Frequent urination antibiotics: Urinary tract infection (UTI) – Diagnosis and treatment

24.04.197812.11.2021 by alexxlab

Содержание

Complicated Urinary Tract Infections – StatPearls

Continuing Education Activity

Urinary tract infections (UTIs) are among the most common presenting causes of sepsis in hospitals, and urinary tract infections have a wide variety of presentations. Some are simple UTIs that can be managed with outpatient antibiotics and lead to almost universally good outcomes. On the other end of the spectrum, florid urosepsis in a patient with comorbidities can be fatal. There are several risk factors that can complicate urinary tract infections and lead to treatment failure, repeat infections, or significant morbidity and mortality. It is vitally important to determine if the patient’s infection may have resulted from one of these risk factors and whether the episode is likely to resolve with first-line antibiotics. Complicated urinary tract infections are those that carry a higher risk of treatment failure, and typically require longer antibiotic courses and often additional workup. Complicated urinary tract infections include those that occur: in males, in pregnant females (including asymptomatic bacteriuria), as a result of obstruction, hydronephrosis, renal tract calculi, or colovesical fistula, in immunocompromised patients or the elderly, due to atypical organisms, after instrumentation or in conjunction with medical equipment such as urinary catheters, in renal transplant patients, in patients with impaired renal function, or after prostatectomies or radiotherapy. Additionally, urinary tract infections that recur despite adequate treatment are complicated. This activity reviews the evaluation and management of complicated urinary tract infections and highlights the role of interprofessional team members in collaborating to provide well-coordinated care and enhance outcomes for affected patients.

Objectives:

Describe the criteria of a complicated urinary tract infections.
Outline populations in whom all urinary tract infections are complicated.
Summarize management considerations for patients for patients with complicated urinary tract infections.
Explain the importance of improving coordination amongst the interprofessional team to enhance care for patients affected by complicated urinary tract infections.

Access free multiple choice questions on this topic.

Introduction

Urinary tract infections (UTIs) are among the most common causes of sepsis presenting to hospitals. UTIs have a wide variety of presentations. Some are simple UTIs that can be managed with outpatient antibiotics and carry a reassuring clinical course with almost universal good progress, and on the other end of the spectrum, florid urosepsis in a comorbid patient can be fatal. UTIs can also be complicated by several risk factors that can lead to treatment failure, repeat infections, or significant morbidity and mortality with a poor outcome. It is vitally important to determine if the presenting episode is the result of these risk factors and whether the episode is likely to resolve with first-line antibiotics. [1][2][3][4]

It is important to properly define a complicated UTI as infections which carry a higher risl of treatment failure as these typically require longer antibiotic courses and sometimes additional workup.

In a clinical context that is not associated with treatment failure or poor outcomes, a simple UTI, or simple cystitis, is an infection of the urinary tract that occurs due to appropriate susceptible bacteria. Typically this is an infection in a nonpregnant immune competent female patient. Pyuria and/or bacteriuria without any symptoms is not a UTI and may not require treatment. An example would be a patient with a Foley catheter or an incidental positive urine culture in an asymptomatic non pregnant immune competent female.

The normal female urinary tract has a comparatively short urethra, and therefore, carries an inherent predisposition to proximal seeding of bacteria. This anatomy increases the frequency of infections. Simple cystitis, a one-off episode of ascending pyelonephritis, and occasionally even recurrent cystitis in the right context can be considered as simple UTI, provided there is a prompt response to first-line antibiotics without any long-term sequela.

Any urinary tract infection that does not conform to the above description or clinical trajectory is considered a complicated UTI. In these scenarios, one can always find protective factors that failed to prevent infection or risk factors that lead to poor resolution of sepsis, higher morbidity, treatment failures, and reinfection.[5][6][7]

Examples of a complicated UTI include:

Infections occurring despite the presence of anatomical protective measures (UTI in males are by definition considered complicated UTI)
Infections occurring due to anatomical abnormalities, for example, an obstruction, hydronephrosis, renal tract calculi, or colovesical fistula
Infections occurring due to an immune compromised state, for example, steroid use, post chemotherapy, diabetes, elderly population, HIV)
Atypical organisms causing UTI
Recurrent infections despite adequate treatment (multi-drug resistant organisms)
Infections are occurring in pregnancy (including asymptomatic bacteriuria)
Infections are occurring after instrumentation, nephrostomy tubes, ureteric stents, suprapubic tubes or Foley catheters
Infections in renal transplant patients
Infections are occurring in patients with impaired renal function
Infections following prostatectomies or radiotherapy

Etiology

Most cases of urinary tract infections are due to the colonization of the urogenital tract with rectal and perineal flora. The most common organisms include Escherichia coli, Enterococcus, Klebsiella, Pseudomonas, and other Enterococcus or Staphylococcus species. Residential care patients, diabetics and those with indwelling catheters or any form of immunocompromise can also colonize with Candida.

Epidemiology

Cohorts with more risk factors show an increased incidence of urinary tract infections. Risk factors include female anatomy, increasing age, diabetes, obesity, and frequent intercourse (although UTI is not defined as a sexually transmitted infection).

Simple UTI (nonpregnant immune competent female) have been estimated to occur with as high a frequency as 0.7 infections per person per year. Fifty percent of females will have at least one UTI at some stage in life.

Complicated UTI incidence is associated with specific risk factors. For example, there is a 10% daily risk of developing bacteriuria with indwelling bladder catheters, and up to a 25% risk that bacteriuria will progress to a UTI.

Bacteriuria occurs in up to 14% of diabetic females but does not tend to occur with a higher frequency in diabetic males.

The incidence of asymptomatic bacteriuria in pregnant females is similar to that in nonpregnant females (2% to 7%) but tends to progress to symptomatic UTI in as many as 40% of pregnant women.

Asymptomatic bacteriuria also tends to increase with age in females and is present in up to 80% of the elderly female population. It is rare among younger healthy males but can be present in up to 15% of older males.

UTIs are the most common infections in renal transplant patients. Up to 25% of these patients will develop a UTI within the first year after a transplant.

Increased incidence of UTI has been described in patients using Dapagliflozin (SGLT2i). [8]

History and Physical

Despite the frequency of which urinary tract infections present to a hospital, UTI (especially complicated UTI) remain a clinical entity causing considerable confusion, diagnostic uncertainty, and a source of significant inappropriate antibiotic prescriptions.

Symptoms (increased urinary frequency, urgency, hematuria, dysuria, suprapubic or flank pain) are the most important clinical criteria for initially diagnosing a UTI. There must also be an appropriate clinical scenario in which infection of the urogenital tract is the most likely explanation for these symptoms. In this situation, it is appropriate to start empiric treatment with first-line antibiotics. A urine sample should also be sent for microscopy and culture before starting treatment, although that is not always possible. The urine sample would almost always show an abnormal red cell or white cell count and bacteria.

Severe complicated urinary tract infections can present as severe undifferentiated sepsis or even septic shock.

Furthermore, urinary tract infections may present with nonspecific grumbling symptoms, atypical presenting features (delirium in the elderly), signs mimicking an acute abdomen, be a trigger for precipitating diabetic emergencies such as diabetic ketoacidosis (DKA), and even present without any symptoms (asymptomatic bacteriuria in pregnancy).

