointment includes a thorough history. Testing is ordered based on what we find — never a panel-for-the-sake-of-a-panel approach.

How long until I feel better?

Complex chronic illness takes time to unpack. Most patients notice measurable shifts within 8-12 weeks of starting their individualised plan, with deeper changes over 6-12 months.

Where is Mojo Klinik located?

Suite 11, 40 Yeo Street, Neutral Bay NSW 2089, Sydney, Australia.

What are the clinic hours?

Monday to Friday, 9:00am to 5:00pm. Bookings are by appointment only.

Is parking available?

Yes. There is 2-hour free parking on Yeo Street and surrounding streets, plus public transport options including the Neutral Bay ferry wharf a 5-minute walk away.

Do you offer telehealth?

Yes. Telehealth follow-ups are available Australia-wide. The first appointment is strongly recommended in-person at our Neutral Bay clinic.

What kinds of conditions do you treat?

Chronic, complex, multi-system, often unexplained conditions — including hormonal, digestive, metabolic, fatigue, immune and toxicity-related presentations. We do not provide acute or emergency care.

Do you treat cancer, Alzheimer's or dementia?

No. We do not advertise treatment for cancer, Alzheimer's, dementia or serious neurodegenerative conditions per TGA prohibited representations.

How do I know which condition page to start with?

Most patients begin with the Mojo New Patient Appointment (one hour) which covers the full clinical picture. From there we identify which condition-specific testing is needed.

Can I see both doctors?

Yes. Many patients see both Dr Mackey and Dr Varipatis — typically Dr Mackey for hormonal, digestive and metabolic presentations and Dr Varipatis for environmental, heavy metal and chronic infection work.

Small Intestinal Bacterial Overgrowth (SIBO) is a condition where bacteria that normally live in the large intestine overgrow in the small intestine, causing bloating, gas, abdominal pain and altered bowel habits.

How is SIBO diagnosed?

We use a lactulose or glucose breath test that measures hydrogen and methane gas over 2-3 hours. This identifies bacterial overgrowth and the dominant gas pattern (hydrogen-dominant, methane-dominant, or hydrogen sulfide).

Is IBS the same as SIBO?

No, but they overlap. IBS is a functional diagnosis of digestive symptoms without identifiable disease. SIBO is one identifiable cause of IBS-like symptoms. Many IBS patients have underlying SIBO, but not all.

How long does treatment take?

Treatment duration depends on the case. A typical SIBO protocol involves 2-4 weeks of antimicrobial therapy followed by gut repair and prevention of recurrence. Underlying motility and digestive function must also be addressed.

Yes, SIBO has a moderate recurrence rate. We focus on identifying and treating the underlying causes (motility, structural issues, MMC function, diet) to reduce recurrence risk.

Do I need to stop my medications before testing?

Some medications (particularly antibiotics and probiotics) need to be stopped before breath testing. Your practitioner will advise specific preparation instructions at booking.

Will Medicare or private health insurance cover this?

The Mojo New Patient Appointment carries a Medicare rebate. Breath testing is privately billed. Private health fund rebates depend on your policy — check with your insurer.

What is perimenopause?

Perimenopause is the transition period leading up to menopause, typically lasting 4-10 years. Hormone levels fluctuate, causing symptoms that often begin years before periods stop.

At what age does perimenopause start?

Most women begin perimenopause in their mid-40s, but it can start earlier. Symptoms before age 40 may indicate primary ovarian insufficiency and warrant investigation.

Menopausal Hormone Therapy (formerly HRT) replaces the hormones that decline during perimenopause and menopause. Modern body-identical MHT is far safer than older synthetic versions.

Current evidence shows body-identical MHT is safe for most women when started within 10 years of menopause onset. Individual risk assessment is essential — your family history, personal history and current symptoms all inform the decision.

What is DUTCH testing?

DUTCH (Dried Urine Test for Comprehensive Hormones) measures hormones and their metabolites over 24 hours, giving a fuller picture than a single blood draw. It's particularly useful for perimenopause where hormone levels fluctuate.

Do I need blood tests or urine tests?

Both. We typically run a full blood panel (thyroid, sex hormones, metabolic markers, vitamins) plus DUTCH for detailed hormone metabolite analysis. The combination gives the clearest clinical picture.

Can I take MHT if I've had breast cancer?

This requires careful specialist input. Non-hormonal options are usually preferred. Decisions are made in consultation with your oncology team.

What is heavy metal toxicity?

