Fred A. Williams, MD: Gynecologist

About 40% of women develop at least one urinary tract infection (UTI) in their lifetime. Having one UTI over the span of decades doesn’t sound too bad, but not all women are that lucky.

It’s estimated that 20-30% of women will have a second UTI within 3-4 months. And for 11% of women, UTIs become an ongoing problem, recurring at least once every year and often more frequently.

UTIs typically cause a specific cluster of symptoms: a strong need to urinate, frequent urination, burning when you urinate, and passing small amounts of urine. Women receive comprehensive care for UTIs at Fred A. Williams, MD, so call the office in Paris, Texas, if you experience any of those symptoms.

We’re also available to answer your questions if you develop one or more of these three uncommon symptoms of a UTI.

Side and suprapubic pain

Pain during urination is on the list of typical UTI symptoms, but other types of pain often aren’t mentioned because they’re less common. An uncomplicated urinary tract infection may cause mild to moderate suprapubic pain, a type of pain that most patients experience as a feeling of pressure or discomfort just above the public bone.

You may also experience a more generalized pelvic pain or cramping in your abdomen. Short-lived pelvic pain may occur during your infection. It can also turn into chronic pain after the infection clears up.

When your infection travels from the bladder to your kidneys, you can develop flank pain, or pain that’s felt in your side. Flank pain arises as the infection causes swelling in the kidneys. When that happens, you’ll experience a steady, aching pain.

Fatigue

Fatigue is a generic symptom that you may not associate with a UTI, but it’s a classic sign of an infection. Many women experience fatigue before other symptoms of a UTI appear. Whether or not you develop fatigue depends on variables like your overall health, age, and the severity and location of the infection.

If you already have a weakened immune system due to a medical condition, medications, or your age, you’re more likely to become fatigued at the early stage of an uncomplicated UTI. However, fatigue is also a sign that the UTI that started in your lower urinary tract (urethra and bladder) has spread to your kidneys.

Confusion or changes in mental state

The symptoms of UTIs in older adults are often uncommon and complex. For example, seniors may have bacteria in their urine, which indicates a UTI, but not have any of the typical symptoms.

When seniors have a UTI, they often develop confusion, disorientation, and dizziness. These uncommon symptoms most likely arise due to the infections’ impact on their immune system.

An untreated UTI will only worsen, leading to more severe symptoms, and giving the infection time to spread to your kidneys. If you’re not sure your symptoms are due to a UTI, it’s best to schedule an appointment so we can determine the cause of your symptoms and begin treatment if needed.

Recurrent Urinary Tract Infections Management in Women

Sultan Qaboos Univ Med J. 2013 Aug; 13(3): 359–367.

A review

Ahmed Al-Badr

¹King Fahad Medical City, Riyadh, Saudi Arabia;

Ghadeer Al-Shaikh

²King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia

¹King Fahad Medical City, Riyadh, Saudi Arabia;

²King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia

Received 2013 Jan 2; Revisions requested 2013 Feb 3; Revised 2013 Feb 23; Accepted 2013 Mar 27.

© Copyright 2013, Sultan Qaboos University Medical Journal, All Rights ReservedThis article has been cited by other articles in PMC.

Abstract

Urinary tract infections (UTIs) are one of the most frequent clinical bacterial infections in women, accounting for nearly 25% of all infections. Around 50–60% of women will develop UTIs in their lifetimes. Escherichia coli is the organism that causes UTIs in most patients. Recurrent UTIs (RUTI) are mainly caused by reinfection by the same pathogen. Having frequent sexual intercourse is one of the greatest risk factors for RUTIs. In a subgroup of individuals with coexisting morbid conditions, complicated RUTIs can lead to upper tract infections or urosepsis. Although the initial treatment is antimicrobial therapy, use of different prophylactic regimens and alternative strategies are available to reduce exposure to antibiotics.

Keywords: Urinary Tract Infection, therapy; Antibiotic Prophylaxis; Prevention

Urinary tract infections (UTIs) occur more often in women than in men, at a ratio of 8:1. Approximately 50–60% of women report at least one UTI in their lifetime, and one in three will have at least one symptomatic UTI necessitating antibiotic treatment by age 24.1–3

Normally, the urinary tract is sterile, but bacteria may rise from the perianal region, possibly leading to UTI. Pathogens in the bladder may stay silent or can cause irritative symptoms like urinary frequency and urgency, and 8% of women may have asymptomatic bacteriuria. If bacteria enter the blood stream, they could cause severe complications, including septicaemia, shock and, rarely, death.4,5 The definition of recurrent urinary tract infection (RUTI) is three UTIs with three positive urine cultures during a 12-month period, or two infections during the previous 6 months.5–8

This article provides an up-to-date review of the epidemiology, pathophysiology, risk factors, diagnosis, management and prevention of RUTIs in women.

Classification of Urinary Tract Infections

UTIs are classified into 6 categories. The first category is an uncomplicated infection; this is when the urinary tract is normal, both structurally and physiologically, and there is no associated disorder that impairs the host defense mechanisms. The second category is an complicated infection; this is when infection occurs within an abnormal urinary tract, such as when there is ureteric obstruction, renal calculi, or vesicoureteric reflux. The third category, an isolated infection, is when it is the first episode of UTI, or the episodes are 6 months apart. Isolated infections affect 25–40% of young females. The fourth category, an unresolved infection, is when therapy fails because of bacterial resistance or due to infection by two different bacteria with equally limited susceptibilities. The fifth category, reinfection, occurs where there has been no growth after a treated infection, but then the same organism regrows two weeks after therapy, or when a different microorganism grows during any period of time.9,10 This accounts for 95% of RUTIs in women. Bacterial persistence happens when therapy is impaired by the accumulation of bacteria in a location that cannot be reached by antibiotics, such as infected stones, urethral diverticula and infected paraurethral glands. The sixth category, relapse, is when the same microorganism causes a UTI within two weeks of therapy; however, it is usually difficult to distinguish a reinfection from a relapse.11

Epidemiology and Pathophysiology

UTIs are one of the most frequent clinical bacterial infections in women, accounting for nearly 25% of all infections. Around 50–60% of women will experience a UTI in their lifetime.2,9 The estimated number of UTIs per person per year is 0.5 in young females.12 Recurrences usually occur within three months of the original infection, and 80% of RUTIs are reinfections.13 The incidence of UTI increases with age and sexual activity.14 Post-menopausal women have higher rates of UTIs because of pelvic prolapse, lack of oestrogen, loss of lactobacilli in the vaginal flora, increased periurethral colonisation by Escherichia coli (E. coli), and a higher incidence of medical illnesses such as diabetes mellitus (DM).15 The microorganism that causes RUTIs is similar, in most cases, to the sporadic infection. Most uropathogens from the rectal flora ascend to the bladder after colonising the periurethral area and urethra.

Despite the fact that most E. coli are eradicated by the host defence mechanisms within days, only small clusters of intracellular E. coli are observed to persist for several months in an antibiotic-resistant state. 16 Reactivation of uropathogenic E. coli (UPEC), an intracellular bacteria, could cause RUTIs.17

Other significant pathogens that can cause UTI include Proteus mirabilis, Staphylococcus saprophyticus, Staphylococcus epidermidis, and Klebsiella pneumonia.18 In diabetic patients, Klebsiella and group B streptococcus infections are more common. Pseudomonas infections are more common in chronically-catheterised patients.18,19

Risk factors for RUTI in sexually-active pre-menopausal women are the onset of symptoms shortly after sexual intercourse, the use of spermicides for contraception, taking on new sexual partners, the age of the first UTI, a maternal history of UTI and voiding dysfunction.5,8,20,21 Many other factors have been thought to predispose women to RUTIs, such as voiding patterns pre- and post-coitus, wiping technique, wearing tight undergarments, deferred voiding habits and vaginal douching; nevertheless, there has been no proven association. 22 Medical conditions such as pregnancy, DM and immunosuppression increase a woman’s risk of RUTI by facilitating the access of uropathogens overcoming normal host defense mechanisms.23 Patients with DM have a higher risk of asymptomatic bacteriuria, RUTIs and pyelonephritis.24

Clinical Presentation and Diagnosis

Common symptoms of a UTI are dysuria, urinary frequency, urgency, suprapubic pain and possible haematuria. Systemic symptoms are usually slight or absent. The urine may have an unpleasant odour and appear cloudy.23 Diagnosis of RUTI depends on the characteristic of clinical features, past history, three positive urinary cultures within the previous 12-month period in symptomatic patients and the presence of neutrophils in the urine (pyuria).7,8,21 Irritative voiding symptoms are present in 25–30 % of women with RUTIs.25 The probability of finding a positive culture in the presence of the above symptoms and the absence of vaginal discharge is around 81%.26 In a complicated UTI, such as pyelonephritis, the symptoms of a lower UTI will persist for more than a week with systemic symptoms of persistent fever, chills, nausea and vomiting. 25

A recent study showed how to distinguish the clinical symptoms of a RUTI from irritative voiding symptoms (urgency, dysuria and frequency) without infection. Women with RUTIs were more likely to experience symptoms after intercourse, have a previous history of pyelonephritis, and experience rapid resolution of symptoms post-antibiotic therapy than those women with irritative voiding symptoms.5,6 Moreover, women with RUTIs were more unlikely to report nocturia and have symptoms between episodes of UTI than women without infection. The presence of irritative voiding symptoms between perceived episodes of UTI suggests a non-infectious cause as seen in interstitial cystitis, urethral syndrome or detrusor muscle overactivity.5,27

Women with RUTIs should have an initial evaluation including a history-taking and a physical and pelvic examination; the latter is important to detect pelvic organ prolapse and to assess the status of the vaginal epithelium.28 Urinalysis and urine culture with sensitivity are also valuable investigations. Women with a positive family history of DM, obesity or RUTI must be screened for DM.28,29 Women with suspected urine retention need to be evaluated for high post-void residual urine volume.

Urine culture and sensitivity testing are the standard diagnostic investigations to detect the causative organism and to determine the type of antimicrobial therapy needed.8,21 A UTI is defined as a positive urine culture with greater than 100,000 colony-forming units (cfu)/ml. In acute cystitis, even 1,000 cfu/ml and in acute pyelonephritis 10,000 cfu/ml may be sufficient for diagnosis in a symptomatic patient. A urine culture is recommended in a RUTI or in the presence of complicating factors.9,21 A urine culture can remain positive for more than two weeks even after treatment in cases of chronic UTIs or RUTIs. A ‘clean-catch’ or midstream technique needs to be used when collecting the urine sample, which reduces the risk of vaginal and skin contamination to approximately 30%.30 Urinalysis, either by dipstick or microscopy, for the detection of pyuria, as a method for predicting a UTI has a sensitivity of 80–90% and a specificity of 50%, but it only detects those bacteria which reduce nitrates to nitrites in the urine. Bacteria such as Staphylococcus saprophyticus lack that enzyme, which makes the nitrite test considerably less useful. Dipstick analysis for leukocyte esterase (the enzyme produced by neutrophils) is indirect and is the least expensive test that detects pyuria with a sensitivity of 72–97% and a specificity of 41–86%, as organisms other than uropathogens can also produce leukocyte esterase.31

More advanced investigations, such as cystoscopy, are advised in women over the age of 50.32 Ultrasound of the kidneys, an intravenous pyelogram (IVP) and a computed tomography (CT) scan can help in detecting congenital structural urogenital anomalies.9

Management of Recurrent Urinary Tract Infections (RUTIs)

COUNSELLING

Women with RUTIs should be educated about the characteristics of reinfection and relapse; the proper way to practice post-coital voiding; the importance of avoiding skin allergens, tight clothing and bubble baths; ways to ensure personal hygiene, and the choice of alternative forms of contraception rather than spermicides. 21,33,34

GENERAL THERAPIES

Patients should be advised and encouraged to drink plenty of fluids (two to three litres per day) and to urinate frequently to help flush bacteria from the bladder. Holding urine for a long time allows bacteria to multiply within the urinary tract, resulting in cystitis. Preventive measures related to sexual intercourse may reduce the recurrence rate. Moreover, women are encouraged to clean the genital areas before and after sex and to wipe from front to back, which will reduce the spread of E. coli from the perigenital area to the urethra.35 Avoiding multiple sexual partners will reduce the risk of both UTIs and sexually transmitted infections. Women are encouraged to avoid spermicidal contraceptives, diaphragms and vaginal douching, which may irritate the vagina and urethra and facilitate the entry and colonisation of bacteria within the urinary tract. Skin allergens introduced to the genital area, such as bubble bath liquids, bath oils, vaginal creams and lotions, deodorant sprays or soaps are better avoided as they could alter vaginal flora and ultimately result in UTIs. 36

ANTIMICROBIAL THERAPY

Antimicrobial therapy is the core treatment for UTIs, with the main objective being the eradication of bacteria growth in the urinary tract through an efficacious, safe and cost-effective antimicrobial agent. This can be achieved within hours if the antibiotics are maintained at sufficient urine levels.37 In order to ensure compliance and be patient-friendly, the drug should be given for a short period of time to prevent bacterial resistance. Antimicrobial agents should be prescribed according to the susceptibility of the infecting bacteria, the concentrations of uropathogens in the urine and the urinary complaint. This is important to consider when there is septicaemia or parenchymal infection, as antimicrobials are usually at higher levels in the urine than in serum.33

Dose modification is required for patients with renal insufficiency and in the case of other factors such as: age, pregnancy or lactation status, primary or recurrent infections, hospitalised patients, DM, liver disease, an immuncompromised state, hydration levels and psychiatric problems. 34

A variety of antimicrobials are used for the prevention and management of RUTIs.6,15,24,29,33,38–41 A Cochrane review has shown that antibiotics in comparison to a placebo are more effective in preventing recurrences in pre- and post-menopausal women with RUTIs.6 The criteria for the selection of the most effective antibiotic depend on a patient’s pattern of resistance, adverse effects, interaction with drugs and cost.