Evaluation

A good quality urine specimen is vital in making the diagnosis. However, treatment must not be delayed if the clinical scenario is strongly suggestive of a urinary tract infection.[9][10][11]

Most patients can provide a high-quality midstream urine sample with appropriate instructions. If that is not possible, a catheterized urine sample (indwelling catheter or a straight in-out catheter) may be used. Catheter insertion is not without some risk, and this must be weighed against the diagnostic advantage of having a urine specimen for analysis and culture. In general, obtaining a urine specimen for culture is recommended whenever possible and feasible.

Different normal white cell ranges depend on the urine sample, and the results should be interpreted accordingly.

Often, urine samples in prostatitis may not be diagnostic, especially if the patients have already been partially treated. A pre-prostate and post-prostate massage urine sample (also known as the four-glass test or even the shortened 2-glass test) can improve the diagnostic yield.

Blood cultures are also useful in more severe septic presentations. A positive blood culture can sometimes also help corroborate a urine sample result and reduce the suspicion of contamination.

Other microbiology and culture specimens can be directed if there is multifocal sepsis.

Radiological investigations are not helpful in the initial diagnosis of most infections limited to the genitourinary tract, as there should be sufficient clues from the history, physical examination, and laboratory results. Ultrasound and CT scans may sometimes be useful or even critical for diagnosing perinephric abscess, urinary retention, hydronephrosis and obstructive pyelonephritis from stones in septic patients. All patients who fail to respond to appropriate broad-spectrum antibiotics should undergo imaging to exclude complications such as abscesses, urinary retention, calculi, gas, obstructive uropathy and hydronephrosis.

All patients who present with a complicated UTI, even the first presentation of ascending pyelonephritis in nonpregnant immune competent females, should undergo a renal tract ultrasound at a minimum to evaluate for anatomical abnormalities, hydronephrosis or lesions. Since there is no reliable clinical method to rule out urinary obstructions in complicated UTIs (such as a stone), it is the responsibility of the treating physician to do so with ultrasound or CT.

Treatment / Management

As UTI can present with severe, life-threatening sepsis and multiorgan involvement. Resuscitation often precedes definitive treatment. The severely septic patient might need aggressive fluid resuscitation as well as broad-spectrum antibiotics administered in the emergency department. Antibiotic choice should always be according to local guidelines.[12][13][14][15]

Patients presenting with septic shock may not respond to fluid resuscitation alone, and there should be a low threshold to consider vasopressor support in light of a poor initial response to fluids.

On the other hand, nonseptic stable patients may be treated as outpatients.

Broad-spectrum, empiric antibiotics should always be switched to a targeted narrow-spectrum antibiotic, if possible, once culture results are available. Initial broad-spectrum choices tend to be penicillins or beta-lactams, cephalosporins, fluoroquinolones, and carbapenems (especially if dealing with an extended-spectrum beta-lactamases (ESBL) organism). The specific choice will depend on the individual hospital’s microbiological spectrum and antibiogram.

Patients who present with repeat infections may also be initially treated as per their previous urine culture results until new cultures are available. Imaging to look for a source of infection such as an abscess or stone should be done with relapsing infections that involve the same organisms.

In most cases, treatment response should be evident in 24 to 48 hours. A poor response may indicate inappropriate antibiotic selection, polymicrobial infections, atypical infections, hydronephrosis, obstructing stone causing pyonephrosis, complications such as a perinephric abscess or emphysematous UTI, fluid collections such as urinary retention or anatomical lesions leading to poor response (nephrocalcinosis acting like an infective nidus, obstructive urinary tract lesions, or fistulas). A Foley catheter, to guarantee good bladder drainage, is often recommended for these patients if they are septic and have increased post-void residual volumes.

Failure to respond to appropriate antibiotics should suggest a possible obstructive component such as obstructive pyelonephritis. In such cases, a renal ultrasound or non-contrast CT scan should be done for diagnosis and immediate surgical drainage performed if an obstructed, infected kidney is found (either double J stenting or a percutaneous nephrostomy).

Prophylactic antibiotics are seldom recommended due to rapid bacterial resistance patterns developing. When the clinical situation requires prophylaxis, nitrofurantoin is usually the preferred agent.

Patients with permanent Foley catheters or suprapubic tubes should avoid prophylactic antibiotics and should only be treated when symptomatic. More frequent changes of urinary catheters is recommended in chronically cahteterized patients with reurrent infections.

Mandelamine is a twice-daily medication that, in acid urine, is converted to formaldehyde which is a potent urinary antiseptic. This can be useful in patients with persistently elevated post-void residuals instead of prophylactic antibiotics.

Patients with frequent UTI recurrences, especially if already performing intermittent self catheterization, can be managed with daily bladder instillations of Gentamycin solution. The recommended dosage is to instill 30-60 cc’s of a solution of 480 mg of Gentamycin in 1 Liter of Normal Saline after initially draining the bladder.[16] Gentamycin has no significant systemic absorption when used in this fashion so it can be used regardless of renal function. Interestingly, heparin bladder instillations have also shown some activity in reducing recurrent UTIs.[17]

Pearls and Other Issues

Diagnostic Pitfalls

Urinary tract infections are primarily a clinical diagnosis, and expert opinion should be sought before initiating treatment of an isolated positive result in an otherwise asymptomatic patient, the only exception being asymptomatic bacteria.

Quite often, clinicians end up treating the positive culture report rather than a genuine urinary tract infection. Most often, positive culture in an asymptomatic patient can be traced to a poor sampling technique.

Another confusing scenario is that of septic, delirious, elderly patient who is unable to provide a history or demonstrate adequate examination signs to help localize a septic source. Quite frequently, these patients are treated as having a presumed UTI in the absence of a clear alternative septic source.

UTI associated radiological changes can sometimes take several months to resolve and must be interpreted with care in cases of recurrent or persistent infections.

UTI must be considered as a differential diagnosis when evaluating a patient with a pelvic inflammatory disease or an acute abdomen.

Male patients with a urinary tract infection must also be screened for sexually transmitted infections.

Interstitial cystitis is frequently misdiagnosed and treated as a UTI, and must be considered as an alternative diagnosis in patients who keep presenting with cystitis symptoms without positive cultures.

“Sterile pyuria,” with persistent urinary WBCs but negative standard urine cultures, could indicate tuberculosis which requires special cultures.

Bacterial infections only tend to account for 80% of all urinary tract infections, and antibiotics may sometimes prove ineffective.

Management Pitfalls

Multidrug-resistant infections are becoming a major source of in-hospital mortality and morbidity. Suppressive antibiotic regimens are sometimes used in poorly responding or resistant cases. These presentations should always be guided by a dedicated infectious disease team, as long-term suppressive antibiotics come with a unique set of complications.

Long-term antibiotic prophylaxis must also be used with caution, as it would increase the risk of resistance and change susceptibilities of colonized organisms. On occasion, residual urinary symptoms may take several months to resolve or might never resolve (especially in the case of indwelling catheters, post-prostatectomy cases, post bladder surgery, or radiotherapy), and do not always indicate a genuine urinary tract infection.

Long-term prophylaxis with nitrofurantoin is associated with hypersensitivity pneumonitis. Patients should be counseled accordingly.

It helps to identify predisposing factors for the infection and correct them if possible. For example, the diabetic patient would benefit from improving glycemic control. Renal tract anatomic abnormalities may be assessed by urology to see if an intervention is appropriate (renal calculi, BPH, ureteric strictures). Immunocompromising factors may be addressed if possible (steroids, HIV). Finally, nephrotoxic medications may be rationalized in patients with suboptimal renal functions.

