Urinary tract infections (UTIs) occur when bacteria is present within the urinary tract in significant numbers. UTIs are common in women, with 1 in 5 adult women aged 20-65 years experiencing a UTI at least once a year. Approximately 50% of women will experience UTIs at least once in their life.
Cystitis (bladder infection) makes up the majority of these infections. Involvement of the upper urinary tract (pyelonephritis) is less common compared to that of cystitis but can be associated with more serious complications.
If UTI is left untreated, the infection can spread upwards to the kidneys, causing infection in the kidneys and even renal failure. It can also spread via the blood stream (septicaemia) to affect the body in general, which may be fatal.
The onset of UTIs can be associated with one or more of the following symptoms:
As UTI is a common occurrence in women, one should be aware of its symptoms. If you have any of the above symptoms, it is advisable to see a doctor early. Early recognition and appropriate treatment is necessary to prevent complications.
Although UTIs can be easily treated with antibiotics, the prevention of UTIs or the avoidance of further infection is more important.
About 25% of women with acute cystitis develop recurrent UTIs. Most recurrent infections are from bacteria present in the faecal or periurethral reservoirs. Some strategies can be undertaken to reduce the risk of recurrent infections.
In 80-90% of cases of uncomplicated cystitis, Escherichia coli (E. coli) is involved. This bacteria is present in 70-95% of both upper and lower UTIs. Other common pathogens are Enterococcus faecalis, Klebsiella species, Proteus species and yeast.
The largest group of patients with UTIs is adult women. Women are more prone to UTIs than men because in females, the urethra is much shorter and closer to the anus.
The occurrence of UTI also varies with age. The incidence of UTI is ten times higher in adolescent girls as compared with boys and this continues throughout adult life.
Other predisposing factors include:
The diagnosis of a UTI can be suspected from a well-taken history and physical examination.
Specific tests to confirm a UTI include a urine dipstick, urine analysis and urine culture. The main emphasis lies with the detection of pyuria (white blood cells or pus cells in the urine) on dipstick and urine analysis.
Associated findings can include microscopic haematuria (blood in the urine which cannot be detected by the naked eye). A urine culture will help in the identification of the organism causing the infection.
No imaging studies are indicated in the routine evaluation of an uncomplicated cystitis.
Empirical antibiotics are usually prescribed for UTIs. The patient may be prescribed alternative antibiotics after the urine culture results are available.
The duration of treatment of the UTI depends on the antibiotic in use. Some common first-choice agents for the treatment of uncomplicated cystitis in women include nitrofurantoin, Bactrim or beta-lactams such as Cephalexin.
You may also be given medication to make the urine more alkaline and asked to drink more water.
Most patients can be treated on an outpatient basis. However, hospital admission for management of complicated UTIs may be indicated in some patients. Complicating factors include the presence of structural abnormalities (e.g., stones, indwelling catheters), metabolic disease (e.g., diabetes, pre-existing kidney disease) or patients who are immunosuppressed and therefore more prone to serious infections (e.g., HIV, patients on chemotherapy).
Recurrent UTI is defined as having UTI three or more times in a year. This can be due to the same or different bacteria. In these cases, further investigations may need to be done (e.g., renal ultrasound, intravenous pyelogram, cystoscopy, urine for tuberculosis and cytology) to look for any underlying causes and complications of recurrent UTIs.
Patients with recurrent UTIs may be given prophylactic antibiotics for a period of six months. They will also be advised on the various preventive measures and the importance of keeping good personal hygiene.