Ampicillin, amoxicillin, and sulfonamides are no longer the drugs of choice for empirical treatment because of the widespread emergence of resistance in 15–20% of E. coli in several areas of the USA and other countries.18,42–44 Nitrofurantoin or amoxicillin/clavulanic acid remain effective in terms of bacterial sensitivity, but nitrofurantoin needs to be avoided in patients with pyelonephritis because of its poor serum and tissue levels. Less than 5% of E. coli strains are resistant to nitrofurantoin, whereas other strains are often resistant to it. The rate of E. coli resistance to fluoroquinolones, even in uncomplicated UTIs, varies between countries with rates reported as 0.5–7.6% in Europe,45 15% in Korea,46 and up to 35% in some parts of India.47

Penicillins and cephalosporins are considered safe during pregnancy, but trimethoprim, sulphonamides, and fluoroquinolones should be avoided. Oral antibiotic therapy resolves 94% of uncomplicated UTIs, although recurrence is not uncommon. In the recently published International Clinical Practice Guidelines for the Treatment of Acute Cystitis, a 3-day regimen of trimethoprim-sulfamethoxazole (TMP-SMX) and a 5-day course of nitrofurantoin are recommended as a first-line therapy for the management of uncomplicated UTIs. A 5-day course of nitrofurantoin has an efficacy equivalent to a 3-day TMP-SMX course.48,49 A 3- to 7-day regimen of beta-lactams, such as cefaclor or amoxicillin/clavulanic acid, is appropriate when first-line therapies cannot be used.43,48 Although a 3-day course of fluoroquinolones can be quite effective, it is not usually recommended as first-line therapy because of the emerging resistance to them and their potential side effects, as well as the high cost; nevertheless, fluoroquinolones are the drug of choice in women who are experiencing low tolerance or an allergic reaction after empirical therapy. 48,50 In a meta-analysis, a single-dose regimen of fosfomycin trometamol has been shown to be a safe and effective alternative for the treatment of UTIs in both pregnant and non-pregnant women, as well as in elderly and paediatric patients, but it seems to be slightly less effective than the above mentioned therapies.43,48,51 Pivmecillinam in a 3- to 7-day course is also effective, but not available in most regions. Because of its poor efficacy, amoxicillin and ampicillin should not be used for the empirical treatment of UTIs.48

TMP-SMX and fluoroquinolones prevent RUTI by inhibiting the recovery rate of uropathogens (especially E. coli) from the faecal reservoir,52 while nitrofurantoin plays its role in the treatment of RUTI by sterilising the urine and inhibiting bacterial attachment.24,53,54 A follow-up urinalysis and urine culture, also called the ‘test of cure’, is not indicated in women with uncomplicated UTIs, but should be performed in those women who are suffering from RUTIs or a complicated UTI.

Different antibiotic prophylaxis regimens such as continuous prophylaxis, post-coital prophylaxis and acute self-treatment are important management strategies in preventing RUTIs. Patient self-treatment is recommended in cases of those with ≤2 episodes of UTIs per year, whereas continuous antimicrobial prophylaxis, low-dose prophylaxis, or post-coital prophylaxis is generally considered in ≥3 episodes of UTIs annually.24

CONTINUOUS ANTIBIOTIC PROPHYLAXIS

Continuous prophylaxis is considered when simple measures fail. For this purpose, low-dose antibiotics can be given daily for 6 months or longer. Some physicians advise prophylaxis on alternate nights or 3 nights per week. One study showed that prophylaxis given weekly was more effective than one given monthly, but there is no study comparing daily and weekly regimes.6,21,55

POST-COITAL ANTIBIOTIC PROPHYLAXIS

When a RUTI is related to sexual activity, post-coital therapy is considered an effective alternative prophylactic approach. 21,28,56 Post-intercourse prophylaxis has fewer side effects than daily prophylaxis, as antibiotic consumption is reduced to only one-third.53 After intercourse, a single dose of the most common antibiotics is used, such as nitrofurantoin, TMP-SMX or a fluoroquinolone.21,54 Studies have shown that women using continuous or post-coital prophylaxis will report about 1.2 to 1.3 UTIs per year within 6 months of stopping the treatment.6

ACUTE SELF-TREATMENT

The patient self-treatment management strategy is an ideal effort to decrease overall antibiotic consumption, and for women who are not suitable candidates for long-term daily prophylaxis. Schaeffer showed that “self-start therapy” should be confined to those women who are self-motivated and have good compliance.57 A patient needs to consult a physician immediately if she becomes pregnant or if there is any change in symptoms, an increased recurrence of episodes of infection, or no change in symptoms within 48 hours of antimicrobial treatment. These patients can effectively self-treat RUTIs by initiating a standard 3 day course of recommended antimicrobials with minimum side effects.58

Adjuvant Measures

OESTROGEN

Oestrogen use stimulates the proliferation of lactobacillus in the vaginal epithelium, reduces pH and avoids vaginal colonisation by uropathogens. After the menopause, oestrogen levels and lactobacilli numbers drop; this plays a significant role in the development of bacteriuria, and makes post-menopausal women susceptible to UTIs. Vaginal oestrogen use reduces RUTIs by 36–75% and has minimal systemic absorption. Based on a Cochrane review in post-menopausal women with RUTIs, when compared to a placebo, vaginal oestrogens were found to prevent RUTIs, but oral oestrogen did not have the same effect.59,60 Local oestrogen cream twice a week and an oestradiol-releasing vaginal ring are both effective in reducing RUTI attacks.59,61,62 They restore vaginal flora, reduce pH and therefore reduce UTIs; however, the reappearance of vaginal lactobacilli takes at least 12 weeks when using an oestrogen vaginal ring. 61–63 Although evidence does not support using a particular type or form of vaginal oestrogen topical creams are cheaper than an oestradiol-releasing vaginal ring but have more side effects.21,57,59,64

CRANBERRY JUICE AND TABLETS

Cranberry juice and tablets have been shown to reduce RUTIs as they contain a compound called tannin, or proanthocyanidin, which reduces E. coli vaginal colonisation.65,66 Although earlier, smaller studies have shown that consuming cranberry juice or tablets can prevent RUTIs, an updated Cochrane review showed that evidence for its benefit in preventing UTIs is small; therefore, cranberry juice cannot be recommended any longer for UTI prevention.21,67–69

ACUPUNCTURE

Recent studies indicate that the rate of cystitis among cystitis-prone women treated with acupuncture was one-third the rate of that among untreated women and half the rate among women treated by sham acupuncture. Therefore, acupuncture may prevent RUTIs in healthy adult women. 21,70,71

PROBIOTICS

Probiotics are beneficial microorganisms that could protect against UTIs. Lactobacilli strains are the best-known probiotics and are found in fermented milk products, mainly yogurt. Other probiotics include Lactobacilli bifidobacteria, rhamnosus, casei, planetarium, bulgaricus and salivarius; Streptococcus thermophiles and Enterococcus faecium. Reid et al. showed in vitro that lactobacillus can prevent uropathogen infections.72,73 Other trials have showed that L. rhamnosus gr-1 and L. fermentum rc-14 can colonise the vagina, which could subsequently prevent UTIs. Nevertheless, more clinical studies need be carried out to determine their role in RUTI prevention.72–76

IMMUNOPROPHYLAXIS

Immunoprophylaxis taken orally may prove an effective alternative to antibiotics in the prevention of RUTIs. A meta-analysis of 5 studies showed that oral immunoprophylaxis with the Uro-Vaxom^®E. coli extract (Terra-Laba, Zagreb, Croatia) taken for a period of 3 months was effective in preventing RUTIs over a period of 6 months.77 Another double-blind study has confirmed that E. coli extracts are efficient and well-tolerated in the treatment of UTIs, reducing the need for antibiotics and preventing RUTIs.78

Other Therapies

Methenamine hippurate is used for prophylaxis and treatment of RUTIs. Methenamine is hydrolysed to ammonia and formaldehyde when in acidic urine, which act as a bactericide to some strains of bacteria.79 They are well-tolerated and have mild adverse effects, such as gastrointestinal upsets, rashes, anorexia, and stomatitis. Patients should be informed regarding adequate hydration, adverse effects and the need to avoid milk products and antacids to help keep the urine acidic. A recent Cochrane review on the use of methenamine hippurate concluded that short-term use is effective in preventing RUTIs in patients with a normal renal tract. Nevertheless, it is not effective in women who have urinary tract abnormalities or a neuropathic bladder.80,81

Recurrent Urinary Tract Infection in Pregnancy

UTI is the most frequent medical complication of pregnancy. The risk factors of preterm delivery, low infant birth weight and abortions are most commonly associated with symptomatic and asymptomatic bacteriuria during pregnancy.77 In pregnancy, factors that contribute to UTI risk are ureteric and renal pelvis dilation; increased urinary pH; decreased muscle tone of the ureters, and glycosuria, which promotes bacterial growth. Treatment of asymptomatic bacteriuria in pregnancy reduces the risk of pyelonephritis. As RUTIs are common in pregnancy, they need prophylactic treatment if they occur. Screening for bacteriuria is recommended in all pregnant women at their first prenatal visit and then in the third trimester.82,83 They should subsequently be treated with antibiotics such as nitrofurantoin, sulfisoxazole or cephalexin. 21,24,82–84 Antibiotic prophylaxis for RUTI in pregnant women is effective using continuous or post-coital regimens. The causative organisms of UTI in pregnancy are similar to those found in non-pregnant patients, with E. coli accounting for 80–90% of infections.85,86 Urinary group B streptococcal infections in pregnant women need to be treated and followed by intrapartum prophylaxis.21

Conclusion

UTIs are some of the most frequent clinical bacterial infections in women. RUTIs are less common and are mainly caused by reinfection by the same pathogen. Women with RUTIs need to be properly investigated by urinalysis, urine cultures and other radiological techniques in order to rule out causes of recurrence, as well as to assess possible anatomical or functional urinary tract abnormalities. Although standard UTI therapy starts with antimicrobial therapy, alternative strategies are available to reduce exposure to antibiotics, such as the use of methenamine salts, probiotics, cranberry juice, immunoprophylaxis and vaginal oestrogens in post-menopausal women. Continuous antibiotic prophylaxis, postcoital prophylaxis, and acute self-treatment are cost-effective treatment strategies for reducing the number of RUTIs in some patients.

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How I Beat Recurrent Urinary Tract Infections. My UTI Tips.

Recurrent urinary tract infections were once a focal point the rest of my life revolved around. For a time, my UTI anxiety was such that I feared I would never return to what I had previously considered normal.

“When I look back at my experience with recurrent urinary tract infections, I have flashbacks of traumatic moments followed by lingering anxiety about when the next one would hit me.”

Was it possible to overcome constant UTIs and yeast infections? It took me around five years to find out that yes, I could. But to recover, I had to address a few main areas of my health.