Enhancing Healthcare Team Outcomes

The management of complex UTI is an interprofessional that includes a urologist, nephrologist, infectious disease expert, internist, pharmacist and the primary care provider.Complicated UTIs need to treated more carefully to serve patients with these infections and to avoid overuse and misuse of antibiotics that will ultimately result in more resistant infections in the future. Using the right antibiotic for the right duration is key. Practitioners should not hesitate to take advantage of infectious disease specialty services in these situations to help optimize antibiotic use.

Failure of a standard UTI or pyelonephritis to respond to initial treatment should suggest some other medical problem such as diabetes, sepsis, an abscess, urinary retention or an obstructing stone with a possible pyonephrosis. Bladder drainage with a Foley and appropriate imaging tests can identify these problems.

These patients need close monitoring because of potential complications. The outlook for patients with severe UTI is guarded and even those who do recover tend to have a prolonged recovery period.[18][19][20] (Level V)

References

1.: Girgenti V, Pelizzo G, Amoroso S, Rosone G, Di Mitri M, Milazzo M, Giordano S, Genuardi R, Calcaterra V. Emphysematous Pyelonephritis Following Ureterovesical Reimplantation for Congenital Obstructive Megaureter. Pediatric Case Report and Review of the Literature. Front Pediatr. 2019;7:2. [PMC free article: PMC6354553] [PubMed: 30733936]
2.: Habak PJ, Griggs, Jr RP. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 10, 2021. Urinary Tract Infection In Pregnancy. [PubMed: 30725732]
3.: Shortridge D, Duncan LR, Pfaller MA, Flamm RK. Activity of ceftolozane-tazobactam and comparators when tested against Gram-negative isolates collected from paediatric patients in the USA and Europe between 2012 and 2016 as part of a global surveillance programme. Int J Antimicrob Agents. 2019 May;53(5):637-643. [PubMed: 30716448]
4.: Shi H, Kang CI, Cho SY, Huh K, Chung DR, Peck KR. Follow-up blood cultures add little value in the management of bacteremic urinary tract infections. Eur J Clin Microbiol Infect Dis. 2019 Apr;38(4):695-702. [PubMed: 30689071]
5.: Gomila A, Carratalà J, Eliakim-Raz N, Shaw E, Wiegand I, Vallejo-Torres L, Gorostiza A, Vigo JM, Morris S, Stoddart M, Grier S, Vank C, Cuperus N, Van den Heuvel L, Vuong C, MacGowan A, Leibovici L, Addy I, Pujol M. , COMBACTE MAGNET WP5 RESCUING Study Group and Study Sites. Risk factors and prognosis of complicated urinary tract infections caused by Pseudomonas aeruginosa in hospitalized patients: a retrospective multicenter cohort study. Infect Drug Resist. 2018;11:2571-2581. [PMC free article: PMC6302800] [PubMed: 30588040]
6.: Esposito S, Rinaldi VE, Argentiero A, Farinelli E, Cofini M, D’Alonzo R, Mencacci A, Principi N. Approach to Neonates and Young Infants with Fever without a Source Who Are at Risk for Severe Bacterial Infection. Mediators Inflamm. 2018;2018:4869329. [PMC free article: PMC6287153] [PubMed: 30581369]
7.: Cruz J, Figueiredo F, Matos AP, Duarte S, Guerra A, Ramalho M. Infectious and Inflammatory Diseases of the Urinary Tract: Role of MR Imaging. Magn Reson Imaging Clin N Am. 2019 Feb;27(1):59-75. [PubMed: 30466913]
8.: Donnan JR, Grandy CA, Chibrikov E, Marra CA, Aubrey-Bassler K, Johnston K, Swab M, Hache J, Curnew D, Nguyen H, Gamble JM. Comparative safety of the sodium glucose co-transporter 2 (SGLT2) inhibitors: a systematic review and meta-analysis. BMJ Open. 2019 Feb 01;9(1):e022577. [PMC free article: PMC6361337] [PubMed: 30813108]
9.: Al Midani A, Elands S, Collier S, Harber M, Shendi AM. Impact of Urinary Tract Infections in Kidney Transplant Recipients: A 4-Year Single-Center Experience. Transplant Proc. 2018 Dec;50(10):3351-3355. [PubMed: 30577206]
10.: Belyayeva M, Jeong JM. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 10, 2021. Acute Pyelonephritis. [PubMed: 30137822]
11.: Bono MJ, Reygaert WC. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jun 23, 2021. Urinary Tract Infection. [PubMed: 29261874]
12.: NICE Guidance – Complicated urinary tract infections: ceftolozane/tazobactam: © NICE (2016) Complicated urinary tract infections: ceftolozane/tazobactam. BJU Int. 2018 Jun;121(6):825-834. [PubMed: 29878700]
13.: Lemoine L, Dupont C, Capron A, Cerf E, Yilmaz M, Verloop D, Blanckaert K, Senneville E, Alfandari S. Prospective evaluation of the management of urinary tract infections in 134 French nursing homes. Med Mal Infect. 2018 Aug;48(5):359-364. [PubMed: 29747905]
14.: Expert Panel on Pediatric Imaging: Karmazyn BK, Alazraki AL, Anupindi SA, Dempsey ME, Dillman JR, Dorfman SR, Garber MD, Moore SG, Peters CA, Rice HE, Rigsby CK, Safdar NM, Simoneaux SF, Trout AT, Westra SJ, Wootton-Gorges SL, Coley BD. ACR Appropriateness Criteria^® Urinary Tract Infection-Child. J Am Coll Radiol. 2017 May;14(5S):S362-S371. [PubMed: 28473093]
15.: Yasuda M. Urogenital infections. Nihon Rinsho. 2017 Apr;75(4):558-566. [PubMed: 30549857]
16.: Abrams P, Hashim H, Tomson C, Macgowan A, Skews R, Warren K. The use of intravesical gentamicin to treat recurrent urinary tract infections in lower urinary tract dysfunction. Neurourol Urodyn. 2017 Nov;36(8):2109-2116. [PubMed: 28503891]
17.: Chernyak S, Salamon C. Intravesical Antibiotic Administration in the Treatment of Recurrent Urinary Tract Infections: Promising Results From a Case Series. Female Pelvic Med Reconstr Surg. 2020 Feb;26(2):152-154. [PubMed: 31990805]
18.: Bonine NG, Berger A, Altincatal A, Wang R, Bhagnani T, Gillard P, Lodise T. Impact of Delayed Appropriate Antibiotic Therapy on Patient Outcomes by Antibiotic Resistance Status From Serious Gram-negative Bacterial Infections. Am J Med Sci. 2019 Feb;357(2):103-110. [PubMed: 30665490]
19.: Kaye KS, Bhowmick T, Metallidis S, Bleasdale SC, Sagan OS, Stus V, Vazquez J, Zaitsev V, Bidair M, Chorvat E, Dragoescu PO, Fedosiuk E, Horcajada JP, Murta C, Sarychev Y, Stoev V, Morgan E, Fusaro K, Griffith D, Lomovskaya O, Alexander EL, Loutit J, Dudley MN, Giamarellos-Bourboulis EJ. Effect of Meropenem-Vaborbactam vs Piperacillin-Tazobactam on Clinical Cure or Improvement and Microbial Eradication in Complicated Urinary Tract Infection: The TANGO I Randomized Clinical Trial. JAMA. 2018 Feb 27;319(8):788-799. [PMC free article: PMC5838656] [PubMed: 29486041]
20.: Karve S, Ryan K, Peeters P, Baelen E, Rojas-Farreras S, Potter D, Rodríguez-Baño J. The impact of initial antibiotic treatment failure: Real-world insights in patients with complicated urinary tract infection. J Infect. 2018 Feb;76(2):121-131. [PubMed: 29128389]

Burning, Cloudy Urine, Frequent Urination

Bladder infections are often more annoying than they are serious. But they can travel up to your kidneys, where they can cause more severe problems.

