Urinary Tract Infection

A urinary tract infection (UTI) occurs when one or more parts of the urinary system (kidneys, ureters, bladder, or urethra) become infected with a pathogen (most frequently, bacteria).

UTIs most commonly occur in females; about 50% of all females get a UTI during their lifetime. Many UTIs are not serious but if infection reaches the kidneys, serious illness, and even death, can occur.

Bladder infections are the most common type of UTI. Some individuals may have few or no symptoms; however, the usual symptoms include dysuria (pain or burning during urination), low abdominal pain, and/or urine that is cloudy or smells bad or unusual.

UTI Symptoms: Kidney Infection

Some bladder infections do not resolve and get worse with the pathogens moving up (retrograde) the ureters to the kidneys. Symptoms may include those listed for bladder infections on the pervious slide, but often include other symptoms such as pain in the lower back (flank pain on one or both sides), fever, chills, and nausea and/or vomiting.

When to Visit Your Doctor

Although a bladder infection is not a medical emergency, the following individuals have a higher risk for UTI complications such as infection spread to the kidneys or elsewhere in the body:

• Pregnant women
• People who have diabetes
• Individuals with kidney problems
• Elderly individuals
• Immunocompromised patients
• Men with enlarged prostates
• People with urinary retention

 UTI symptoms described in previous slides may also be symptoms of other fairly common types of infections, sexually transmitted diseases (STDs).These diseases include gonorrhea (and sometimes syphilis along with gonorrhea), chlamydia, and trichomoniasis. Lab tests are readily available to diagnose and differentiate a UTI from an STD. Discharge of pus or fluid from the penis or vagina is a symptom often present in STDs but not usually present in UTIs.UTIs without symptoms are not unusual; urine tests can show that bacteria are present in the urine and the condition is termed asymptomatic bacteriuria. Usually this condition is not treated, but in some patients it is better to treat them with antibiotics (for example, pregnant women, some children, and kidney transplant patients). There are two major complications of UTIs. The first is infection spread to one or both kidneys. If the infection continues, kidney function can be damaged and result in kidney failure or complete loss of kidney function. The second complication is that the infecting organisms occasionally enter the bloodstream and may infect other organs or, rarely, cause sepsis and death.

Urinary Tract Infections in Men

Adult men have infrequent UTIs; if they get a UTI there usually is an underlying cause (for example, having an enlarged prostate or kidney stone or being an elderly person with a catheter).

How Do UTIs Begin?

The vast majority of UTIs start when pathogens (usually bacteria like E. coli ) reach the urethra and then travel up (retrograde) the urethra to the bladder. Urine is usually sterile until it reaches the distal urethra. Women have short urethras compared to men and most clinicians think the shorter urethra is the major reason women have more UTIs than men.

What Increases Your Risk?

Risk factors for UTIs were presented previously, but besides being a woman who is sexually active or someone who is elderly or immunocompromised, there are other risk factors:

• Not drinking enough fluids (slows the wash of pathogens out of the body)
• Taking frequent baths (soaking in fluid that may promote retrograde infections)
• Waiting to urinate (promotes retrograde bacterial movement)
• Kidney stones (causes slowing or partial blockage of urine flow)

Diagnosing UTIs

Urinalysis is usually the first diagnostic test done after a patient presents their medical history and has a physical exam. The test provides information about the presence of bacteria, white and red blood cells, and chemical abnormalities. It can indicate that other studies such as urine culture and bacterial drug sensitivity tests should be done. Simple tests like the urine dipstick test or even home tests of urine can be done but they are not 100% accurate. It is best to have your doctor evaluate your symptoms and test results.

Treating UTIs

Although severe kidney infections are often treated in the hospital with IV antibiotics, most UTIs (and many mild-to-moderate kidney infections) are treated with oral antibiotics. However, many clinicians are sending urine samples to identify the infecting organisms and determine their antimicrobial resistance. It is not unusual for a doctor to call a patient and switch antibiotics because of antibiotic resistance. In addition, the doctor will usually recommend that the patient take in plenty of fluids (water) and encourage frequent urination to flush bacteria out of the urinary tract.

Treating Recurrent UTIs

Recurrent UTIs are not unusual; you should ask your primary care physician (PCP) for a referral to a urologist if you have three or more UTIs per year to see if there may be an underlying urinary tract problem that may be the cause. Your PCP may also suggest taking long-term (months) low-dose antibiotics, recommend taking an oral antibiotic after sex, or taking an oral antibiotic as needed when UTI symptoms appear.

UTI Prevention

Prevention methods for UTIs have been presented in several preceding slides; here is a short summary of common and easy ways to prevent UTIs:

• Drink a lot of water daily
• Don't "put off" going to the restroom (don't delay urination)
• Wipe from front to back
• Don't use feminine hygiene sprays
• Take showers instead of baths