Story Quick Links

• How My Recurrent Urinary Tract Infections Began >>>>
• Recurrent UTI: The Highlights Reel >>>>
• Diet and Recurrent Urinary Tract Infections >>>>
• How Standard UTI Testing Failed Me >>>>
• Hormones, UTIs And Yeast Infections >>>>
• My Recurrent UTI Treatment Regimen >>>>

How My UTI Story Applies To You

Although I recovered from recurrent urinary tract infections to the point where I no longer had to take medication or supplements to manage my symptoms (they were completely gone), this isn’t a story about a miracle cure.

There is rarely such a thing when it comes to recurrent UTI. I promise I will provide more insight into what worked for me, but I do want to say this:

Thinking one person’s approach will work for everyone else is like saying you’ve found a single pair of jeans that fits everyone perfectly.

But before you jump to the next blog post promising a 24 hour cure, I’ll tell you why this story may apply to you. It’s about finding the root cause of your recurrent UTIs, and addressing it.

Only by addressing the root cause of frequent UTIs can you hope to break the cycle of symptoms and treatment. Breaking the cycle will likely mean sacrifices, and this is a story about permanent change for the better.

If there is one piece of advice I will freely give to other recurrent UTI sufferers, it’s that knowledge is the key to recovery.

Learn everything you can about why UTIs can become recurrent, other causes of lower urinary tract symptoms, and how your overall health can prevent you from getting well. Hopefully, my story will help.

My First UTI Gave No Hint Of The Recurrent Urinary Tract Infections Ahead

If I could start this process again I would do it differently.

I had my first UTI at 23. The after-hours doctor asked, ‘Are you sure you don’t have your period?’ – clearly unaware of the danger created by patronizing a female in the midst of a UTI.

I managed to stay calm and suppress the urge to retort, ‘You think I can’t tell the difference between my period and blood coming out of my urethra??’ (But seriously, really?).

All I wanted was something to fix the pain, and for him to leave my sight immediately. He delivered in both respects.

The antibiotics worked within a few hours and I never thought about it again… Until nine years later.

As it turns out, I was really good at getting UTIs. If getting UTIs was a desirable skill, I nailed that skill for five years, with barely a break.

How My Recurrent Urinary Tract Infections Began

I was going through a stressful relationship breakup, and selling my business, and was completely run down.

I was still exercising daily, and had a fairly healthy vegetarian diet, but stress took its toll.

The UTI hit me fast. The pain was just as intense as I remembered, but I didn’t panic quite as much as the first time. I knew I’d get antibiotics when I showed up at the emergency room.

Plus, I didn’t have time to think about it. Life was way too hectic for me to put extra energy towards my health.

Just as with my first UTI, the antibiotics worked and I dismissed it. But the symptoms crept back. A month later I was at a friend’s farm when it got so bad I had to make a run for the hospital.

Driving more than an hour was too much for me and I ended up squatting on the side of a dangerous road in the dark more than once.

“Recurrent urinary tract infections had officially become a part of my life, though I had no idea of this at time.”

The thing is, when it first hits you, it’s out of the blue, and you never imagine this is going to be your life now. You take antibiotics, it goes away, you’re generally healthy, so chances are it was just an anomaly.

Is It My Fault That I Keep Getting UTIs?

Even the second or third time you get a UTI it can seem like a bit of a coincidence. The words ‘recurrent urinary tract infections’ don’t really register at this stage. You figure you just haven’t been sleeping enough.

Or maybe you’ve been fighting a virus and your immune system is just having a rough time.

Denial is probably the most accurate word for this phase. I was just so certain the antibiotics would work every time. Even though they didn’t.

Selling my business and packing up my life for a move overseas was my priority, and the frequent trips to the doctor for antibiotics were more of a nuisance than cause for concern.

“I thought I was being responsible when I asked my doctor for antibiotics to take abroad with me ‘in case I got another UTI’. That optimism is almost laughable now.”

Recurrent Urinary Tract Infections: The Highlights Reel

A trip to the UK resulted in a UTI the day before my 30 hour flight home to Australia. Flying with a UTI was my worst nightmare.

I managed to get a single dose antibiotic from a walk-in clinic, but was still cracking sweats by the time I got to the airport.

Armed with copious amounts of water, I requested an aisle seat, and proceeded to drink fluids nonstop. I was using the bathroom every 20 minutes, like clockwork, and by the time I landed for my stopover in Hong Kong 13 hours later, I really thought I was on top of it.

How wrong I was. I boarded my flight for Sydney, and over the next 10 hours descended into fevers, chills, shakes and a little delirium.

At Sydney airport I missed my onward flight to Melbourne and broke down at the customer service desk. I barely remember stowing my bag in a locker and wandering around looking for help.

Fortunately, I was able to find the airport doctor, who prescribed antibiotics and anti-nausea pills. He assured me I needed them, and he was right. Within the next 30 minutes I was on the verge of throwing up – a new symptom of UTI for me.

I had forfeited my flight, but I didn’t care. I eventually made it home to Melbourne, a full 35 hours after the start of my journey, where I passed out for 20 hours. My body was defeated.

When UTIs Become A System For Measuring Time

“My life started to become broken into modules, based on UTIs.”

Like, ‘Which trip was that? Oh the one where I had the UTI when we were camping and I had to keep going outside in the cold to pee near that weird herd of sheep.’

Or, ‘Was that March or April? It must have been March, because I had that UTI at the same time as food poisoning and it was my sister’s birthday and I had to call her between vomiting and peeing blood.’

I know it’s gruesome, but that’s exactly what I want to illustrate. Just how recurrent urinary tract infections can become an everyday thing. Even though they hurt just as much, every single time and can be truly debilitating.

Could I Fight UTIs Without Antibiotics?

Three or four UTIs later I was living in a village in Greece. And when I say village, imagine a handful of houses on a hillside by the sea, hours from the nearest hospital.

And when I say houses, imagine a tiny, lovely, concrete box, with an outdoor bathroom beside an olive tree. It was a truly amazing experience, and I loved every minute of it – between UTIs.

I sat on the toilet in that outdoor bathroom for a few hours at a time, debating whether to take the antibiotics I had brought with me. I contemplated whether my kidneys were actually disintegrating and coming out through my urethra.

Recurrent urinary tract infections can be terrifying. But once I’d had half a dozen, I became dubious about the antibiotics. I looked for answers to questions like, ‘Can you treat a UTI without antibiotics?’

Maybe my body needed to fight this on its own to get better? Or maybe I would die in a remote village and my parents would have to expatriate my body.

Does Blood In My Urine Mean I Have A Kidney Infection?

The internet told me if there was blood in my urine, my kidneys were affected and I HAD to take antibiotics. So I took them.

I didn’t die in a little village in the middle of nowhere and I didn’t even tell my parents how close they had come to organizing an international funeral.

I was alive, but I wasn’t well.

Recurrent Urinary Tract Infections Hindsight Tip #1:

I later discovered that blood in your urine doesn’t always mean your kidneys are involved. For many people I’ve spoken with, that’s just a typical symptom of a bladder infection. And no doctor I saw was ever concerned about my kidneys.

UTI symptoms are different for everybody, and symptoms you think are a UTI may actually be caused by something else entirely. Learn more about UTI symptoms and what causes UTIs. It pays to document all your symptoms, and discuss them with a doctor.

Recurrent UTI And Constant Yeast Infections

Frequent antibiotic use came with other side effects. The most obvious was yeast infections. Although this was a less painful experience than the UTIs, it was an even more constant companion.

Each time I took antibiotics, I would need to use over the counter antifungals. These would relieve the symptoms just long enough for the next UTI to take hold. This of course meant more antibiotics, then more antifungals.

Then more antibiotics, then more antifungals… You get the picture.

It felt as though I was never not taking something. I felt completely out of control of the state of my body. I had no confidence in its ability to find a better balance.

The antibiotics and antifungals had destroyed any semblance of a healthy microbiome in all areas, including my digestive tract.

Eventually the effectiveness of the antibiotics and antifungals lessened, and I would have just a few hours respite before the UTI and yeast infections would return.

“My UTI symptoms became constant at this point. I virtually had not a single moment where I wasn’t aware of discomfort in my urinary tract. And discomfort is mostly putting it lightly.”

I began to notice a link between digestive symptoms, yeast related symptoms and the frequency of UTI flare ups. There was hardly a moment that I felt symptom free. I’d had enough, and I decided to take what felt like drastic action.

Diet And Recurrent Urinary Tract Infections

I researched Candida (yeast), and quickly cut all processed sugar, fruits and grains from my diet. I was running and swimming every day, and avoided alcohol.

My digestive symptoms subsided somewhat, but the constant yeast infections and UTIs still plagued me.

After three months in Greece it was time to move to Berlin. While packing my bags, I made sure to take those UTIs with me…

I became acquainted with the German healthcare system pretty quickly. This meant finding a doctor who was willing to give me antibiotics whenever I got a UTI, and an extra prescription so I could self-administer them next time.

He also sent my urine to a lab a number of times (I lost count). Every time we’d get the results it would show raised leukocyte (white blood cells) levels, and ‘insignificant’ levels of bacteria or ‘contamination’, but generally nothing to report.

“According to the lab, I didn’t have a UTI. According to what I knew about my own body, I did, and it would not go away.”

The one thing the lab could easily identify was an overgrowth of vaginal yeast. By this stage, my digestive symptoms had returned to 24 hour a day abdominal pain. I had this low down, solid abdominal bloating that would not subside.

So I further restricted my diet. I transitioned from vegetarian to vegan, and implemented an intermittent fasting approach.

I maintained this for the next 9 months, and slowly, my body transformed from bloated, painful and symptomatic, to lean, strong, and free of digestive issues. Yet still, the UTIs and yeast infections remained.

How Standard UTI Testing Failed Me

I started researching and bringing information to my doctor about other organisms I wanted to test my urine for. He was happy to comply. He didn’t know what else to do to help me. Significantly though, he did believe that I had an infection.

Still the results were unhelpful. Specific organisms were not found. But other signs of infection were.

By this time, I was around 3 years in. I was really starting to lose my patience and my sanity. I tried different doctors. Same deal. They did tests. And while they were also sure I had an infection, they didn’t know what was causing it.

I was completely uninformed about testing, and why it wasn’t helping me figure this out.

Recurrent Urinary Tract Infections Hindsight Tip #2:

I’ve since learned that standard UTI testing is very inaccurate. Many studies have proven that standard urine culturing techniques fail to identify infection in at least 50% of cases.

If you have received inconclusive or negative test results despite your symptoms, or if your treatment does not seem to work as it should, inaccurate testing could be the issue.

I encourage you to learn more about this issue, so you can take control of the situation and seek better care.

There are 7 main reasons your UTI test results could be wrong, and I’ve laid all these out for you (follow the link above), along with what you can do about it.

I Refused To Accept UTIs As My Future

It’s not in my nature to learn to deal with something that I know shouldn’t be. There is no way my body is built to crumble at the first hint of sex, or fatigue, or dehydration. I’ve always been stronger than that.

I’m pretty good at knowing exactly what is happening in my body and when. I’ve accurately diagnosed myself with injuries that have taken years to show up in scans. I’m my very own body whisperer.

So when this happened, it was a virtual kick in the guts, or more specifically, the bladder.

“Getting a UTI every few weeks or months doesn’t give you much breathing room to feel human. To get things done.”

There is a constant shadow hanging over you. Restaurant and bar reconnaissance isn’t about people anymore. It’s about toilets. You learn to scope out any venue for its bathrooms. At any given moment, I could tell you where the nearest public toilet was.

I never went anywhere without a remedy in my bag. For me, that meant carrying antibiotics 24 hours a day.

Holiday planning came with underlying anxiety, and relationships – don’t even get me started on how recurrent urinary tract infections impact those.

Too late… I’m on a roll.

UTI After Sex

Sex becomes a source of anxiety. You’re constantly calculating the probability of getting a UTI each time. Talk about a buzz kill.

Then afterwards, you do your best to leave it a respectable amount of time before you jump up and head to the bathroom to flush your urinary tract. Post-sex contented snuggling is NOT a thing when you have recurrent UTIs.

I’m terrified now to think how close I came to giving up. I’m not even sure what that would have meant. UTIs forever? With each episode a little sooner than last time?

“One doctor suggested I ‘might just have irritable bladder or Interstitial Cystitis’. Such a throwaway comment, like it’s a minor nuisance or just one of those things.”

I knew that in their mind that was a life sentence, and I refused to accept it. It was a wake up call.

Recurrent Urinary Tract Infections Hindsight Tip #3:

It’s impossible for every practitioner to stay up to date with all the research on recurrent UTIs. If you feel that your doctor is unable to help you, you should feel comfortable looking for another doctor.

