Half of all women report at least one Urinary Tract Infection before their mid-thirties. Consultant Urological Surgeon Marco Bolgeri , at The Princess Grace Hospital, part of HCA Healthcare UK reveals the symptoms to look out for and what treatments are avai
Urinary Tract Infections (UTI’s) are one of the most common problems affecting patients. UTI’s are also the most common cause of infection in hospitalised patients in the UK.
In fact, it is estimated that half of all women report at least one urinary tract infection by their mid-thirties, with recurrence rates of 25 to 50 per cent within six months, which further increases in cases with more than one prior urinary tract infection.
The incidence of UTI symptoms in men is considerably lower than that in women, nevertheless with an estimated life- time prevalence of 13.7 per cent.
What is a UTI?
Women aged under 65 years are diagnosed with a urinary tract infection (UTI) if they have two or more key urinary symptoms and no other excluding causes or warning signs.
Key symptoms include:
- dysuria (burning pain when passing urine)
- new nocturia (passing urine more often than usual at night)
- cloudy urine (urine cloudy to the naked eye)
Other symptoms may include frequency and urgency, suprapubic pain.
Other excluding causes are other possible genitourinary causes of urinary symptoms, such as vaginal discharge, urethritis (urinary symptoms may be due to urethral inflammation post sexual intercourse, irritants, or sexually transmitted infection) and genitourinary symptoms of menopause/atrophic vaginitis/vaginal atrophy.
Warning signs are signs of upper urinary tract infection (pyelonephritis) or sepsis (such as loin pain, temperature >38°C, rigors) and possible signs of cancer such as haematuria.
Urinary Tract Infections (UTI’s) are one of the most common problems affecting patients
A recurrent UTI is defined as repeated infection with a frequency of two or more UTIs in the last six months, or three or more UTIs in the last 12 months. A recurrent UTI may be due to relapse (with the same strain of organism), or reinfection (with a different strain or species of organism).
Persistent or chronic UTI defines those patients who have chronic UTI symptoms despite initial antibiotic treatment.
Mental Health and UTI’s
Not only are UTI’s physically frustrating and uncomfortable, but they can also play havoc on your mental health.
Lower physical and mental health scores have been recorded in patients experiencing UTIs when compared to unaffected controls, with negative emotional responses including anxiety and depression.
Patients often miss work, study and social commitments, or can’t function at their best due to the symptoms (pain, urinary frequency) but also the embarrassment of frequent toilet visits or a potential accident.
Difficulties in accessing the doctor for treatment, including the need to take time off work and the long waits, can also cause additional stress and frustration, and ultimately resulting in patients avoiding or delaying seeking medical help.
Patients often miss work, study and social commitments, or can’t function at their best due to the symptoms
Patients with recurrent UTI symptoms reported not feeling listened to when it comes to discussing management options with doctors who may not be familiar with their cases and possibly suggest treatments that have not previously worked, adding to frustration and avoidance of medical care.
What to tell the doctor is you suspect you have a UTI…
The information offered to the doctor should include the specific symptoms experienced, the number of occurrences and the duration of symptoms and which treatment, if any, had been tried and with what response.
Past medical and surgical history and drug history are also important to establish possible underlying risk factors and causes of infection.
information offered to the doctor should include the specific symptoms experienced
Lifestyle habits in terms of hygiene practice but mostly sexual and gynaecological history should also be discussed. The presence of vaginal discharge or vaginal irritation substantially reduces the probability of a UTI, and vaginal infections and some sexually transmitted diseases can mimic UTI symptoms.
More worrying symptoms and signs suggesting more serious infection or possible cancer (in particular haematuria) should be reported as likely to need urgent secondary care referral.
Similarly, men with a recurrent UTI, and women with a recurrent lower UTI where the cause is unknown or a recurrent upper UTI are referred for specialist advice.
How are UTI’s treated?
Non-pharmacological management includes behavioural measures such as hygiene practices (wiping front to back and avoiding strong/scented intimate detergents), voiding before/after sexual intercourse and refraining from contraceptive methods that include spermicide creams.
Adequate hydration and avoidance of constipation are also advisable.
Various non-antibiotic agents are available for prevention of recurrent UTIs. Some act by preventing bacterial adhesion to the urinary tract, like cranberry (both in tablet or juice form) or D-mannose.
Others block bacterial growth either directly (Methenamine hippurate) or by strengthening the natural defences (probiotics, topical estrogen). The scientific evidence regarding the majority of these is limited and often conflicting, and the cost to the patient not insignificant as usually not available on the NHS.
Similar considerations apply to other strategies such as intravescical instillations of glycosaminoglycan analogues and UTI vaccines, the latter being agents that stimulates the patient’s immune system against the most common uro-pathogens.
Antibiotics remains the main stem of UTI treatment
Antibiotics remains the main stem of UTI treatment. For acute uncomplicated UTIs in women, a 3-day course is recommended by the major guidelines, whereas more at-risk categories such as male patients and pregnant women warrant a 7-day course.
Complicated infections, as well as antibiotic treatment, require diagnosis and management of the underlying cause, common examples being urinary tract obstruction, stones or foreign bodies.
For recurrent or chronic UTIs, low dose antibiotic prophylaxis for 3 to 6 months is the most established regime, with reported reduction in the risk of infection up to 95 per cent.
The emerging challenge of multi-drug bacterial resistance has however highlighted the need to limit widespread antibiotic use, hence the development of the alternative agents mentioned above, but also alternative strategies such as post-coital prophylaxis (single dose of antibiotic immediately after sexual activity) or intermittent self-start therapy.
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