So it’s important to treat bladder infections right away. Doctors usually use antibiotics to kill the bacteria causing the infection.

Women, especially, should watch for symptoms. They are more likely to get bladder infections than men are.

Symptoms

The most common sign of cystitis (the medical term for a bladder infection) is a burning feeling when you pee. Some people might call it a “scalding” sensation.

Other symptoms you might have include:

Need to pee more often.
Peeing only in small amounts at a time
Cloudy or bloody urine
Urine that smells worse than it should
Pain around your pelvis
Fever (a sign that the infection might have spread to your kidneys)

In older people, prolonged tiredness (fatigue) or mental confusion might be signs of a more serious urinary tract infection.

If you help take care of a child, you may want to watch for accidental daytime wetting that wasn’t happening before. Other signs include a drop in appetite and vomiting.

When to Call a Doctor

Get medical help at once if it hurts to pee and you also have any of these symptoms:

This may mean potentially life-threatening kidney disease, a prostate infection, a bladder or kidney tumor, or a urinary tract stone.

You should also call your doctor if:

Symptoms return after you’ve finished treatment.
You also have discharge from your vagina or penis. This may be a sign of a sexually transmitted disease (STD), pelvic inflammatory disease (PID), or other serious infections.
You have ongoing pain or a hard time peeing. This may also be a sign of an STD, a vaginal infection, a kidney stone, enlargement of the prostate, or a bladder or prostate tumor. Or it could be that the infection is resistant to the antibiotic your doctor prescribed.

Urology | Urethritis Causes & Symptoms

Urethritis is swelling and irritation or inflammation of the urethra. Urethritis is most commonly caused by bacteria or a virus, but can also result from physical injury or sensitivity to some chemicals in spermicides and contraceptive foams and jellies.

The bacteria responsible for urethritis include:

E. coli: Present in stool, it’s the same bacteria that causes urinary tract infections (UTIs)
Gonococcus: Sexually transmitted and causes gonorrhea
Chlamydia trachomatis: Sexually transmitted and causes chlamydia

Virues that are commonly responsible for urethritis include:

Herpes simplex (HSV-1 and HSV-2)
Trichomonas: A single-celled sexually-transmitted organism

Who’s At Risk?

The primary causes of urethritis are linked to behaviors, like inadequate hygiene or risky sexual behaviors. Behaviors that put people at the most risk for developing urethritis include:

multiple sexual partners
high-risk sexual behavior, such as anal sex without a condom
a history of sexually transmitted diseases

Symptoms of Urethritis

The primary symptoms of urethritis are urethral inflammation and painful urination. In addition, urethritis symptoms include:

frequent or urgent need to urinate
difficulty starting urination
itching, pain or discomfort when not urinating
pain during sex
vaginal or urethral discharge
abdominal and pelvic pain
fever and chills

Diagnosing Urethritis

If you are experiencing painful urination or vaginal or urethral discharge, your doctor may assume an infection is present and may prescribe antibiotics immediately while awaiting test results. Tests can help confirm the diagnosis of urethritis and its cause and can include:

physical examination of the genitals, abdomen and rectum to check for discharge and tenderness
urine tests for gonorrhea, chlamydia or other bacteria
examination of any discharge under a microscope

Blood tests are sometimes performed, but are not often necessary for an accurate diagnosis.

Treating Urethritis

The goal of any treatment for urethritis is to eliminate the cause of infection, prevent the spread of infection and improve your symptoms. There are different treatment options depending on the cause and severity of infection. Pain relievers may also be used in conjunction with other medications to lessen painful symptoms of urethritis .

People with urethritis who are being treated should avoid sex or use condoms during intercourse. If an infection is the cause of the inflammation, your sexual partner must also be treated.

Treating urethritis caused by bacteria

Antibiotics can successfully cure urethritis caused by bacteria. Many different antibiotics can treat urethritis, but some of the most commonly prescribed include:

Doxycycline (Adoxa, Monodox, Oracea, Vibramycin)
Ceftriaxone (Rocephin)
Azithromycin (Zithromax, Zmax)

Urethritis due to trichomonas infection (called trichomoniasis) is usually treated with an antibiotic called Flagyl (metronidazole). Tindamax (tinidazole) is another antibiotic that can treat trichomoniasis. Urethritis that does not clear up after antibiotic treatment and lasts for at least six weeks is called chronic urethritis. Different antibiotics may be used to treat this problem.

Treating urethritis caused by a virus

Urethritis due to the herpes simplex virus can be treated with a number of medications, including:

Famciclovir (Famvir)
Valacyclovir (Valtrex)
Acyclovir (Zovirax)

Preventing Urethritis

Urethritis can be prevented with good personal hygiene and by practicing safer sexual behaviors such as monogamy (one sexual partner only) and using condoms.

Urethritis is preventable and curable, but can lead to permanent damage to the urethra as well as other organs in women. Common complications from urethritis include:

UTI treatment reduces E. coli, may offer alternative to antibiotics – Washington University School of Medicine in St. Louis

Visit the News Hub

Treatment with molecular decoy may lessen recurrent infections, mouse study shows

Scott Hultgren and John Heuser

An E. coli bacterium (above, in gold) attaches to and invades cells lining the inner surface of the bladder. UTIs are among the most common infections, and they tend to recur. Researchers at Washington University School of Medicine in St. Louis have found a molecular decoy that reduces the number of UTI-causing gut bacteria. This compound potentially could lower the chance of repeat UTIs.

Urinary tract infections (UTIs) are among the most common infections, and they tend to come back again and again, even when treated. Most UTIs are caused by E. coli that live in the gut and spread to the urinary tract.

A new study from Washington University School of Medicine in St. Louis has found that a molecular decoy can target and reduce these UTI-causing bacteria in the gut. With a smaller pool of disease-causing bacteria in the gut, according to the researchers, the risk of having a UTI goes down.

“The ultimate goal of our research is to help patients manage and prevent the common problem of recurrent urinary tract infections while at the same time helping to address the worldwide crisis of antimicrobial resistance,” said Scott J. Hultgren, PhD, the Helen L. Stoever Professor of Molecular Microbiology and the study’s senior author. “This compound may provide a way to treat UTIs without the use of antibiotics.”

The study is published June 14 in Nature.

Related: Researchers identify protein critical in causing chronic UTIs

Findings suggest a new way to prevent common infection

Close to 100 million people worldwide acquire UTIs each year, and despite antibiotic treatment, about a quarter develop another such infection within six months. UTIs cause painful, burning urination and the frequent urge to urinate. In serious cases, the infection can spread to the kidneys and then the bloodstream, where it can become life-threatening.

Most UTIs are caused by E. coli that live harmlessly in the gut. However, when shed in the feces, the bacteria can spread to the opening of the urinary tract and up to the bladder, where they can cause problems. Conventional wisdom holds that UTIs recur frequently because bacterial populations from the gut are continually re-seeding the urinary tract with disease-causing bacteria.

Hultgren, graduate student Caitlin Spaulding, and colleagues reasoned that if they could reduce the number of dangerous E. coli in the gut, they could reduce the likelihood of developing a UTI and possibly prevent some recurrent infections.