If you’ve received a diagnosis of Interstitial Cystitis or have been told that you are just prone to UTIs, yet you’re certain you should be able to get well, find a practitioner who can help you on that journey.

Learn about different approaches to recurrent UTI treatment, and read about one practitioner’s approach to chronic UTI and Interstitial Cystitis and more about Interstitial Cystitis testing.

I Stopped Taking Antibiotics For Recurrent UTI

I had tried every UTI home remedy I could find. Nothing helped.

I’d been fighting this for 3.5 years. Keeping my life together and keeping up appearances. I even managed to travel to the Balkans to volunteer for a few months.

Sarajevo was the turning point. I like to think of it as the final frontier.

I got a UTI that never went away. The symptoms stayed with me despite taking a longer course of two different types of strong antibiotics. These were prescribed to me as a ‘last resort.’

“Without finding out what was causing my UTI, I knew there was little chance of finding the right antibiotic and I wasn’t willing to continue taking them without being better informed.”

My body was suffering. It had become sensitive to everything.

I would get itchy daily, still had yeast infections constantly, and my contraceptive pill had ceased to control my cycle. I felt like a complete mess.

So I stopped taking antibiotics.

For me this was like taking a deep breath and jumping from a cliff into the sea, without knowing if I could really swim.

Hormones, UTIs And Yeast Infections

I also stopped taking the contraceptive pill, forever.

This is emphasized because quitting the pill felt momentous at the time. I had been on the pill since I was 16. Not for contraception then, but because I had periods so heavy I ended up severely anemic and required treatment.

Later, the pill became convenient for other reasons. I didn’t want to worry about irregular, heavy periods, but I also didn’t want to get pregnant, so the pill allowed me to live a life fairly free from those concerns.

My problems with the pill started around the same time as my recurrent urinary tract infections. The antibiotics I was taking meant my gut and vaginal flora took a serious hit. Despite being on the pill, my cycle had become unpredictable.

A gynecologist I saw suggested the pill I was on just wasn’t right for me and prescribed me another, then another. They didn’t help, and my unpredictable cycles continued.

Soon, I began suffering from skin sensitivities and itchiness that drove me crazy.

A Doctor That Helped Me Turn Things Around

By some miracle, I was given an appointment with a trainee doctor in Berlin who identified the skin symptoms as part of a bigger problem – a possible Candida overgrowth – aggravated by my frequent antibiotic use and the estrogen in my contraceptive pill.

Not only did my new doctor believe yeast may have been at the heart of these symptoms, she also suspected it was causing my urinary symptoms. Testing confirmed that Candida was an issue in both my gut and vaginal microbiomes.

She managed to convince me, by sharing her own experiences, to go off the pill. This was terrifying to me at the time. I imagined the heavy periods returning, and all that came with that, including the possibility of babies.

“But I was done making excuses for myself. I was ready to take control of my health.”

The decision to stop taking medications seemed counterintuitive, but I was ready to try a different approach.

I needn’t have worried. The process of changing my diet, and the other measures I’ve mentioned below, resulted in a super regular and almost symptom-free menstrual cycle.

UPDATE: Although I felt the need to stop using antibiotics when I was recovering, I’m not against using antibiotics and I have seen through our community that antibiotics can indeed be the right solution for many.

My Recurrent Urinary Tract Infections Treatment Regimen

“I didn’t realize at the time that this was the beginning of my recovery. My regimen took me to a place where I no longer had any symptoms. I was able to stop taking supplements on a daily basis. It wasn’t about managing my symptoms anymore, they were just gone.”

I was basically back at square one and I wanted a fresh start. I wanted more information; everything I could get my hands on. I started with a range of blood tests to check my general health.

I discovered I was quite low in a few essential vitamins and minerals. In speaking with clinicians I have learned this is very common in people who have been fighting long term chronic infection.

First, I began to take a range of supplements targeting my deficiencies. Then I created a regimen of strong herbal antifungals and antibacterials based on the advice of my new doctor.

These were teamed up with oral and vaginal probiotics that contained probiotic strains showing promise for urinary tract and vaginal health.

I had tried all of these separately (minus the vitamins and minerals) after reading studies about each of them. But I had never tried them together, or with a plan and a timeframe in mind.

I started my new regimen.

UPDATE 2020: I’ve received so many requests to provide more information about my own regimen, so I’ve put together a list of products I used and the lifestyle changes I made. I don’t share all of this publicly here because this site is about sharing factual information and experience, not selling products. I prefer to share more detail about the full list of changes I made, via email, so we can discuss. If you would like more information on this, look for the green box at the end of my story that says ‘Receive More Information About My Approach‘ and share your name and email address there (not in the comments).

Why Tracking Your Symptoms Can Help

Now, I don’t know about you, but I love a good spreadsheet. And it’s amazing how much more fulfilling a health regimen can be when you plot it out, then mark off your progress daily. Feels so goooood.

I downloaded a counter on my phone to track how many days since my last UTI – at the very least I would see how long I could last between episodes.

Every morning I woke up and looked at my counter. After 30 days I started to feel my first glimmer of hope. I was still getting twinges and minor symptoms, but nothing I couldn’t handle.

My first milestone came around that time, when I went hiking with my partner. Without a map, without a compass, and without enough water. We got lost. We were out there for 10 hours and I was dehydrated.

But I didn’t get a UTI. And I didn’t even think about it until I was home safe again. That alone blew my mind. This thing that had been my focus for four years had somehow become an afterthought.

The counter kept going up. 45 days, 60 days, 90 days since a UTI. I suddenly felt like declaring myself officially healed of recurrent UTIs at the six month point might not be so far-fetched.

Sometime, around three months in, I had a relapse of symptoms and upped some elements of my regimen in response. That UTI never happened and my count remained intact.

Six months came and went and I set my sights on a year UTI free.

Amazingly, my UTI regimen also cleared up my yeast infections. Four years later, I’ve not had even the slightest hint of one returning.

UPDATE 2020: It’s almost exactly 5 years since my symptoms resolved and I’ve just completed another round of follow up testing. Both my gut and vaginal microbiome tests came back with lower than detectable levels of Candida, meaning no Candida was found.

Leaving UTI Anxiety Behind

Out of fear, leftover antibiotics had become a permanent feature in my bag. If I changed bags, the antibiotics came with me. I never opened them, but they were my psychological backup.

“Around the nine month mark I made the momentous decision to leave the antibiotics behind. It might sound overly dramatic, but tearing up your safety blanket and tossing it to the wind IS huge. I hadn’t taken antibiotics in nine months, but I still relied on their presence, psychologically speaking.”

When I embarked on my healing regimen, I envisioned massive celebrations at the one year mark, for I would then be officially free of recurrent urinary tract infections. In reality, I had put UTIs so far behind me that it was almost a non-event.

I did have some celebratory drinks, with an emphasis on the fact I COULD drink alcohol without fearing a UTI.

How Am I Since Completing My UTI Recovery?

I still have that counter. At the time I write this, I am 625 days UTI free. But it’s no longer important. I keep it as a memento of what I went through, and what it took to get past it.

UPDATE 2020: My counter is now at 1701 days since I overcame my experience with chronic UTI. The regimen that I implemented at the beginning of this journey resulted in a long term ‘remission’ from UTIs. I say remission because I know it will always be possible for me to get another UTI. My urinary tract isn’t impervious to bacteria, just as my sinus isn’t impervious to a cold or flu. But, I was able to stop taking all the supplements I started, and continue only with basic vitamins that proved essential due to my particular diet. I have never again experienced the ongoing pain and symptoms I experienced then (touch wood). I do have a story about food poisoning in Asia that led to urinary tract symptoms, but that’s for another time (and I’m fine now, in case you were worried).

How Long Does It Take To Heal From Recurrent Urinary Tract Infections?

In total, I had painful, recurrent urinary tract infections for more than 4 years. Many people I have spoken with have suffered for many more. The longer you have experienced recurrent infection, the longer it may take to heal.

Commitment to the process of healing is so important. It may take months or years of consistent treatment for you to feel truly recovered. Hopefully, along the way, your symptoms will continually improve, and you can take your life back.

For me, it took around 9 months from the moment I stopped antibiotics and the pill, and adopted my final regimen.

Recovering from recurrent UTI is not a finite process.

I know my bladder is not invincible. I know I could still get a UTI now, just as I always could. The difference is, I now understand better what contributed to my recurrent UTIs. I also have the knowledge and resources to ensure I never again reach the place I was once in.

“UTIs no longer rule my life. I no longer live with the daily fear of a recurrence. I want to help others find answers.”

Recurrent Urinary Tract Infections Are More Common Than You Think

Even after I broke the cycle of recurrent urinary tract infections, I never stopped researching.

I’d been full circle through wondering what was wrong with me, to wondering what was wrong with doctors, to being furious at yet another female health issue overlooked by the healthcare industry, to wanting to do something about it.

And here we are. We created this website so you wouldn’t have to look so far and wide for helpful information.

We’ve done our best to break recurrent UTI into the pieces of the puzzle you need to understand in order to get well:

1. What causes urinary tract infections
2. How recurrent UTIs may be caused by chronic infection
3. Why your UTI test may be negative, despite your symptoms
4. Recurrent UTI treatment approaches
5. UTI home remedies

Plus a whole range of other content to expand on the above.

You Are Not Alone. Recurrent Urinary Tract Infections Are So Common.

Since launching our site, I’ve reached out to others who know what recurrent urinary tract infections feel like. They have had me in hysterics as they recounted their now funny UTI stories in an interview.

Catching the train for 45 minutes in UTI-induced agony only to then resort to peeing in the front garden with the key in the door. So close!

Or getting approached by the police for suspicious behaviour resembling a drug deal, when all that was really happening was frantic clawing at a box of antibiotics. It turns out the police will back off quickly if they know a UTI is involved. (Read all about Juliet’s tips for preventing UTIs after sex).

Then of course there is the infuriating side of this. The side that has left so many females feeling helpless.

The urologist whose best advice was that his own wife drinks aloe vera juice to help with her recurrent urinary tract infections. What the?

The many doctors and specialists who have said there’s nothing we can do about it, ‘some women just get recurrent urinary tract infections,’ and ‘it’s just your plumbing.’

Inspired and frustrated by the similarities we heard from all these stories, we started speaking to doctors, and researchers, and pieced together what we found.

Our aim is to provide the most complete source of recurrent UTI and chronic cystitis information available. We’re only part of the way there, but we’ll continue adding new research as we find it.

We hope to lift others out of the murky waters of misinformation and empower them towards their own recovery.

You can help us by sharing your story.

To get answers to commonly asked questions about chronic and recurrent UTI, visit our FAQ page. Share your questions and comments below, or get in touch with our team.

If you’d like more information about my experience, I can respond faster if you provide your name and email address in the green ‘Receive More Information About My Approach‘ box below, rather than leaving a comment.

Urinary tract infection (UTI) – Illnesses & conditions

About urinary tract infections

Urinary tract infections (UTIs) are common infections that can affect the bladder, the kidneys and the tubes connected to them.

Anyone can get them, but they’re particularly common in women. Some women experience them regularly (called recurrent UTIs).

UTIs can be painful and uncomfortable, but usually pass within a few days and can be easily treated with antibiotics.

This page is about UTIs in adults. There is a separate article about UTIs in children.

This page covers:

Symptoms

When to get medical advice

Treatment

Causes

Prevention

Symptoms of UTIs

Infections of the bladder (cystitis) or urethra (tube that carries urine out of the body) are known as lower UTIs. These can cause:

• a need to pee more often than usual
• pain or discomfort when peeing
• sudden urges to pee
• feeling as though you’re unable to empty your bladder fully
• pain low down in your tummy
• urine that’s cloudy, foul-smelling or contains blood
• feeling generally unwell, achy and tired

Infections of the kidneys or ureters (tubes connecting the kidneys to the bladder) are known as upper UTIs. These can cause the above symptoms and also:

• a high temperature (fever) of 38C (100.4ºF) or above
• pain in your sides or back
• shivering and chills
• feeling and being sick
• confusion
• agitation or restlessness

Lower UTIs are common and aren’t usually a cause for major concern. Upper UTIs can be serious if left untreated, as they could damage the kidneys or spread to the bloodstream.

UTI self-help guide

Complete this guide to assess your symptoms and find out if you should visit your GP, pharmacist or treat your condition at home.