Accumulation of toxic metals (mercury, lead, arsenic, cadmium, aluminium) in body tissues beyond levels the body can safely excrete. Sources include dental amalgams, contaminated fish, occupational exposure, old plumbing and some traditional medicines.

How do you test for heavy metal burden?

We use provoked urine testing — a chelating agent is administered to mobilise stored metals, then urine is collected over 6 hours. This reveals what's actually stored in tissues, not just recent exposure. Blood tests only show recent exposure.

Is chelation therapy safe?

When medically supervised, chelation is safe and well-tolerated. The Heavy Metal Initial Appointment assesses kidney function, mineral status and overall suitability before any chelation is undertaken. Treatment is individualised.

Do I need to see a specific doctor?

Both Dr Mackey and Dr Varipatis offer Heavy Metal Initial Appointments. For chelation therapy specifically, both doctors prescribe — Dr Varipatis has the longer clinical history with chelation, Dr Mackey integrates it with broader hormonal and metabolic work.

Will my insurance cover this?

The Heavy Metal Initial Appointment does not carry a Medicare rebate. Private health fund coverage depends on your policy. Itemised receipts are provided for you to submit.

How long does treatment take?

A typical chelation programme runs 6-12 months depending on the metal burden identified. Repeat provoked urine testing guides treatment duration.

What's the difference between you and a naturopath?

Dr Mackey and Dr Varipatis are AHPRA-registered medical doctors. Provoked urine testing, chelation therapy and pharmaceutical prescribing are medical acts not available to naturopaths. Your treatment is medically supervised throughout.

Clinically termed 'increased intestinal permeability' — the gut lining becomes more porous than it should, allowing partially digested food particles, bacterial fragments and toxins to enter the bloodstream, driving systemic inflammation.

What causes bloating?

Common drivers: SIBO, food intolerances (FODMAP sensitivity, histamine, lactose), microbiome imbalance, low stomach acid, sluggish motility, and increased intestinal permeability.

How do you diagnose it?

We use a combination of detailed symptom analysis, breath testing (SIBO), stool microbiome analysis, intestinal permeability markers (zonulin, lactulose/mannitol test), and food intolerance panels where indicated.

Is bloating always related to food?

Not always. Bloating can also be driven by HPA axis dysfunction, hormonal fluctuations, stress, structural issues, and microbiome imbalance independent of specific foods.

How long does treatment take?

Most patients see significant improvement within 8-12 weeks. Full gut repair typically takes 6-12 months depending on the underlying cause and how long the issue has been present.

Should I do an elimination diet?

Elimination diets can help identify triggers short-term, but they're not a long-term solution. We use targeted testing where possible to identify specific drivers, then individualise dietary advice.

Sometimes, but not always. The wrong probiotic for your specific microbiome imbalance can worsen symptoms. We test first, then prescribe specific strains based on your results.

Can stress cause bloating?

Yes. Chronic stress alters gut motility, microbiome composition, digestive enzyme secretion, and intestinal permeability. We address the stress component alongside the physical drivers.

Hashimoto's thyroiditis is an autoimmune condition where the immune system attacks the thyroid gland, gradually reducing its function. It's the most common cause of hypothyroidism in Australia.

Why is my TSH 'normal' but I still have symptoms?

Standard TSH testing misses many thyroid issues. We test the full panel — TSH, free T3, free T4, reverse T3, and thyroid antibodies (TPO and TG). Patterns of suboptimal T3 conversion, elevated reverse T3, or positive antibodies explain persistent symptoms.

Do you prescribe thyroid medication?

Yes. As AHPRA-registered medical doctors, we prescribe all forms of thyroid medication including T4 (Oroxine), T3 (Cytomel/Tertroxin), and combination T4/T3 therapy. Decisions are based on the full panel and your symptoms.

What's reverse T3 and why does it matter?

Reverse T3 is an inactive form of T3 that blocks thyroid receptors. Elevated reverse T3 (from chronic stress, calorie restriction, illness, or low iron) causes hypothyroid symptoms even when TSH and free T4 look 'normal'.

How long until I feel better on thyroid treatment?

Most patients notice meaningful improvement within 4-8 weeks of starting treatment, with full stabilisation over 3-6 months. Repeat testing at 6-8 weeks guides dose adjustment.

Will my GP continue to manage my thyroid?

We work alongside your GP. Once stable, we can transition thyroid monitoring back to your GP with a clear management plan. Many GPs prefer this collaborative approach for complex thyroid cases.