First, the researchers identified genes that E. coli need to survive in the gut. One set of genes coded for a kind of pilus, a hairlike appendage on the surface of E. coli that allows the bacteria to stick to tissues, like molecular velcro. Without this pilus, the bacteria fail to thrive in the gut.

Earlier studies found that the identified pilus attaches to a sugar called mannose that is found on the surface of the bladder. Grabbing hold of mannose receptors on the bladder with the pilus allows the bacteria to avoid being swept away when a person urinates. Bacteria that lack this pilus are unable to cause UTIs in mice.

Previously, Hultgren and co-author, James W. Janetka, PhD, an associate professor of biochemistry and molecular biophysics at Washington University, chemically modified mannose to create a group of molecules, called mannosides, that are similar to mannose but changed in a way that the bacteria latch onto them more tightly with their pili. Unlike mannose receptors, though, these mannosides are not attached to the bladder wall, so bacteria that take hold of mannosides instead of mannose receptors are flushed out with urine.

Since the researchers found that this same pilus also allows the bacteria to bind in the gut, they reasoned that mannoside treatment could reduce the number of E. coli in the gut and perhaps prevent the spread of the bacteria to the bladder.

To test this idea, they introduced a disease-causing strain of E. coli into the bladders and guts of mice to mirror the pattern seen in people. In women with UTIs, the same bacteria that cause problems in the bladder usually also are found living in the gut.

The researchers gave the mice three oral doses of mannoside, and then measured the numbers of bacteria in the bladders and guts of the mice after the last dose of mannoside. They found that the disease-causing bacteria had been almost entirely eliminated from the bladder and reduced a hundredfold in the gut, from 100 million per sample to 1 million.

“While we did not entirely eliminate this strain of bacteria from the gut, the results are still promising,” said Spaulding, the paper’s first author. “Reducing the number of disease-causing bacteria in the gut means there are fewer available to enter the urinary tract and cause a UTI.”

The type of pilus the researchers studied is found in most strains of E. coli and some related bacterial species as well. In theory, mannoside treatment could cause other bacteria living in the gut with the same kind of pilus to be swept away, much as antibiotic treatment kills bystander bacteria along with the intended target. Eliminating harmless bacteria potentially opens up space in the gut for more dangerous microbes to grow. This can result in intestinal disorders, one of the known risks of broad antibiotic treatment.

In collaboration with co-author Jeffrey I. Gordon, MD, the Dr. Robert J. Glaser Distinguished University Professor at the School of Medicine, researchers measured the composition of the gut microbiome after mannoside treatment. They found that mannoside treatment had minimal effect on intestinal bacteria other than the ones that cause most UTIs. This is in stark contrast to the massive changes in the abundance of many microbial species seen after treatment with antibiotics.

“This finding is exciting because we’ve developed a therapeutic that acts like a molecular scalpel,” Spaulding said. “It goes in and specifically cuts out the bacteria you want to get rid of, while leaving the remainder of the microbial community intact.”

Furthermore, since mannoside is not an antibiotic, it potentially could be used to treat UTIs caused by antibiotic-resistant strains of bacteria, a growing problem. UTIs account for 9 percent of all antibiotics prescribed every year in the United States, so a therapy for UTI that avoids antibiotics could help curb the development and spread of antibiotic-resistant organisms.

Differences in anatomy and behavior between mice and women make mice a challenging model for testing whether reducing the bacterial load in the gut actually reduces the number of repeat UTIs. To answer that question, human studies are needed.

Hultgren has co-founded a company, Fimbrion Therapeutics, with Janetka and Thomas ‘Mac’ Hooton, MD, of the University of Miami School of Medicine, to develop mannosides and other drugs as potential therapies for UTI. Fimbrion is working on identifying a promising candidate drug for clinical trials in humans.

Spaulding CN, Klein RD, Ruer S, Kau AL, Schreiber HL, Cusumano ZT, Dodson KW, Pinkner JS, Fremont DH, Janetka JW, Remaut H, Gordon JI, Hultgren SJ. Selective depletion of uropathogenic E. coli from the gut by a FimH antagonist. Nature. June 14, 2017.

This work was supported by the National Institutes of Health (NIH), grant numbers K08AI113184, R01AI048689, RO1DK051406, P50DK064540, RC1DK086378, DK30292, RO1DK051406, and 1F31DK107057; the Research Foundation – Flanders, grant number G030411N; the Hercules Foundation, grant number UABR/09/005; and the Flanders Institute for Biotechnology, grant number PRJ9.

Hultgren and Janetka are inventors on patent application US8937167, which covers the use of mannoside-based FimH ligand antagonists for the treatment of disease. The two have ownership interest in Fimbrion Therapeutics and may benefit if the company is successful in marketing mannosides.

Washington University School of Medicine‘s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient-care institutions in the nation, currently ranked seventh in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.

Urinary Tract Infections – HealthyWomen

Overview

What Is It?
Most urinary tract infections are caused by a variety of bacteria, including Escherichia coli (E. coli), found in feces. Because the openings of the bowel, vagina and urethra are close together, it’s easy for the bacteria to spread to the urethra and travel up the urinary tract into the bladder and sometimes the kidneys.

Urinary tract infections result in eight to 10 million doctors’ office visits each year in the United States, and at least 50 percent of women will have at least one urinary tract infection at some point in their lives.

Luckily, most urinary tract infections are not serious and can be easily treated with antibiotic medications. The symptoms of a urinary tract infection can be stubborn and can persist after treatment. Sometimes an infection recurs a few weeks after treatment. Nearly 20 percent of women who have a urinary tract infection will have another, and 30 percent of those who have had two will have a third. About 80 percent of those who have had three will have a fourth. If left untreated, urinary tract infections can lead to other more complicated health problems so they should not be ignored.

How the Urinary Tract Works

Your urinary tract includes two kidneys, two ureters, the bladder and the urethra. Your kidneys remove waste and water from your blood to produce urine. Urine travels through muscular tubes, called the ureters, to the bladder. The bladder is a balloon-like organ composed of muscle, connective tissue and nerves that swells as it fills with urine. Urine is stored in the bladder until it is released from the body through another tube, called the urethra. Two muscle groups, the pelvic floor muscles and the urinary sphincters, control the activity of the urethra and bladder neck. These muscles must work together to hold urine in the bladder most of the time and allow the bladder to empty when appropriate.

Cause of Urinary Tract Infection: Bacteria

Most urinary tract infections are caused by a variety of bacteria, including Escherichia coli (E. coli), found in feces. Because the openings of the bowel, vagina and urethra are very close together, it’s easy for the bacteria to spread to the urethra and travel up the urinary tract into the bladder and sometimes up to the kidneys.

Untreated Urinary Tract Infections: Bladder & Kidney Infections

Infection occurs when the bacteria cling to the opening of the urethra and multiply, producing an infection of the urethra, called urethritis. The bacteria often spread up to the bladder, causing a bladder infection, called cystitis. Untreated, the infection can continue spreading up the urinary tract, causing infection in the kidneys, called pyelonephritis. Pyelonephritis can also occur without a preceding bladder infection.

A kidney infection that is not treated can result in the bacteria entering the bloodstream (this is known as urosepsis), which can be a life-threatening infection requiring hospitalization and intravenous antibiotics.

The first sign of a bladder infection may be a strong urge to urinate or a painful burning sensation when you urinate. You may feel the urge to go frequently, with little urine eliminated each time. At times, the urge to urinate may be hard to control and you may have urinary leakage. You may also have soreness in your lower abdomen, in your back or in the sides of your body. Your urine may look cloudy or have a reddish tinge from blood. It may smell foul or strong. You also may feel tired, shaky and washed out.