Self-help guide: Urinary infection

When to get medical advice

It’s a good idea to see your GP if you think you might have a UTI, particularly if:

• you have symptoms of an upper UTI (see above)
• the symptoms are severe or getting worse
• the symptoms haven’t started to improve after a few days
• you get UTIs frequently

Your GP can rule out other possible causes of your symptoms by testing a sample of your urine and can prescribe antibiotics if you do have an infection.

Antibiotics are usually recommended because untreated UTIs can potentially cause serious problems if they’re allowed to spread.

Treatment for UTIs

UTIs are normally treated with a short course of antibiotics.

Most women are given a three-day course of antibiotic capsules or tablets. Men, pregnant women and people with more serious symptoms may need a slightly longer course.

Your symptoms will normally pass within three to five days of starting treatment. But make sure you complete the whole course of antibiotics that you’ve been prescribed, even if you’re feeling better.

Over-the-counter painkillers such as paracetamol can help with any pain. Drinking plenty of fluids may also help you feel better.

Return to your GP if your symptoms don’t improve, get worse or come back after treatment.

Pharmacy First: UTI treatment from your local pharmacy

Women between 16 to 65 years with uncomplicated UTIs can seek advice and treatment directly from their pharmacist through the Pharmacy First scheme.

Find your local pharmacy on Scotland’s Service directory.

Pharmacies

Causes of UTIs

UTIs occur when the urinary tract becomes infected, usually by bacteria. In most cases, bacteria from the gut enter the urinary tract through the urethra.

This may occur when wiping your bottom or having sex, for example, but often it’s not clear why it happens.

The following may increase your risk of getting a UTI:

Women may be more likely to get UTIs because their urethra is shorter than a man’s and is closer to their anus (back passage).

Preventing UTIs

If you get UTIs frequently, there are some things you can try that may stop it coming back. However, it’s not clear how effective most of these measures are.

These measures include:

• avoiding perfumed bubble bath, soap or talcum powder around your genitals – use plain, unperfumed varieties, and have a shower rather than a bath
• going to the toilet as soon as you need to pee and always emptying your bladder fully
• staying well hydrated 
• wiping your bottom from front to back when you go to the toilet
• emptying your bladder as soon as possible after having sex
• not using a contraceptive diaphragm or condoms with spermicidal lubricant on them – you may wish to use another method of contraception instead
• wearing underwear made from cotton, rather than synthetic material such as nylon, and avoiding tight jeans and trousers

Speak to your GP if these measures don’t work. They may suggest taking a long-term course of antibiotics or they may give you a prescription for antibiotics you can use as soon as you experience symptoms of a UTI.

There’s currently little evidence to suggest that drinking cranberry juice or using probiotics significantly reduces your chances of getting UTIs.

Readers Share Pain and Frustration Over Urinary Tract Infections

Cece Turner, 30, who described herself as a “healthy mum” from Scotland, wrote that she had learned the hard way to seek a culture after a harrowing first experience with a U.T.I. two years ago.

She said that she “blindly followed orders, taking drug after drug with no reprieve.”

“I ended up being severely ill with a multi-drug resistant infection,” she continued. “Having tried 6+ different courses of antibiotics over the course of 4 months, my U.T.I. was eventually ‘cured’ in July by a 2 week course of antibiotics.”

Less than a year later, she got a second U.T.I. “This time,” she wrote, “I was a bit more savvy and demanded a culture immediately.”

Doctors and researchers interviewed agreed that in an ideal world, it would be great to culture each infection for possible infection. But that is far from realistic because cultures cost money and take time, discouraging doctors, labs and insurance providers, and also because the usual practice is to quickly treat urinary tract infections with antibiotics.

Dr. Eva Raphael, a physician at San Francisco General Hospital who does research on U.T.I.s, said cultures should be taken more often. “Yes, it takes manpower to send a urine culture, plate it, identify the colonies,” she said, but she added that she believes it’s worth doing “if we’re going to be judicious about the use of antibiotics.”

It might hearten some readers to know that the rise in resistance has spurred policymakers to think about whether to make getting cultures more standard. Dr. Drekonja, who is involved in discussing those kinds of issues with the Infectious Disease Society of America, said: “I suspect it will be addressed in the next version of U.T.I. guidelines,” although it is not clear when those will come out or what they will say.

Many readers who responded to The Times query were women in their 50s or older. Women who are postmenopausal are particularly susceptible to urinary tract infections because their falling levels of vaginal estrogen can interfere with the body’s ability to fight off bladder infections.

4 Reasons Why You Might Get Recurring UTIs

Many women who get a urinary tract infection (UTI) may get one again at some point in their lives. In fact, one in five women experience recurrent UTIs—an infection that occurs two times or more within six months or at least three times in a year. Men can get recurrent UTIs too, but it is not as common and is often due to some type of urinary tract blockage.

What Causes Recurring UTIs in Women?

There are many reasons why women may have recurring urinary infections, but we will focus on four common reasons.

1. Anatomy and/or genetics

Women are more prone to UTIs mostly because of their anatomy. A woman’s urethra is shorter than a man’s. Plus it is located near the openings of the vagina and anus, meaning there’s more opportunity for bacteria from both those areas to spread—or be wiped—into the urethra. Once bacteria is in the urethra, it only has a short distance to travel to the bladder and cause an infection.
Additionally, some women have cells that are naturally more receptive to bacteria, meaning the bacteria are less likely to be flushed out by your natural body functions. In a 2009 study of more than 1,200 women who experience recurrent UTIs and kidney infections, researchers determined that a genetic variation in these cell receptors is associated with an increased risk of bladder and kidney infections.

2. Bathroom habits

Because a woman’s urethra is so short and so close to the vagina and anus, it’s important to wipe from front to back after going to the bathroom. This lessens the risk of any fecal matter or bacteria being moved from the anus into the urethra. It’s also important to make sure you are clean and dry before pulling your underwear back up. Any fecal matter or bacteria can land on the underwear and spread as the underwear moves as you walk, sit, exercise, etc.

3. Sexual activity

Bacteria can spread more easily during sexual activity, from your partner’s genitals, fingers, tongue or even sex toys. Such activity in that intimate area can also spread your own bacteria from your vagina or anus into your urethra. That’s why doctors tell you to pee after having intercourse or participating in any sexual activity—to help flush any errant bacteria out of the urethra. Practicing good hygiene before and after sexual activity is also helpful. Wash your intimate area as well as your hands and fingers before and after sex. Clean sex toys before and after using as well.
Diaphragms, spermicides and condoms may increase your risk for UTI if you are prone to recurrent infections. However, talk to your doctor about solutions. You may be able to go on a low-dose of antibiotics as a preventive measure for six months at a time or after having sex.

4. Other health issues

Having a suppressed immune system or chronic health condition can make you more prone to recurring infections, including UTIs. Diabetes increases your risk for a UTI, as does having certain autoimmune diseases, neurological diseases and kidney or bladder stones. If you’ve had surgery on any part of your urinary tract (urethra, bladder, ureter, kidney), resulting scar tissue or alteration in anatomy could leave you more susceptible to infection.

What Can You Do If You Keep Getting UTIs?

If you keep getting UTIs, you must talk to your doctor. After talking with you, your doctor will either recommend treatments for recurring urinary infections or send you to a special doctor called a urologist. A urologist focuses on diseases and problems of the entire urinary system, so he may be able to better pinpoint what is causing your infections and how to treat and prevent them.
In addition to the tips mentioned above, you can also take some other simple steps to help prevent UTIs, such as:

• Drink plenty of water.
• Wear cotton underwear.
• Do not hold pee in—if you have to go, find a bathroom and go.
• Avoid using scented products like sprays, douches and powders that are not gynecologist tested

If you have had a UTI, you know they can be painful. To help with that pain, try Uristat® Pain Relief Tablets. If you have kidney problems or diabetes, talk to your doctor first to make sure this pain reliever is safe for you.

Urinary Tract Infection (UTI) | Loma Linda University Health

Recurrent Urinary Tract Infection (Recurrent UTI) or Chronic Urinary Tract Infection

WHAT IS A RECURRENT URINARY TRACT INFECTION (UTI)?

A urinary tract infection (UTI) is a bacterial infection in one or more parts of the urinary system: the kidneys, ureters, bladder or urethra. A urinary tract infection that occurs two or more times in a six month period is a recurrent urinary tract infection (also called a recurring UTI or a chronic urinary tract infection).

From the moment you contact Loma Linda University Health, we do everything we can to make sure your UTI treatment runs smoothly. Our goal is to make your experience as convenient, comfortable and stress-free as possible.

WHAT ARE THE SYMPTOMS OF A RECURRENT URINARY TRACT INFECTION (UTI)?

The symptoms of a urinary tract infection (UTI) include:

• A strong urge to urinate
• Frequent urination in small amounts
• A painful burning sensation when urinating
• Cloudy urine
• Reddish pink, or brown urine
• Urine with a strong unpleasant smell
• Aching in the pelvis

If the urinary tract infection has spread to the kidneys, symptoms may include:

• Nausea
• Vomiting
• Fever
• Chills
• Back pain below your ribs on either side of your body

A person who experiences two or more UTIs in a six month period or three or more UTIs in a 12 month period is experiencing a recurrent urinary tract infection.

WHAT CAUSES A RECURRENT URINARY TRACT INFECTION (UTI)?

Urinary tract infections are often caused when bacteria from the vagina or anus gets into and travels through the urinary system.

A common cause of a recurrent UTI is that some bacteria from a previous UTI may remain in the urinary tract system. In these cases, it may not have been completely eradicated the last time it was treated.

Another common cause of a recurring UTI could be related to your habits, such as:

• Not urinating frequently enough to flush your system
• Not urinating after sexual intercourse (especially for women)
• Wiping incorrectly

HOW IS A RECURRENT URINARY TRACT INFECTION (UTI) DIAGNOSED?

Diagnosing a urinary tract infection is usually done by a simple urinalysis. In some cases, doctors may order additional tests, such as:

• Blood tests
• X-rays
• CT scans
• MRIs
• Ultrasound of the urinary tract
• Cystoscopy

HOW IS A RECURRENT URINARY TRACT INFECTION (UTI) TREATED?

There are a variety of effective ways to treat urinary tract infections:

Medications

For those with recurrent infections, taking a short course of antibiotics when each infection occurs is associated with the lowest antibiotic use. A prolonged course of daily antibiotics is also effective. Some recommend against prolonged use of antibiotics due to concerns of antibiotic resistance. Medications frequently used include:

• Nitrofurantoin and trimethoprim/sulfamethoxazole (TMP/SMX)
• Methenamine 
• Antibiotics after intercourse – In cases where infections are related to intercourse, taking antibiotics afterward may be useful. 
• Topical vaginal estrogen – In post-menopausal women, topical vaginal estrogen has been found to reduce recurrence.
• Antibiotics following short term urinary catheterization – This appears to decrease the subsequent risk of a bladder infection. 

Alternative Medicine

The following remedies should be discussed with a medical provider:

• Cranberry juice or capsules
• Phenazopyridine  
• Acetaminophen (paracetamol, Tylenol)
• Asymptomatic bacteriuria
• Uncomplicated UTIs
• Fluoroquinolones
• Amoxicillin-clavulanate

More severe UTIs may require hospital treatment, especially if the infection has spread to the kidneys.

WHAT ARE THE COMPLICATIONS OF A RECURRENT URINARY TRACT INFECTION (UTI)?

One serious complication of chronic urinary tract infection is damage to the kidneys. In this case, hospitalization may be required.

WHO IS AT RISK FOR RECURRENT URINARY TRACT INFECTIONS (UTI)?

Those most at risk of developing recurrent urinary tract infections include:

• Women more than men
• Menopausal and post-menopausal women
• People who use catheters
• People who suffer from diabetes, chronic illness, or a compromised immune system

NEXT STEPS

• Be preventive. Your habits can help prevent urinary tract infections. Note the UTI causes listed above and take preventive action to avoid them.    
• Seek medical intervention. If you are suffering from UTI symptoms, seek medical attention. To request an evaluation at Loma Linda University Health for acute or recurrent UTI symptoms, contact your provider or schedule the appointment through MyChart.