How do you test hormones?

We use a combination of blood tests (for thyroid, sex hormones, metabolic markers) and DUTCH (Dried Urine Test for Comprehensive Hormones) for detailed hormone metabolite analysis. The combination reveals patterns a single blood draw misses.

Do I need to test on a specific day of my cycle?

Yes for blood tests — typically day 21 for progesterone, day 2-3 for baseline hormones. DUTCH can be done any day and is more forgiving.

Can hormones cause weight gain?

Hormonal drivers of weight gain include thyroid dysfunction, cortisol dysregulation, insulin resistance, oestrogen dominance, and perimenopausal changes. We test for these before any weight management advice.

What about testosterone in women?

Testosterone in women is essential for energy, libido, muscle mass and motivation. We test and address both deficiency and excess (PCOS-related).

Chronic Infections | Recurring UTI, Chronic Sinusitis, Ch...

Mojo Klinik / Conditions / Metabolic & toxicity / Chronic Infections: UTI, Sinusitis, Prostatitis

BIO – FILM AWARE · DR EMMANUEL VARIPATIS

Mojo Klinik · Neutral Bay Sydney

Chronic infections: UTI, sinusitis, prostatitis.

The same infection keeps coming back. Bio film is usually why.

Three antibiotics in. Still not better.

Or feeling fine on the antibiotic, then crashing the week it ends.

There is a measurable mechanism behind that pattern.

SOUND FAMILIAR?

You will recognise yourself in some of these.

Most patients arrive carrying one or more of these.

You are searching for recurring UTI treatment after multiple courses of antibiotics
You have chronic sinusitis that has not cleared with the standard rounds of antibiotics, steroids, and saline rinses
You have chronic or relapsing prostatitis that has not responded to standard urological care
You have been told your culture is negative but the infection symptoms continue
The same infection keeps coming back within weeks of finishing antibiotics
You suspect bio film is involved but no clinician has investigated it
You want a clinician who looks for the mechanism, not just the next prescription
You have tried multiple short antibiotic courses without lasting resolution

There is almost always a clinical explanation. Pulling on the thread is what we do.

WHAT CHRONIC INFECTIONS ACTUALLY ARE, AND WHY BIO FILM MATTERS

Persistent or relapsing infection in a confined anatomical space where bacterial communities can establish a bio film.

A bio film is a structured microbial community embedded in a self produced polymeric matrix. The bacteria inside live in a metabolically slowed state, the matrix prevents antibiotic penetration, and the surface bacteria continually shed planktonic (free-floating) cells, which is what shows up on standard cultures.

This is why the same infection keeps returning. Standard antibiotic courses kill the planktonic cells circulating, the patient feels better, the antibiotic course ends, and the bio film releases another wave. The cycle repeats. A chronic infections doctor Sydney approach addresses the bio film, not just the planktonic bacteria.

Approximately 65 to 80% of human bacterial infections involve bio film formation according to NIH estimates, and bio films are central to the persistence of chronic UTI, chronics inusitis, and chronic prostatitis.

"The reason these three infections behave the way they do is bio film. Once you understand that, the treatment plan looks completely different from a standard short antibiotic course. You are not just trying to kill bacteria. You are trying to disrupt the matrix that is protecting them, then deal with what comes out."

Dr Emmanuel Varipatis, MBBS FACNEM FASLM

A FOCUS MAP

The three chronic infections we focus on.

Different locations. The same underlying biology.

RECURRENT UTI

More than 3 in 12 months. Standard cultures
often miss the bio film, partner microbiome, or oestrogen depletion.

CHRONICS INUSITIS

Sinuses do not clear between courses. Often
bio film-related or fungal contribution.

CHRONIC PROSTATITIS

Few to none of the usual signs. Pelvic floor and bio film picture often overlooked.

The host investigation drives the plan, not the location of the symptom.

OUR THREE – PHASE APPROACH

Investigate the mechanism. Combined-modality treatment. Restoration.

Correspondence can be provided for your treating GP, urologist, or ENT as appropriate.

Phase 1

Investigate

Weeks 1 to 4

Targeted culture and sensitivity, including bio film aware sampling. Comprehensive immune function panel. Gut microbiome. Inflammatory markers. Nutritional status. Hormonal contributors where relevant.

Phase 2

Treat

Months 2 to 6

Combined approach: prescription antibiotics where genuinely indicated, plus biofilm-disrupting agents, evidence-supported herbal antimicrobials, and immune support. Sequenced and individualised.