If the infection has spread to the kidneys, you may have fever, chills, nausea, vomiting and back pain, in addition to the frequent urge to urinate and painful urination.

Common Causes of UTIs

Some women are more prone to urinary tract infections than others because the cells in their vaginal areas and in their urethras are more easily invaded by bacteria. Women with mothers or sisters who have recurring urinary tract infections also tend to be more susceptible. Your risk of urinary tract infection also is greater if you’re past menopause. Thinning of the tissues of the vagina, bladder and urethra, as well as change in the vaginal environment after menopause, may make these areas less resistant to bacteria and cause more frequent urinary tract infections.

Irritation or injury to the vagina or urethra caused by sexual intercourse, douching, tampons or feminine deodorants can give bacteria a chance to invade. Using a diaphragm can cause irritation and can interfere with the bladder’s ability to empty, giving bacteria a place to grow.

Any abnormality of the urinary tract that blocks the flow of urine, such as a kidney stone or significant prolapse of the uterus or vagina, also can lead to an infection or recurrent infections. Illnesses that affect the immune system, such as diabetes, AIDS and chronic kidney diseases, increase the risk of urinary tract infections. A weak bladder can also make it difficult to empty completely, allowing bacteria to grow. Lengthy use of an indwelling catheter, a soft tube inserted through the urethra into the bladder to drain urine, is a common source of urinary tract infections. Intermittent catheterization (where a person empties the bladder several times a day but the catheter is removed immediately) actually is used to prevent recurrent infections in some patients.

Because the uterus sits directly on the bladder during pregnancy and can block the drainage of urine from the bladder, UTIs are more common in pregnant women. And when women develop urinary tract infections during pregnancy, the bacteria are more likely to affect the kidneys. Hormonal changes and repositioning of the urinary tract during pregnancy may make it easier for bacteria to invade the kidneys. Such infections in pregnant women can lead to urosepsis, kidney damage, high blood pressure and premature delivery of the baby. All pregnant women should have their urine tested periodically during pregnancy. Pregnant women with a history of frequent urinary tract infections should have their urine tested often.

Most antibiotic medications are safe to take during pregnancy, but your health care professional will consider the drug’s effectiveness, how far your pregnancy has progressed and the potential side effects on the fetus when determining which medication is right for you and how long you should take it.

Diagnosis

Your health care professional will determine whether you have a urinary tract infection based on your symptoms, a physical examination and the result of a laboratory test of your urine. You will be asked to urinate into a small cup. The urine will be examined under a microscope for bacteria and for a large amount of white blood cells, which fight infection. A urine culture may be done in which the bacteria in the urine are encouraged to grow. The bacteria can then be identified and may be tested to see which antibiotic best kills them.

If you are having recurrent symptoms of infections despite treatment, it is important that your urine be cultured before you are placed on antibiotics. Repeated treatment of presumed infections without urine culture should be avoided.

Some bacteria, such as chlamydia, can only be found with special urine cultures. A health care professional may suspect these infections when a woman has urinary tract infection symptoms, but a standard culture doesn’t grow the bacteria.

If you have recurring urinary tract infections, your health care professional may suggest other tests to look for obstructions or other problems that might trap urine in the tract and cause infection:

Intravenous pyelogram (IVP) is an X-ray exam of the urinary tract using a dye that is injected into a vein and then enters the kidneys, ureters and bladder. This test is not commonly used alone anymore.
A computed tomography scan (CT scan), also known as a CT urography, is a type of X-ray test used to capture images of different structures in the body. The CT scan is usually given with an intravenous dye similar to that used in an IVP (see above). The dye allows your doctor to better see your kidneys, ureters and bladder. Newer CT scanners use much less radiation.
Ultrasound uses sound waves to produce images of the urinary tract. No radiation is involved in this test.
Cystoscopy is a test using a thin telescope-like instrument that allows your health care professional to see inside the urethra and bladder and examine them for problems.

Treatment

Urinary tract infections are treated with medications that kill the bacteria causing the infection. Your health care professional will determine which medication to prescribe and how you should take it, based on your medical history and condition and the results of the urine tests. Many medications can have side effects, so talk to your health care professional about what to expect. Also, medications can interact with other prescriptions and over-the-counter drugs, so make sure you tell your health care professional what drugs you are taking.

The antibiotics most often used to treat urinary tract infection are pills typically taken for three days. More complicated infections are usually treated with seven to 10 days or more of antibiotics, depending on the bacteria causing the infection, the drug used and your medical history. The most frequently prescribed drugs include:

ciprofloxacin (Cipro)
levofloxacin (Levaquin)
nitrofurantoin (Macrobid, Furadantin)
norfloxacin (Noroxin)
fosfomycin (Monurol)
trimethoprim/sulfamethoxazole (Bactrim, Septra)

Note: Fluoroquinolones, which include the antibiotics ciprofloxacin, gatifloxacin, levofloxacin and norfloxacin, have been associated with an increased risk of tendonitis and tendon rupture. If you are prescribed one of these medications for a urinary tract infection, discuss this risk with your health care professional.

Urinary tract infections caused by microorganisms, such as chlamydia, may be treated with the antibiotics azithromycin, tetracycline or doxycycline.

Although your symptoms may be relieved in a day or two after starting the medication, you must take all the medication your health care professional prescribes. Otherwise, you run the risk of a recurrence. That is, some bacteria may survive and cause your infection to return or cause reinfection with a new or different organism.

To help ease your discomfort until the antibiotics kick in, you can take a prescription medication called phenazopyridine (Pyridium). A similar medication, called Uristat, is available over the counter. However, keep in mind that these medications only ease symptoms; they do not treat the infection. They also change the color of your urine, can interfere with laboratory testing and shouldn’t be taken for more than 48 hours unless told differently by your health care provider.

If you are menopausal, you may experience more frequent urinary tract infections because thinning of the tissues of the vagina and urethra following menopause may make these areas less resistant to bacteria. Hormone replacement (either systemic or vaginal) may help. Vaginal estrogen has fewer health risks than systemic estrogen (such as in birth control pill and patches) because only a small amount is absorbed into the bloodstream. Vaginal estrogen is available as a cream (Estrace), a tablet (Vagifem, Premarin) and a flexible plastic ring (Estring). Femring is another vaginal estrogen product, but it has higher doses of estrogen and is primarily recommended for hot flashes; women with a uterus who use Femring should take progestin to minimize their risk of uterine cancer.

Discuss these treatment options and the latest research about their risks and benefits with your health care professional, keeping your personal health history and needs in mind. If you decide to take hormone replacement therapy, you should take the lowest dose that helps for the shortest time possible. You and your doctor should also reevaluate every six months whether or not you should be taking hormones.

Severe kidney infections may require hospitalization and treatment with intravenous antibiotics, especially if nausea, vomiting and fever increase the risk of dehydration and prevent the ability to swallow pills. Kidney infections usually require two weeks of antibiotic therapy, although treatment may extend as long as six weeks (this extended course usually is prescribed for men whose infections are due to prostatitis, however).

In addition to taking your medication, your health care professional may recommend drinking plenty of fluid (the equivalent of six to eight 8-ounce glasses a day) to help flush the urinary tract and avoiding foods and beverages that can irritate the urinary tract, such as coffee and alcohol. A heating pad may help to temporarily relieve pain.

After you’ve completed your course of medication, your health care professional may suggest a follow-up urine test to make sure the infection is gone.