90,000 experience in Ontario, Canada

Dr. Patrick Tifi MD FRCP

University of West London, London Health Sciences Center

The manuscript presents the experience of increasing the availability of diagnostic and invasive therapies for the heart using The Ontario model for Cardiac Care / CorHealth Network in order to maintain and improve care for a large population or a specific geographic region. New PCI medical centers have been established throughout Ontario and new medical protocols for STEMI patients have been introduced to improve access to specialized care.

keywords: Ontario, PCI, ST IMp

for citation: Dr. Patrick Tifi MD FRCP. Coordination and oversight of interregional cardiovascular care: an experience in Ontario, Canada. Emergency cardiology and cardiovascular risks, 2019, V. 3, No. 1, pp. 605-609

Coordination and control of interregional cardiovascular care: an experience in Ontario, Canada

Dr. Patrick Tiffy MD FRCP

The manuscript presents the experience of increasing the availability of diagnostic and invasive therapeutic procedures for the heart using the example of The Ontario model for Cardiac Care / CorHealth Network with the aim of maintaining and improving medical care for a large population or a specific geographical region …Throughout Ontario, new PCI centers have been set up, and new medical protocols have been introduced for patients with UTI, which will improve access to specialist care.

keywords: province of Ontario, PCI-capable hospitals, STEMI

for references: Dr. Patrick Tiffy MD FRCP. Coordination and control of interregional cardiovascular care: an experience in Ontario, Canada. Emergency Cardiology and Cardiovascular Risks, 2019, Vol. 3, No. 1, P. 605-609

1.Pagiamtzis J., Kingsbury K. Creating Collaboration Out of Chaos: The Experience and Evolution of the Cardiac Care Network. 20 years of the Cardiac Care Network in Ontario: Past, Present and Future: National Healthcare Leadership Conference, Winnipeg Convention Center, Winnipeg, June 8, 2010.
2. CorHealth Ontario is an entity formed by the 2016 merger of the Cardiac Care Network of Ontario (CCN) and the Ontario Stroke Network (OSN) [electronic resource]. Available at: https: //www.corhealthontario.ca / what-we-do / annual-reports
3. Recommendations for best-practice STEMI management in Ontario [electronic resource]. Cardiac Care Network, 2013, 146 p. Available at: https://www.corhealthontario.ca/Recommendations-for-Best-Practice-STEMI-Management-in-Ontario-(6).pdf.
4. Management of acute coronary syndromes: best practice recommendations for remote communities [electronic resource]. Cardiac Care Network, 2013, 38 p. Available at: https://www.corhealthontario.ca/ACS-management-in-remote-communities-FINAL-Sept-2013.pdf.
5. Cardiac Care Network of Ontario Ontario STEMI Bypass Protocol [electronic resource]. Cardiac Care Network, 2015, 9 p. Available at: https://www.corhealthontario.ca/Ontario-STEMI-Protocol-2015.pdf.
6. Tu J.V., Ko D.T., Guo H., Richards J.A., Walton N., Natarajan M.K., Wijeysundera H.C., So D., Latter D.A., Feindel C.M., Kingsbury K., Cohen E.A. Determinants of variations in coronary revascularization practices. CMAJ, 2012, vol. 184, no. 2, pp. 179-186. doi: 10.1503 / cmaj.111072.

File format: pdf (2.81 Mb)

Beneficiaries of the military alert – Vedomosti

The escalation of the armed confrontation in southeastern Ukraine has once again demonstrated that the unresolved conflicts in the former Soviet Union and today, 30 years after its collapse, remain a major problem of regional and international security. One can argue about how important the consequences of the current military alert will be and who will ultimately be the beneficiary of it.The task of understanding the likely trajectories of development of one of the largest military-political confrontations in Europe is to find its systemic foundations. It is important to see its general and specific features against the background of other post-Soviet conflicts.

The reasons are fundamental. First, the collapse of the USSR itself took place outside the legal framework, with disregard for Soviet legislation on the right to secession. Secondly, at the international level, the recognition of the new independent states was based not on some developed criteria, but on the principle of uti possidetis (from lat.”Because you own”) applied during decolonization in Africa. The country, which became independent, inherited the territories and borders that it had, being an administrative entity as part of another, larger state. A paradoxical situation arose: radically breaking with the Soviet past, the newly emerging states did not want to give up the territories that they received thanks to their stay in the USSR.

At the same time, as the American historian Charles King justly remarked, the international community “was simply able to tolerate one type of secession, but reject the other.”The withdrawal of Georgia, Moldova or Ukraine was considered legitimate, while the aspirations of the Abkhaz, Ossetians or residents of Transnistria were considered the whims of the separatists. The obvious fact was ignored that the newly emerging states built their national model not on the ideas of federalism and dialogue, but on the dominance of the center. It is here, and not in the intrigues of the Kremlin, that it would be worth looking for the roots of the separatist whims.

The post-Soviet conflicts went through two stages in their development. And if at first the disputes over the lines “Moscow – union republic” and “union republic – autonomy” were played out, then closer to 2000 the process of “geopolitization” began.The new state formations began to realize their special interests, different from those of Russia. Not seeing in Moscow a force capable of replaying the results of the first wave of conflicts, the political elites of the CIS countries focused on cooperation with the United States, NATO, and the European Union. In parallel with this, the latter, having strengthened their influence in the Balkans and the Middle East, turned their eyes to the space of the former USSR. As a result, the status quo, formalized following the collapse of the USSR, began to be contested, and frozen conflicts began to unfrozen. Five-day war in the Caucasus in August 2008became the most striking demonstration of this trend.

Ukraine, unlike Azerbaijan, Georgia or Moldova, has resisted the first wave of conflict – the ethnopolitical one. But the growing geopolitical confrontation between Russia and the West has covered her head over heels. Many of the lessons of the same Georgia, which decided instead of careful balancing to enter the struggle on one of the sides, were not properly learned. The failed experience of building a state without attention to multiple regional and ethnic identities was also not taken into account.In this regard, the Minsk agreements became the point of freezing the conflict for Ukraine. Azerbaijan, Georgia and Moldova went through it in 1992-1994. And each of these countries at different times and to varying degrees tried to unfreeze conflicts, that is, to unilaterally change the prevailing military-diplomatic and socio-economic realities to their advantage. But if Chisinau limited itself to correcting the issues of customs regulation, then Baku, Kiev and Tbilisi resorted to force.

In the Azerbaijani case, the defrosting did not fit into the format of the West-Russia confrontation traditional for Eurasia.And this is one of the reasons for its success. Georgia and Ukraine are in a more vulnerable position in this regard. Largely for reasons of the electoral order, the politicians of these countries cannot openly raise questions about the special status of Abkhazia, South Ossetia, Donetsk and Luhansk regions. Any even neat hint of federalism would be viewed as almost treason. But this is not so bad. Today all these issues are not a dispute between Tbilisi and Sukhumi, Kiev and Donetsk. This is part of the menu for Russian-American relations.And attempts to correct the current status quo in one direction or another will be viewed precisely as a correction of the balance of power between Moscow and Washington in Eurasia. Therefore, any defrost according to the scenario of either 2008 or 2021 will, by definition, go beyond the Caucasus or the European part of the former USSR.

Sooner or later, representatives of the Georgian and Ukrainian elites will have to answer the question: how beneficial is participation in ethno and geopolitical confrontation? Are they ready for the not cheap, literally and figuratively, integration of the elites of problem regions, as Russia did in Chechnya? And isn’t it easier to make a choice in favor of “small” Georgia and Ukraine?

Urinary Tract Infection in a Small Animal Model: Transurethral Catheterization of Male and Female Mice

Urinary Tract Infections (UTI) are one of the most common infections in developed countries ¹ .Infection rates are similar between women and men in newborns and the elderly 90,060 2 90,061. Premenopausal adult women, however, have a significantly increased incidence of community-acquired UTI, compared to men ^{2 , 3} . Given that this disease mainly affects women, basic and clinical research has primarily focused on UTI in females. However, UTI in men is a significant and well-studied health challenge of ⁴ .Indeed, because UTIs in men are associated with a higher incidence, these infections are commonly defined as complex ^{4 , 5} .

As our understanding of the central role of gender bias in physiology and pathology develops, new methods are required to explore this aspect of previously neglected diseases. Sex differences play an important role in immunity and infection; women have a high rate of autoimmune diseases, while men are more susceptible to certain infections such as tuberculosis, malaria and HIV ^{6 , 7} .Bladder cancer, another urological pathology, is significantly more common in men than women, and several studies have shown the role of androgens in malignant development ^{8 , 9 , 10 , 11 , 12} . Notably, however, investigations into intravesical therapy for bladder cancer are performed exclusively in female animals, due to the inability to repeatedly catheterize male mice ¹³ .

The study of the pathogenesis of UTI relies on rodent models of infection ( eg , mice and rats). In mouse models, UTI can employ uropathogens initially isolated from human infections such as uropathogenic E. coli (UPEC), neutrophils , Enterococcus , Staphylococcus or Proteus ^{14 As a rule, bacteria are introduced into the bladder through urethral catheterization.After infection, reservoirs and kidneys can be removed to assess specific parameters of infection, such as bacterial colonization, tissue damage, or host immune response 15 , 16 . Universally, however, only female animals are used for UTI research. Indeed, many studies have noted that, due to anatomical reasons, catheterization of male mice is not possible 13 , , 17 18 , 19 .More recently, a surgical approach to male instillation has been described in which the abdomen is opened, the bladder is externally displaced, applying gentle opening pressure to the abdomen and bacteria is injected into the bladder 20 . This approach allows male infections at the cost of surgery. Thus, the main nuance of this approach includes the effect of inflammation on the results of infection, such as the potential to induce an anti-inflammatory-healing response to incision 21 .As our interests include understanding gender bias in response to disease, we have developed a method of bacterial intravesical instillation in male mice that is more in line with the long-standing nonsurgical transurethral approach used in female rodents 22 .}

Our model is based on established methodology and provides the ability to directly compare the immune response to UTIs in female and male animals. This technique will allow dissection-based differences in infection and potentially offer molecular and cellular clues to pronounced differences in sensitivity and response to infection between the sexes.In addition, this model has implications outside of UTI research, allowing the creation of models for the investigation of other bladder-associated diseases like bladder cancer, prostatitis, under or over active bladder syndrome and interstitial cystitis.

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uso – Wiktionary

Morphological and syntactic properties [edit]

uso

Noun, masculine.

Root: – .

Pronunciation [edit]

Semantic properties [edit]

Meaning [edit]

1. use, use (use), use ◆ There is no example of use (see recommendations).
2. skill, experience; practice ◆ There is no example of use (see recommendations).
3. custom, habit, habitrecommendations).
4. fashion, manner, style ◆ There is no example of use (see recommendations).
5. limited right to use (someone else’s property) ◆ There is no example of use (see recommendations).

Synonyms [edit]

Antonyms [edit]

Hyperonyms [edit]

Hyponyms [edit]

Related words [edit]

Etymology [edit]

Comes from lat.usus “use”, then from uti (Vulg. Lat. usare) “to use, apply, use”, then from arch. oeti, from praith. * oit-.

Phraseologisms and stable combinations [edit]

Morphological and syntactic properties [edit]

uso

Noun, masculine.

Root: – .

Pronunciation [edit]

Semantic properties [edit]

Meaning [edit]

1. use, use (use), use ◆ There is no example of use (see.recommendations).
2. skill, experience; practice ◆ There is no example of use (see recommendations).
3. custom, habit, habit ◆ There is no example of use (see recommendations).
4. fashion, manner, style ◆ There is no example of use (see recommendations).
5. communication, acquaintance; communication ◆ There is no example of use (see recommendations).
6. right to use (someone else’s property) ◆ There is no example of use (see.recommendations).

Synonyms [edit]

Antonyms [edit]

Hyperonyms [edit]

Hyponyms [edit]

Related words [edit]

Etymology [edit]

Comes from lat.usus “use”, then from uti (Vulg. Lat. usare) “to use, apply, use”, then from arch. oeti, from praith. * oit-.

Phraseologisms and stable combinations [edit]

Morphological and syntactic properties [edit]

uso

Noun, masculine.

Root: – .

Pronunciation [edit]

Semantic properties [edit]

Meaning [edit]

1. use, use (use), use ◆ There is no example of use (see.recommendations).
2. skill, experience; practice ◆ There is no example of use (see recommendations).
3. custom, habit, habit ◆ There is no example of use (see recommendations).
4. deterioration ◆ There is no example of use (see recommendations).

Synonyms [edit]

Antonyms [edit]

Hyperonyms [edit]

Hyponyms [edit]

Related words [edit]

Etymology [edit]

Comes from lat.usus “use”, then from uti (Vulg. Lat. usare) “to use, apply, use”, then from arch. oeti, from praith. * oit-.

Phraseologisms and stable combinations [edit]

Morphological and syntactic properties [edit]

uso

Noun.