Phase 3

Restore

Months 6 to 12

Microbiome restoration. Immune resilience. Addressing the conditions that allowed the infection to take hold in the first place. The aim is resolution, not indefinite suppression.

THE THREE CHRONIC INFECTIONS WE FOCUS ON

All three share bio film as a common mechanism.

The clinical approach is shared in principle but tailored to the anatomical site and the specific picture.

Recurring UTI

Chronic Sinusitis

Chronic Prostatitis

Testing matched to the infection pattern. The cost of any privately billed test is explained before you agree to it. Targeted culture and sensitivity, including biofilm-aware sampling techniques where clinically appropriate. Comprehensive immune function panel. Gut microbiome (the foundation of mucosal immunity). Inflammatory markers. Nutritional status (vitamin D, zinc, vitamin C, selenium). Hormonal contributors (low oestrogen in recurrent UTI; testosterone and prostatitis; cortisol and immune suppression). Coordination as appropriate with the patient’s GP, urologist, or ENT surgeon for structural and anatomical context.

IS MOJO KLINIK RIGHT FOR YOU?

Is this approach right for you?

IT'S A FIT IF

You have a recurrent UTI, chronic sinusitis, or chronic prostatitis pattern
Standard antibiotic courses keep working short-term but the infection returns
You suspect biofilm and want it specifically investigated
You want a doctor who can coordinate with your urologist or ENT, not work around them
You are willing to pace through 3 to 6 months of active treatment

NOT A FIT IF

HOW TO START

Two ways to start with us.

Both options are 1-hour Mojo New Patient Appointments. Chronic infection investigation requires the full hour because the work is multi-system.

OPTION 1

Mojo New Patient Appointment with Dr
Emmanuel Varipatis

Medicare rebate available for in-person initial consultations

Dr Varipatis leads our chronic infections work. 40+ years of experience in complex chronic illness. Best for patients with recurrent UTI, chronic sinusitis, or chronic prostatitis where biofilm is suspected.

OPTION 2

Mojo New Patient Appointment with Dr Maria Mackey

Medicare rebate available for in-person initial consultations

Best when chronic infection is layered with hormonal, gut, or HPA axis components. Particularly relevant for women with recurrent UTI tangled with perimenopause or menopausal hormonal change.

For full pricing, see Consultation Fees. Telehealth available Australia-wide for followups. Medicare rebates apply for in-person initial consultations (except Heavy Metal Initial Appointment). For your first appointment, in-person at our Neutral Bay clinic is strongly recommended.

FAQ

Frequently Asked Questions.

How much does a chronic infections consultation cost at Mojo Klinik?

The Mojo New Patient Appointment is the right entry point: 1 hour, $480
with Dr Varipatis or $490 with Dr Mackey (in-person), $500 or $510 by Zoom,
with a Medicare rebate available for in-person initial consultations.
Specialised testing (biofilm-aware culture, expanded organism panels,
immune function) is billed separately by the testing lab.

"The patient with chronic infection has usually been told to just take more antibiotics. That is rarely the answer. The question is: why is your immune system not finishing the job? Why is the infection coming back? Until we answer those questions, we are not really treating it."

Dr Emmanuel Varipatis, MBBS FACNEM FASLM

What is biofilm and why does it matter?

A biofilm is a structured community of bacteria embedded in a protective
polymeric matrix. The bacteria inside the biofilm exist in a metabolically
slowed state, are shielded from antibiotics and the immune system, and
continually release planktonic (free-floating) bacteria back into the
environment. Biofilm is now recognised as the dominant form bacteria take
in nature and in chronic infection. It is the key reason why some infections
keep returning despite repeated antibiotics: standard antibiotic courses kill
the planktonic cells circulating at any given time, but they do not penetrate
or eradicate the biofilm. When the antibiotic course ends, the biofilm
releases another wave.

I keep getting UTIs. Is there an alternative to constant antibiotics?

Yes, often. Recurrent UTI is frequently biofilm-related (bacteria forming a
protective layer that antibiotics struggle to penetrate) or microbiomerelated (loss of protective vaginal lactobacilli) or hormonal (low oestrogen in
perimenopause and menopause). We investigate the underlying drivers and
use combined approaches alongside any necessary antibiotic treatment.

"Recurrent UTI is one of the most frustrating clinical pictures patients live with. The standard answer of taking more antibiotics is rarely the right one long-term. Once we identify whether biofilm is involved, or whether the vaginal microbiome or hormonal status is in play, we have a real plan rather than a holding pattern."