Prevention

There are several simple, do-it-yourself techniques that may prevent a urinary tract infection. Some may work some of the time or only in some women. But, because they carry no side effects, they certainly are worth trying to prevent the often painful and bothersome symptoms the infection can bring:

Drink plenty of fluid––the equivalent of six to eight 8-ounce glasses––every day to flush bacteria out of your urinary system. Water is the ideal fluid because it is readily available, inexpensive and noncaloric, but other beverages also count toward your fluid intake, including juices, milk and herbal teas. Even alcoholic beverages such as beer and wine and caffeinated beverages such as coffee and colas help replenish your fluids, but don’t rely heavily on them because they have diuretic properties. Additionally, alcohol and caffeine, as well as spicy foods, are among the substances that may irritate the bladder and, thus, should be avoided.
Make sure you’re getting vitamin C in your diet, either through diet or supplements. Vitamin C, or ascorbic acid, makes your urine acidic, which discourages the growth of bacteria. Drinking cranberry juice may also produce the same effect. Cranberry supplements are a more concentrated form of cranberry juice without the sugar content.
Urinate frequently and when you feel the urge; don’t hold it in. Keeping urine in your bladder for long periods gives bacteria a place to grow.
Avoid using feminine hygiene sprays and scented douches. They may irritate the urethra.
If you wear a pad for urinary leakage, you should change it often. Wet pads provide an environment for bacteria to grow.

If you suffer from urinary tract infections more than three times a year, your health care professional may suggest one of the following therapies to try to prevent another recurrence:

a low dosage of an antibiotic medication such as trimethoprim/sulfamethoxazole or nitrofurantoin, taken daily for six months or longer
a single dose of an antibiotic medication taken after sexual intercourse if it is determined that your UTIs are related to sex
a short, one- or two-day course of antibiotic medication taken when symptoms appear
Use of preventive medications that change the bladder environment, such as methanamine.

If you experience recurring UTIs, home urine tests, which involve dipping a test stick into a urine sample, may be helpful.

Some research suggests that a woman’s blood type may play a role in her risk of recurrent UTIs. Bacteria may be able to attach to cells in the urinary tract more easily in those with certain blood factors. Additional research will determine if such an association exists and whether it could be useful in identifying people at risk of developing recurrent UTIs.

Vaccines are being developed to help patients build up their own natural infection-fighting powers. Vaccines that are prepared using dead bacteria do not spread like an infection; instead, they prompt the body to produce antibodies that can later fight live organisms. Researchers are currently looking into vaccines that can be administered orally, by way of a vaginal suppository and through the nose.

Facts to Know

Urinary tract infections result in eight to 10 million doctors’ office visits each year in the United States, and at least 50 percent of women will have at least one urinary tract infection at some point in their lives.
Nearly 20 percent of women who have one urinary tract infection will have another, and 30 percent of those who have had two will have a third. About 80 percent of those who have had three will have a fourth. Four out of five such women get another infection within 18 months of the last one.
Some women are more prone to the infection than others. Women at higher risk include those who are past menopause, who have diabetes or who use a diaphragm. If your mother or sister had frequent urinary tract infections, you are more likely to have one. Recently, researchers found that women who use spermicides as contraception—particularly if they use them with diaphragms—are also at a greater risk for recurrent UTIs.
About 2 percent to 7 percent of pregnant women develop a urinary tract infection. Pregnant women are more likely to have UTIs and the infection is more likely to spread to the kidneys. UTIs during pregnancy need prompt attention by a health care professional to avoid a premature birth. Pregnant women may have no symptoms associated with an infection so regular urine tests are important.
One type of bacteria––Escherichia coli (E. coli), which lives in the digestive system and spreads to the urinary tract––causes most urinary tract infections.
Urinaryurgency, urge incontinence and pain with urination can be early symptoms of urinary tract infection. Urinary urgency is characterized by frequent overwhelming urges to urinate. Urgency incontinence is urine leakage resulting from not getting to a toilet in time.
Urinary tract infections usually are not serious and are easily treated by taking antibiotics. Kidney infection is the most common complication and can produce fever, chills, nausea, vomiting and back pain.
Although urinary tract infections do occur in men, women are at greater risk because of their anatomy. The female urethra is short, and the rectum, vagina and urethra are located closely together in women, making it easy to spread bacteria that live in the digestive tract to the urinary tract.
Women who have more than three urinary tract infections in a year may benefit from preventive antibiotic therapy. Such therapy may involve taking a low dose of medication every day for six months or longer, taking a single dose after having sex or taking a dose for one or two days when symptoms begin to appear. If you experience recurring UTIs, home urine tests, which involve dipping a test stick into a urine sample, may be helpful.
When being treated for a urinary tract infection, take all the antibiotic medication you have been given, even if your symptoms are gone before you finish your prescription. If you fail to complete the treatment, the infection may still be present, and your symptoms will return or another infection may arise in a short time.

Questions to Ask

Review the following Questions to Ask about urinary tract infection so you’re prepared to discuss this important health issue with your health care professional.

Am I at risk for a urinary tract infection?
What can I do to prevent a urinary tract infection?
What are the signs of a urinary tract infection?
What tests are available to find the cause of my infection, and which one is right for me?
What are the results of my urine tests, and what do they mean?
What medication are you prescribing for my infection? How should I take it and for how long?
What are the possible side effects of the antibiotic medication, and what should I do to avoid or lessen them? Will the antibiotic interact with any other medications I am taking?
If I keep getting urinary tract infections, will I need more tests? Which ones? How will they be done and what can the results mean?
Am I a candidate for preventive antibiotic therapy, and what treatment would be best for me? What is the medication, and when and how should I take it?

Key Q&A

How do you get a urinary tract infection?
The infection is most often caused by bacteria from the digestive tract being spread to the urethra and then traveling up the urinary tract to the bladder and sometimes the kidneys. It can also be caused by bacteria and microorganisms transmitted during sexual intercourse.
Isn’t it true that once you have a urinary tract infection, you’ll never have another one?
No. In fact, once you have a urinary tract infection, you are more likely to have another. Nearly 20 percent of women who have a urinary tract infection will have another, and 30 percent of those who have had two will have a third. About 80 percent of those who have had three will have a fourth. Four out of five such women get another infection within 18 months of the last one.
How can I tell if I have a urinary tract infection?
Symptoms of urinary tract infections may include frequent, urgent needs to urinate, but not making it to the toilet in time; a painful, burning sensation when urination occurs; cloudy or reddish-colored urine; urine that smells foul or strong; and soreness in the back, side or lower abdomen. If fever, chills, nausea, vomiting and/or back pain accompany the symptoms, you may have a kidney infection. See your health care professional promptly if you have any signs of a urinary tract infection.
My urinary tract infection seems to be gone. Do I still need to take the rest of my antibiotic medication?
Yes, absolutely. Although your symptoms may disappear in one or two days after taking antibiotic medication, you must take all the medication to destroy the germs causing the infection. If you don’t, your symptoms may return, or you may have another urinary tract infection in a short time.
Will a urinary tract infection harm my baby or me when I’m pregnant?
If the infection is caught and treated early, generally not. However, pregnant women are more likely to have a urinary tract infection spread to their kidneys, which can cause kidney damage, high blood pressure and increased risk of premature delivery. If you’re pregnant and suspect you have a urinary tract infection, see your health care professional right away.
Isn’t drinking cranberry juice to prevent urinary tract infection an old wives’ tale?
Not necessarily. Cranberry juice and vitamin C make the urine more acidic, which makes it more difficult for bacteria that can cause urinary tract infections to grow. Cranberry juice also has another unique factor that helps prevent bacteria from adhering to the urinary tract walls.
Why do I keep getting urinary tract infections?
Some women are more prone to urinary tract infections than others because the cells in their vaginal areas and in their urethras are more easily invaded by bacteria. Your risk of developing a urinary tract infection is also greater if you’re past menopause because changes in your tissues after menopause may make the area less resistant to bacteria.Irritation or injury to the vagina or urethra caused by sexual intercourse, douching, tampons or feminine deodorants can give bacteria a chance to invade. Using a diaphragm can cause irritation and can interfere with the bladder’s ability to empty, giving bacteria a place to grow.Any abnormality of the urinary tract that blocks the flow of urine, such as a kidney stone, also can lead to an infection. Illnesses that affect the immune system also increase the risk of urinary tract infections.Practicing good personal hygiene habits, including washing the areas around the bowel, vagina and urethra daily and wiping from front to back, can help prevent spreading bacteria to the urinary tract. Drinking plenty of water daily, urinating when you feel the need (rather than waiting) and urinating after sexual intercourse can help flush the system of bacteria.
Are there any medications that can prevent my recurring infections?
If you have urinary tract infections three times a year or more, ask your health care professional about preventive antibiotic therapy. Taking a low dosage of antibiotics over an extended time or a single dose after sexual intercourse is often prescribed to head off infections. Or, you may take antibiotics for one or two days when you first notice signs of a urinary tract infection. Talk with your health care professional about which treatment may be best for you.