Root: – .

Pronunciation [edit]

Semantic properties [edit]

Meaning [edit]

1. Anat.face (front of the head) ◆ There is no example of use (see recommendations).

Synonyms [edit]

Antonyms [edit]

Hyperonyms [edit]

Hyponyms [edit]

Related words [edit]

Etymology [edit]

From ??

Phraseologisms and stable combinations [edit]

90,000 earnings, earnings beat forecasts in Q3 From Investing.com

Investing.com – Patterson-UTI Energy released a third-quarter report on Thursday that outperformed analysts. Revenue was above forecasts.

The company reported earnings per share of $ -0.44 and earnings of $ 358.0M. Analysts polled by Investing.com had forecast EPS of -0.4433 for $ 352.99M total revenue of $

This year, the share price of Patterson-UTI Energy has risen 41%, performing better than the overall index, climbing 30% YTD.

Patterson-UTI Energy follows the general trend of companies in the Energy sector this month

Thursday Royal Dutch Shell B ADR posted third quarter earnings of $ 1.06 for $ 60.04B earnings, compared with EPS forecasts of $ 1.37 on total earnings of $ 61.17B

Equinor ADR earnings beat analysts’ expectations on Wednesday in the third quarter, with quarterly earnings per share of $ 0.84 on total earnings of $ 23.55B by Investing Analysts.com previously predicted earnings per share of $ 0.7307 on total earnings of $ 21.66B $

Stay on top of all key financial events with Investing.com’s economic calendar.

Warning: Fusion Media would like to remind you that the data contained in this website is not necessarily real-time nor accurate. All CFDs (stocks, indexes, futures) and Forex prices are not provided by exchanges but rather by market makers, and so prices may not be accurate and may differ from the actual market price, meaning prices are indicative and not appropriate for trading purposes.Therefore Fusion Media doesn`t bear any responsibility for any trading losses you might incur as a result of using this data.

Fusion Media or anyone involved with Fusion Media will not accept any liability for loss or damage as a result of reliance on the information including data, quotes, charts and buy / sell signals contained within this website. Please be fully informed regarding the risks and costs associated with trading the financial markets, it is one of the riskiest investment forms possible.

Mail.ru launched an international cloud | ComNews

According to Mail.ru, several dozen racks were used in the data center for MCS and other projects of the holding. The data processing center (DPC) in Amsterdam is designed based on the UTI Tier III standard. This means 2N redundancy for all critical systems and extremely high service availability. The holding rents the data center building in the Netherlands.

“We already have retail, e-commerce and SaaS service providers.Such a service will be of interest to a wide range of customers, first of all to companies that are interested in working in the European market and to comply with local legislation, “- said a representative of the press service of Mail.ru.

First of all, the project is designed for companies from retail, fintech, information technology, gaming industry and education. Managed Kubernetes and DBaaS services, Big Data as a Service, cloud monitoring, backup service, CDN, AntiDDoS will be available in the European cloud Mail.ru.

“In the second quarter of 2021, Mail.ru Cloud Solutions is also going to launch a data center in St. Petersburg. Details will be closer to the official announcement,” added a representative of Mail.ru.

Mail.ru has used

data center in Amsterdam before. Based on this data center, the company launched a cloud platform. According to Sergey Zinkevich, director of development for Croc Cloud Services, this was done in order to attract a wide audience of European users and to meet the requirements of the GDPR, the general data protection regulation for EU citizens.

“In general, this region is considered very promising for cloud players. There are also global players such as Amazon, Google, Microsoft, and Russian providers. The latter mainly work through partner data centers. Most Russian cloud service providers prefer to concentrate on the domestic market, since the core of the client base is concentrated here, “said Sergei Zinkevich.

However, he believes that the situation may change in the near future. “We see a trend towards the expansion of Russian expertise to Western markets. Russian IT architects, developers, administrators are highly qualified. Their experience and knowledge can be used by foreign clients. We see the demand for the administration of global clouds in the format of a managed service by engineers from Russia. For a client in Europe, this is an opportunity to receive quality service and reduce the cost of supporting cloud infrastructure, “said a representative of Croc Cloud Services.

According to Dmitry Yashin, General Director of ActiveCloud (Softline) in Russia, the practice of launching data centers in Europe is not widespread among Russian companies, since most of them are concentrated in the domestic market. The potential domestic demand for cloud hosting services in Europe is not very high and can usually be met with global clouds. “Mail.ru is not the first Russian company to offer accommodation in the European cloud with Russian roots.The ActiveCloud portfolio has had such a service since 2012, ”says the CEO of ActiveCloud. – European installations of Russian companies are mainly aimed at clients from the CIS countries. As a rule, they do not compete for European clients. This is partly due to complex industry regulations in the EU that encourage customers to store data domestically, partly due to strong functional competition from global clouds. “

Leading consultant at iKS-Consulting Stanislav Mirin says that entering the foreign market puts MCS in the field of competition with hyperscalers – AWS, Microsoft Azure, Google and other major providers.

“I do not think that foreign clients will massively use MCS clouds, most likely this is done to meet the needs of Russian clients. Among them are those who are actively conducting international business, startups aimed at providing services around the world, software developers for testing systems , customers who need to keep backup copies of data outside the Russian jurisdiction, – said the analyst. – Now there are a number of resellers that offer foreign clouds of hyperscalers, among them Softline, Mont, etc.”. Some Russian providers are hosted not only in Russian data centers, but also abroad, among them Cloud4Y, Corpsoft24 (they use EvoSwitch and Equinix data centers in Holland and Germany), LinxCloud uses its own data center in Poland, MTS (IT-Grad) uses Datakahti data center in Finland.

90,000 LEI News: July 2018 Update – GLEIF Blog

Global Legal Entity Identifier Foundation provides a brief overview of the latest global advances in the use of

legal entity identification codes

To make it easier for stakeholders to follow developments in the implementation of legal entity identification (LEI) around the world, the Global Legal Entity Identifier Foundation (GLEIF) is publishing relevant updates on its blog.

Summary: In the aftermath of the global financial crisis, the primary goal of the LEI implementation was to improve the ability of regulators to assess systemic and emerging risks, identify trends and take corrective action. While organizations around the world need to comply with regulatory requirements of regulatory agencies, they also need to have the tools to make smarter, more efficient and smarter decisions about who to do business with.Therefore, GLEIF encourages organizations to consider other benefits beyond legal compliance and consider the use of LEIs in their day-to-day operations. LEIs provide the ability to clearly and uniquely identify legal entities involved in financial transactions by providing access to basic reference information. GLEIF provides the Global LEI Index, the only publicly available online resource that offers open, standardized and rigorously reviewed legal entity reference data.Each LEI contains information about the ownership structure of legal entities and allows you to answer the questions of “who is who” and “who owns whom”.

This edition of our Legal Entity ID Newsletter focuses on further promoting common and global data standards (including LEIs) to market participants in both the public and private sectors for financial use. It is becoming increasingly clear that the harmonization of global standards contributes to the achievement of regulatory and commercial goals not only at the international but also at the local level.

This blog post summarizes all LEI news published since February 2018. For the sources used in the blog, see the Related Links section below.

GLEIF Report “The New Future of Legal Entity Identification”

In May 2018, GLEIF published the report A New Future for Legal Entity Identification, containing the results of a study conducted in conjunction with the analytical agency Loudhouse, the purpose of which was to identify the main problems in identifying legal entities in the financial sector. including Know Your Customer (KYC) expertise.This report demonstrates how replacing disparate information with a single, common practice, based on the widespread adoption of LEIs, will greatly simplify business operations and provide measurable benefits for companies in the financial sector.

Banks generally operate in different countries and therefore need a common global standard. The LEI provides companies with a uniform, standardized approach to identifying legal entities. Financial services organizations can gain greater transparency and streamline their operations by adopting LEIs for all of their customers.The dissemination of LEIs could improve the stability of international financial markets and support better quality and accuracy of financial data in general. But individual companies could also reap their own benefits, including faster acquisition of customer information, less inconsistent data, less risk of loss, and more efficient use of valuable resources.

JPMorgan Chase Regulatory Compliance Issues Paper Calling for Data Standardization

In May 2018, Robin Doyle, Managing Director, Regulatory Compliance, JPMorgan Chase and GLEIF Board Member, published Data Standardization – A Call to Action, in which she highlighted “the need for financial institutions, regulatory authorities and other stakeholders to jointly ensure the further development of a data standardization structure capable of eliminating existing shortcomings and allowing the introduction of new innovative technological developments. “

This article points out that the consistent “application of financial data and reporting standards that are common across countries remains an unresolved issue that significantly complicates risk management and financial stability.” It also argues that the adoption and dissemination of “a common global language for financial instruments and transactions will drive efficiency, reduce costs, and ultimately improve the usability of financial data to generate value for information and manage systemic risk.”This article provides a supporting case for LEI adoption. “For this initiative to take place, we believe that: The Financial Stability Board (FSB) must continue to actively promote the application of global data and reporting standards, such as the Legal Entity Identification Code (LEI), across countries and monitor progress in their implementation.”

The publication of this call to action attracted additional attention and initiated support from XBRL, the International Organization for Business Reporting

The LEI Regulatory Oversight Committee has published a preliminary report on the Global LEI System and the use of LEI in regulatory documents

In April 2018, the LEI Regulatory Oversight Committee (LEI ROC) published a highly controversial preliminary report.GLEIF is overseen by the LEI ROC, a group of more than 70 government agencies around the world who have joined forces to promote transparency in the global financial markets. The report confirms that “the FSB’s Global LEI System is now fully managed by the public sector” and that “all operating LEI issuers are now GLEIF accredited by in line with the contractual framework that establishes the role of GLEIF in setting the technical standards of the system and overseeing LEI issuing organizations. “This document also provides a report on government action to confirm that authorities in countries represented on the LEI-ROC “have implemented at least 91 regulations using LEIs, which is described in this report. […] Examples of LEI use in one or more countries include:

• Mandatory reporting of [involved in transactions] of the parties [and their intermediaries], which, among other benefits, simplified the collection of data relating to the same legal entity.
• Optimization, especially in the context of cross-border or cross-sectoral transactions, the comparability of data provided by banks, insurance companies and other financial institutions.
• Providing more detailed information about assets in securities and enabling investors to more efficiently conduct their own analysis of these assets. ”

When looking at opportunities to expand the LEI system, the report states that “standards makers and different countries can use an LEI strategy that suits their needs,” and details four example strategies:

1. An increase in the number of rules and regulations requiring the use of LEIs, as well as an increase in the number of countries in which such rules apply.
2. Implementation of LEIs as a universal identifier in some countries.
3. Voluntary acceptance of LEIs by market participants.
4. Promote increased LEI issuance.

The report also suggests that automation may be “a potential opportunity to further reduce fees,” and that by using the “LEI agent model”, “the costs associated with issuing codes can also be reduced through the massive cost savings provided that the banks have already received documents from their clients in accordance with the requirements of the expertise “Know Your Client (KYC)” “.In addition, the report states that “matching LEIs with other identifiers would increase their value to end users, facilitate interoperability with other systems, optimize data validation and quality, and possibly also enable users to reduce their costs.”

Market expert, MLex Financial Services , noted that “in Europe, the number of issued LEIs significantly exceeds the number in the United States due to the long-term implementation of government standards” […] “According to the latest data, there are four and a half times more companies in the European Union, that have received identification codes for legal entities than in the United States, which gives Europe more tools to control the risks that banks and funds may be exposed to. “

Financial Stability Board: Board peer review in Hong Kong has completed Phase I country assessments

In February 2018, the Financial Stability Board (FSB) published its peer review for Hong Kong, which completed the first round of assessments in the selected countries of the Board. “During the peer review in Hong Kong, two topics related to financial stability were considered: reforms in the over-the-counter (OTC) derivatives market and a framework for restructuring financial institutions.The main objective of the assessment was to examine the measures taken by the regulatory authorities to implement reforms in these areas. ” While the peer review showed “significant progress in recent years on both topics”, it also “demonstrated that more work needs to be done: with regard to reforms in the OTC derivatives market, [should] actively promote the use of legal identification codes. persons in trade reporting ”.

The Hong Kong Monetary Authority and the Hong Kong Securities and Futures Commission consulted on further improvements to the OTC derivatives regulatory regime

In June 2018, the Hong Kong Monetary Authority (HKMA) and the Hong Kong Securities and Futures Commission (SFC) issued a joint consultation opinion on further improvements to the Hong Kong OTC derivatives regulatory regime.Based on market analysis, the use of LEIs in trade reporting will be mandatory to identify only those entities associated with a reporting entity involved in a transaction. This requirement applies to reports of new transactions and daily value information and becomes effective April 1, 2019.