Dr Emmanuel Varipatis, MBBS FACNEM FASLM

A 2024 review in Nature Reviews Urology documented biofilm involvement in more than 80% of
recurrent UTI cases.

My chronic sinusitis has not cleared after multiple antibiotic courses and even surgery. What can integrative medicine offer?

Quite a lot, in this specific scenario. Sinus biofilm is increasingly recognised
as a major driver of chronic rhinosinusitis that does not resolve with
standard care, and biofilm is generally not addressed by short antibiotic
courses or by surgery alone. We investigate the biofilm picture, the immune
factors (low vitamin D, low zinc, low IgA), the gut-immune axis, and the
structural context (in coordination with your ENT surgeon where one is
involved, as appropriate).

"Chronic sinusitis that has not cleared with multiple antibiotic courses is almost always doing the biofilm dance. The patient feels better on the antibiotic, the antibiotic finishes, and within weeks they are back where they started. Disrupting the biofilm is what changes that pattern."

Dr Emmanuel Varipatis, MBBS FACNEM FASLM

A 2023 review in the International Forum of Allergy and Rhinology documented bacterial biofilm
in approximately 70% of chronic rhinosinusitis cases assessed with appropriate techniques.

I have chronic prostatitis. My urologist has done what they can. Is there anything more to investigate?

Often, yes. Chronic bacterial prostatitis with biofilm involvement frequently
does not respond to standard short antibiotic courses because the prostate
is anatomically difficult to penetrate adequately and biofilm-protected
bacteria are not eradicated. Properly treated, chronic bacterial prostatitis
usually requires extended-duration tissue-penetrating antibiotics combined with biofilm-disrupting strategies and inflammatory and hormonal optimisation. Coordination with your urologist remains important and will
be provided as appropriate.

"Chronic prostatitis is one of the most undertreated conditions in men’s health. The standard short antibiotic course almost never resolves a confirmed bacterial prostatitis with biofilm involvement, because the antibiotic does not penetrate the prostate adequately, and what penetrates does not get through the biofilm. Done properly, this needs longer-duration treatment, the right antibiotic choice, and concurrent biofilmdisruption work."

Dr Emmanuel Varipatis, MBBS FACNEM FASLM

Will I be on long-term antibiotics?

Not as a default. We use antibiotics where genuinely indicated, alongside
biofilm-disrupting strategies, herbal antimicrobials, and immune support.
The goal is resolution, not indefinite suppression. Long courses of antibiotics
carry their own risks (microbiome damage, resistance, side effects) and are
used selectively. Biofilm-aware combination protocols often achieve better
resolution than longer single-modality antibiotic courses.

"Long-term antibiotics are sometimes necessary but they are never the only tool. The patient who needs months of antibiotics also usually needs concurrent biofilm work, microbiome support, and immune ssessment. Otherwise we are managing the infection in isolation from everything that allows it to keep coming back."

Dr Emmanuel Varipatis, MBBS FACNEM FASLM

How long does a chronic infection programme take?

It varies significantly by infection type and prior treatment history. Most
programmes run 3 to 6 months for active treatment, with maintenance and
monitoring continuing for 6 to 12 months. Biofilm-related cases (which is
most chronic UTI, sinusitis, and prostatitis) typically take longer than
uncomplicated infection because biofilm disruption is a slower process than
killing planktonic bacteria.

"I tell patients to expect about six months of focused treatment and another six months of monitoring afterwards. The treatment itself is the heaviest part of the work. The follow-on period is where we make sure the picture holds and the conditions that allowed the infection to take hold are addressed properly."

Dr Emmanuel Varipatis, MBBS FACNEM FASLM

What testing will I need?

A chronic infections workup typically includes targeted culture and sensitivity (including biofilm-aware sampling where clinically appropriate), comprehensive immune function panel, gut microbiome assessment, inflammatory markers, nutritional status (vitamin D, zinc, vitamin C, selenium), and hormonal contributors where relevant (oestrogen and recurrent UTI; testosterone and prostatitis). The specific panel is decided at consultation based on the infection pattern.

AN INVITATION

Ready to be properly investigated?

One hour. Your full history. The right tests. A real plan. Book your
first appointment online, or call reception on 02 9133 8500.

WHERE
Suite 11, 40 Yeo Street
Neutral Bay NSW 2089

HOURS
Mon – Fri 8:30am – 5:00pm
Selected Saturdays by arrangement