Lifestyle Tips

Cranberry juice may help
There is some evidence that drinking cranberry juice or taking cranberry tablets may help prevent frequent bladder infections. This has not been proven, however.
How to avoid urinary tract infections
To prevent your next urinary tract infection, be sure to drink the equivalent of at least eight glasses of fluid (water is best) throughout the day. That encourages frequent urination, which flushes bacteria from the bladder. And avoid substances that can irritate the bladder, such as alcohol and caffeine.
UTIs may be harmful to unborn babies
If you develop a UTI while pregnant, be sure to take the medication exactly as directed by your health care professional. Pregnant women who fail to properly treat their UTIs incur a higher risk of high blood pressure, miscarriage and premature labor.
Self-help for urinary tract infections
Although your health care professional can recommend a variety of drugs to relieve the pain of a UTI, there are things you can do on your own. Draping a heating pad over your lower pelvic area can help curb the symptoms, as can drinking plenty of water to help flush bacteria out of the urinary tract. Also, try to avoid coffee, alcohol and spicy foods that can irritate the lining of the urinary tract, particularly while you have a UTI.

Organizations and Support

For information and support on coping with Urinary Tract Infections, please see the recommended organizations, books and Spanish-language resources listed below.

Organizations

American Urogynecologic Society
Website: http://www.augs.org
Address: 2025 M Street NW, Suite 800
Washington, DC 20036
Phone: 202-367-1167
Email: [email protected]

American Urological Association
Website: http://www.auanet.org
Address: 1000 Corporate Blvd.
Linthicum, MD 21090
Hotline: 1-800-RING-AUA (1-866-746-4282)
Phone: 410-689-3700
Email: [email protected]

National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK)
Website: http://www.niddk.nih.gov
Address: Building 31, Room 9A06
31 Center Drive, MSC 2560
Bethesda, MD 20892
Phone: 301-496-3583

National Kidney and Urologic Diseases Information Clearinghouse
Website: https://www.niddk.nih.gov/health-information/kidney-disease
Address: 3 Information Way
Bethesda, MD 20892
Hotline: 1-800-891-5390
Email: [email protected]

National Kidney Foundation
Website: http://www.kidney.org
Address: 30 East 33rd Street
New York, NY 10016
Hotline: 1-800-622-9010
Phone: 212-889-2210
Email: [email protected]

Society of Urologic Nurses and Associates
Website: http://www.suna.org
Address: East Holly Avenue, Box 56
Pittman, NJ 08071
Hotline: 1-888-827-7862
Email: [email protected]

Books

The Interstitial Cystitis Survival Guide: Your Guide to the Latest Treatment Options and Coping Strategies
by Robert M. Moldwin

A Seat on the Aisle, Please! The Essential Guide to Urinary Tract Problems in Women
by Elizabeth Kavaler

Herbs for the Urinary Tract
by Michael Moore

Spanish-language Resources

Medline Plus: Urinary Tract Infection
Website: http://www.nlm.nih.gov/medlineplus/spanish/urinarytractinfections.html
Address: US National Library of Medicine
8600 Rockville Pike
Bethesda, MD 20894
Email: [email protected]

UrologyHealth.org: American Urological Assocation Foundation
Website: https://www.niddk.nih.gov/health-information/informacion-de-la-salud/enfermedades-urologicas/infecciones-vejiga
Address: National Urology Health Hotline
Hotline: 1-800-828-7866

Urinary Tract Infections – Sepsis Alliance

Urinary tract infections, or UTIs, are a common infection that affect more women than men. Most often, they are treated quickly and effectively with antibiotics. Unfortunately, not all UTIs are treated quickly and some aren’t even identified, particularly in people who have limited or no sensation below the waist or who are unable to speak for themselves.

Untreated urinary tract infections may spread to the kidney, causing more pain and illness. It can also cause sepsis. The term urosepsis describes sepsis caused by a UTI.

Sometimes incorrectly called blood poisoning, sepsis is the body’s often deadly response to infection or injury. Like strokes or heart attacks, sepsis is a medical emergency that requires rapid diagnosis and treatment. People shouldn’t die from a UTI, but if sepsis begins to take over and develops to severe sepsis and then to septic shock, this is exactly what can happen. UTIs cause more than half the cases of urosepsis among older adults.

Sepsis and septic shock can result from an infection anywhere in the body, such as pneumonia, influenza, or urinary tract infections. Like strokes or heart attacks, sepsis is a medical emergency that requires rapid diagnosis and treatment. Worldwide, one-third of people who develop sepsis die. Many who do survive are left with life-changing effects, such as post-traumatic stress disorder (PTSD), chronic pain and fatigue, organ dysfunction (organs don’t work properly) and/or amputations.

What is a urinary tract infection?

A urinary tract infection is an infection in the urinary tract, which runs from your kidneys, through the ureters, the urinary bladder and out through the urethra. UTIs are very common and, in general, easy to treat.

A lower UTI, the more common type, affects the lower part of the urinary tract, the urethra and urinary bladder. Infection of the urethra is called urethritis and of the bladder is called cystitis. If the kidney is infected, called pyelonephritis, this is an upper UTI, as the kidney is the highest part of the urinary tract.

A UTI can be caused by bacteria (the most common type of infection) or a fungus.

How do you get urinary tract infections?

The design of the human body makes it so it isn’t difficult to get a bacterial UTI, because the infection comes from outside, through the urethra. Bacteria in the genital area can enter the urethra and the urinary tract, either because wiping after going to the bathroom, sexual activity, or unsanitary conditions. Once the bacteria has entered the urethra, the body tries its best to fight it off, but sometimes the immune system can’t do this, the bacteria multiply, and cause the infection.

In the case of a fungal infection, usually the fungus gets to the urinary tract through the blood stream. Those who develop this type of infection are usually ill with a disease that has compromised their immune system, such as AIDS.

In general, women get more UTIs than do men and this increases with age. Statistics show that many women get more than one. Almost 20% of women who have had one UTI will go on to have a second. Of this 20%, 30% of those will have a third, and in turn, 80% of these women will have more.