Reporting entities must continue to report their counterparties on transactions in accordance with a range of identifiers specified in the supplementary reporting instructions for OTC derivatives transactions.At the same time, reporting entities are expected to establish a process for requesting LEIs from their clients. Regulators will work closely with reporting entities and monitor international developments to assess the need for additional requirements in this area.

Reserve Bank of India: LEI for corporate market participants

In April 2018, the Reserve Bank of India (RBI) released a statement through the media that outlined a range of broadening and regulatory measures that, among other things, are intended to strengthen regulation and control over the bank’s financial operations.Specifically, clause 8 of this statement refers to the use of a “legal entity identification (LEI) code by corporate market participants”. Here, the LEI is “seen as a key measure to improve the quality and accuracy of financial data processing systems to better manage markets in the aftermath of the global financial crisis.” The statement said that “RBI has already implemented the LEI for all over the counter (OTC) derivatives market participants that transact interest, currency and credit derivatives.This also applies to large corporate borrowers. As a follow-up to this initiative to improve transparency in financial markets, we propose implementing an LEI mechanism for all transactions that corporate clients make in interest rate, foreign exchange or credit derivatives markets. ”

In June 2018, RBI Bank issued preliminary guidelines for the “mandatory use of a legal entity identification code for participation in non-derivative markets” and invited banks, market players and other interested parties to provide their comments by June 30, 2018.

United States of America: The Financial Research Authority consulted on a proposed rule to consolidate the collection of data on centrally settled transactions in the US sell-back agreement market

In July 2018, the Office of Financial Research of the US Treasury began consultation on “a proposed rule to consolidate the collection of data on centrally settled transactions in the US sell-back agreement market.[…] The Office has published a summary of the preliminary data collection on interagency bilateral repo agreements, noting the difficulties in dealing with such data due to the lack of standardized information on counterparties. ”

The Office proposes to make LEI reporting mandatory. “The specified LEI must be active, that is, valid and containing the latest information in accordance with the standards set by GLEIF.The Office believes that while the mandatory LEI may incur additional costs, it is reasonable and appropriate to use it as it increases transparency and improves the controls provided and the effectiveness of the bid. […] Each legal entity that interacts with an eligible report reporter will need to obtain only one LEI regardless of the number of transactions reported. […] Mandatory use of the LEI will also be beneficial for companies and regulators, as it will allow the repo information to be combined with other information necessary to control the risks of the system or company [ ss ].This point is especially important as more than 1 million companies have received the LEI and therefore can already take advantage of all these benefits. For the financial services industry, the combined economic impact of widespread use of LEIs is estimated to be in the hundreds of millions of dollars. ”

The Ontario Securities Commission issued updated LEI requirements

In April 2018, the Ontario Securities Commission (OSC) reminded derivatives market participants to obtain an LEI in accordance with Rule OSC 91-507 on the reporting of derivatives and trading repositories.This rule “requires reporting counterparties and specialized trade repositories (DTRs) to identify all counterparties involved in transactions using LEIs […] in accordance with the standards set out in the Global Legal Entity Identification Code System.” Commenting on the need to comply with this rule, the OSC commission also “hopes that the operational difficulties associated with obtaining LEIs from counterparties, which arose in the early stages of implementing this rule, are minimized and are no longer a serious obstacle to the provision of this information.”

The OSC will continue to monitor progress in the use of LEIs in other countries, and in the short term will focus on “monitoring the failure to provide LEIs when counterparties are in countries where LEI reporting is mandatory and there are no legal barriers to provide this information. ”

In a blog post commenting on this story titled “No LEI, No Hope,” the International Business Reporting Organization, XBRL, strongly supported the use of the LEI: “LEIs enable regulators to greatly simplify the identification of legal entities.Today, with over 1.2 million LEIs issued to companies in the financial sector, this global identifier is the most appropriate solution for regulatory reporting worldwide. […] Just as it took the world a while to get domain names and build corporate websites, filling out this global corporate phone book will also take some time. Today in many areas the rule is “No LEI – no trading”.And soon it may change to “No LEI – no hope.”

Investment Industry Regulatory Organization of Canada re-published amendments to Client IDs

In June 2018, the Investment Industry Regulatory Organization of Canada (IIROC) launched a second round of public consultations to expand the use of Client IDs to ensure financial market compliance, investor protection and risk mitigation in electronic commerce, while minimizing its impact. for investment companies.The proposed changes “would require customer IDs for every order sent to the trading floor and for every securities trade reported in IIROC. Customers representing organizations will need to provide an LEI, while private customers will need an account number. ”

“The proposed Client IDs will enable IIROC to better protect investors from potential market manipulation,” said Victoria Pinnington, IIROC Senior Vice President, Market Regulation Specialist.“We are committed to working with industry to analyze the results and costs of the revised proposal and determine the best way to implement the rules.” Comments regarding the above proposal can be sent by September 26, 2018.

European Union: European Securities and Markets Authority announced the end of the transitional LEI agreements under MiFID II and MiFIR

On June 20, 2018, the European Securities and Markets Authority (ESMA) confirmed that the duration of the transition agreements established in accordance with the revised Markets in Financial Instruments Directive and Regulation (MiFID II and MiFIR), which were introduced in December 2017 , “Will no longer be extended.”The MiFID II Directive and the MiFIR Regulation entered into force on January 3, 2018. According to the ESMA council, the temporary six-month period “will last until July 2, 2018 inclusive.” On December 20, 2017, representatives of the ESMA Council stated that it provided “a temporary period of six months during which investment companies can provide a particular service, which requires the mandatory provision of a transaction report, to a client from whom they have not previously received a code LEI, provided that, prior to providing this service, the investment company obtains the necessary documentation from this client in order to apply for an LEI on his behalf. “ESMA and government authorities “have concluded that there is no need to extend the initial six-month period provided for a smooth transition to LEI as required by MiFIR.” According to MiFIR, all investment companies are required to obtain LEIs from their clients before providing services that involve the provision of relevant statutory reporting.

Verena Ross, Executive Director of the ESMA Council: “Many stakeholders are now demanding that the LEI become a standard European-wide identifier that can be used for any regulatory purpose.”

On June 27, 2018, in her speech “MiFID II Directive – An Important Step for LEIs,” Verena Ross, Executive Director of the European Securities and Markets Authority (ESMA), stated: a technical challenge, they are extremely important for financial markets – and not only for regulators, but for all investors. ”

“In the aftermath of the financial crisis, improving transparency in financial markets has become a major challenge in extensive regulatory reforms around the world.The MiFID II Directive is one of the key drivers of these reforms for the EU financial markets. ” ESMA Council Executive Director Ross also stressed that the MiFID directive rules “mean that all clients of EU investment companies must obtain an LEI. In other words, the No LEI – No Bidding Rule has been introduced, which prohibits EU companies from following the instructions of customers who do not have an LEI. This means that the LEI is becoming a must for customers who want to enter the EU markets. ”

She concluded by saying: “I would like to emphasize that while it will take some effort in the beginning, the harmonized use of LEIs under various EU regulations also has a tangible positive effect on the entire industry through simplified operations and ultimately Reduced compliance costs. Now, many stakeholders are demanding that the LEI becomes a standard European-wide identifier that can be used for any regulatory purpose. “

The Bank of England is consulting on the reorganization of its real-time gross settlement system, including the feasibility of using the LEI – the “best corporate identifier”

In a speech on June 21, 2018, Mark Carney, Governor of the Bank of England, mentioned among other topics the “reorganization of the Real Time Gross Settlement System (RTGS) – the core element of all payments in the UK”. Governor Carney noted that “as we are completely changing the RTGS system, the Bank of England is committed to making it easier for the UK financial system to understand the full potential of big data.The new RTGS will store significantly more information about each payment made in a format that is a defining factor of international best practice. The Bank is currently discussing ways of solving this problem, including the feasibility of using the best corporate identifier – the legal entity identification code (LEI) ”.

“This will simplify access to the domestic and global financial system, help make smart choices and stimulate competition for corporate end users, and provide new tools to combat money laundering and terrorist financing,” added Governor Carney.

Center for Global Development Issues Anti-Money Laundering Report: Can New Technologies Avoid the Risk Mitigation Dilemma?

In February 2018, the Center for Global Development (CGD) published a report entitled “Combating Money Laundering: Can New Technologies Avoid the Risk Mitigation Dilemma?” This report, according to its author, is the first comprehensive attempt to assess the potential of six emerging technologies to address the “risk mitigation” challenge of anti-money laundering and counter-terrorist financing measures identified in a 2014 CGD report.Technologies include KYC tools, big data, machine learning, distributed ledger technology, biometric identification techniques and, notably, LEIs. The report argues that these “new technologies (already in use and emerging) have the potential to make it easier to comply with anti-money laundering and counter-terrorist financing measures, which in turn could make it easier for banks to calculate costs and benefits and increase the likelihood of servicing customer correspondent accounts. in undeveloped countries ”.

With regard to LEIs, the CGD report says: “The next step in the proliferation of LEIs would be to include them in payment messages to identify the originators of payments and their recipients, which would increase the transparency of international financial transactions. However, this requires adjusting the formats of payment messages and changing the IT systems of banks, as well as wider use of LEIs outside the financial sector and their implementation in developing countries. “The report also states that only “legal entities (banking institutions, non-financial companies, government agencies and non-profit organizations) can apply for an LEI. Individuals cannot receive this code, […] except in cases when they carry out commercial activities, for example, as an individual entrepreneur. […] Since LEIs are not intended for individuals, a separate standard needs to be created to identify individuals involved in financial transactions. “However, in the future, “LEIs could be used to identify senders and recipients of payments, making the Know Your Customer expertise easier and more accurate.”

The report also provides an overview of the steps that regulators, senior management and standard-setting bodies are taking to facilitate the proper use of LEIs to combat money laundering and terrorist financing, including a link to the GLEIF campaign that invites financial institutions to become “registration agents”. that is, helping legal entities gain access to the LEI issuing network.It also provides a number of useful advice to a wide variety of stakeholders, including standard-setting bodies and ISO along with regulators, banks and financial institutions.

The Financial Stability Board published preliminary report on the decline in activity in correspondent banking

In March 2018, the Financial Stability Board (FSB) published a preliminary report with an action plan for the Board to assess and promote activity in correspondent banking.This report describes the steps taken to implement the FSB’s four-point action plan following the July 2017 update, and highlights the importance of further LEI implementation: infrastructures], such as Know Your Customer forensics tools, a recently published proposal to include legal entity identification codes in payment messages and the standards for using those messages. ”

GLEIF is partnering with the Financial Stability Board in a second discussion on how to manage a Unique Product Identifier (UPI)

In April 2018, the Financial Stability Board published a second advisory article inviting comments on best practices for managing a Unique Product Identifier (UPI), which is a key data element for reporting transactions in the OTC (OTC) derivatives market.The discussion is based on the 2014 feasibility study on the collection of data on transactions in OTC derivatives, which “indicated that regardless of decisions regarding data collection at the global level, work needs to be completed on the standardization and harmonization of important data elements, including through the global implementation of legal entity identification codes (LEI) and creation of a unique transaction identifier (UTI) ”.

In May 2018, GLEIF participated in this discussion, providing information on a range of funding issues, partnership models, and UPI reference data libraries.GLEIF advised that “the management of Unique Product Identifiers, or UPIs, should be done with the collaboration of government and non-government agencies.”

GLEIF invited the Data Foundation to represent it in the US

In April 2018, the Data Foundation announced that GLEIF had invited it to represent it in the United States, “acting as an intermediary for the transmission of information and working to create an expanding network of government entities that use LEIs to control their accountable entities.”

The

Data Foundation is the first organization in the United States to research open data. Providing services related to research, education and programming, Data Foundation helps to publish official information in the form of standardized open data.

The Global LEI Index is the only publicly available online resource that offers open, standardized and rigorously reviewed legal entity reference data. By doing this, GLEIF helps individuals, companies and governments make smarter, more efficient and reliable decisions about who to do business with.The practical effect of this activity can be observed all over the world. Partnering with the Data Foundation will help share the benefits of global LEI distribution and create a formal network of partners for interoperable data standards in the United States.

Permanent link to this article:
https://www.gleif.org/ru/newsroom/blog/legal-entity-identifier-news-july-2018-update

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