Urinary Tract Infection (UTI)
A urinary tract infection (UTI) starts when bacteria travel into the urethra and ascend up to the bladder. If not treated with antibiotics, the bacteria can travel farther along the tract, through the ureters and all the way into the kidneys.
12-13 million.
50% of women experience at least one UTI in a lifetime. Men experience UTIs as well, but at a much lower rate (8 women will experience a UTI for every 1 man who does).
Can lead to kidney damage or sepsis—or premature birth when present in a pregnant mother.
Symptoms
What are the most typical symptoms for UTIs?
Urinary urgency, frequency, and burning are the most prevalent UTI symptoms. Cloudy, malodorous urine or blood in the urine are also not uncommon. In addition, women often describe a sensation of not being able to fully empty their bladder when they urinate.
Does it matter if people have different combinations of symptoms?
There is no single symptom required for a diagnosis of UTI. Some individuals experience a constellation of symptoms, while others have just one vague sign (like cloudy urine). We don’t know exactly why some people have more severe symptoms than others; it’s likely just individual variation.
Why are men’s and women’s UTIs approached and treated differently?
Men have a much lower incidence of UTIs than women, primarily because of anatomical differences (it’s easier for bacteria to enter and ascend the urinary tract in a woman than a man). The initial choice of antibiotics for UTIs can sometimes differ by gender, depending on whether a provider suspects that a patient’s prostate is involved in the infection.
What about other demographics?
UTIs in pregnant women are a risk factor for premature birth, so they should be closely evaluated. Repeat testing should be performed after antibiotic treatment to make sure the infection has resolved.
UTIs in the elderly are common, and often develop without classic symptoms. If left untreated, they can progress into a condition called urosepsis, which is an infection of the blood that can be fatal.
Recurrent UTIs in children warrant evaluation for anatomical abnormalities in the urinary tract, including the kidneys. People with prior bladder surgeries or other conditions that affect their urinary tract may also be vulnerable to more frequent and severe infections.
What factors warrant closer attention or a different approach to treatment?
If bacteria ascend through the entirety of the urinary tract and into the kidneys, the infection warrants close attention. A kidney infection (the medical term is pyelonephritis) requires a specific type of antibiotic, and can lead to a very dangerous condition called sepsis if not treated. The hallmark of pyelonephritis is back pain, and it is often accompanied by fever.
Does having blood in the urine mean it’s a more serious infection?
No. When tissue lining the urinary tract becomes inflamed and irritated--as can happen with even a mild infection—it can bleed, and that blood then appears in the urine. In patients who have blood in their urine related to a UTI, it’s a good idea to do a urine test six weeks after treating the infection to make sure the blood is gone.
If blood is present in the urine without any associated signs or symptoms of a UTI, it’s important to talk to a healthcare provider to make sure that the bleeding isn’t due to a different cause. Rarely, blood in the urine (without any other symptoms) can be a sign of a more serious condition, such as bladder cancer.
Other Diagnoses
What are other conditions that you consider when someone has symptoms that could be a UTI, but you’re not sure?
Genital STIs (sexually transmitted infections) typically cause vaginal or penile discharge, but sometimes urinary burning is the only symptom. If an individual has had recent unprotected sex with a new partner, or is in a non-monogamous relationship, it’s a good idea to check for the presence of an STI when evaluating painful urination.
Ureaplasma/mycoplasma are bacteria commonly found in the genital tracts of men and women. They’re not always symptomatic (and it’s not necessary to treat them it if no symptoms are present). If a standard urine culture doesn’t detect anything, specific testing can be performed for ureaplasma/mycoplasma.
Bladder pain syndrome (formerly known as interstitial cystitis) is a term used when someone has symptoms of a UTI without the presence of bacterial infection. It’s typically chronic and recurrent, and the underlying cause is poorly understood. Because it’s not infectious, antibiotics are not warranted (nor are they helpful). Symptoms often improve with lifestyle interventions, such as the avoidance of bladder irritants (e.g., caffeine, alcohol), bladder training, and pelvic physical therapy.
Prostatitis is an infection of prostate, so it occurs in men only. Symptoms include pain with urination, blood in urine, cloudy urine, and fever/chills. Many of the same antibiotics that are used for UTIs can be used for prostatitis, though the duration of therapy is much longer (up to six weeks).
A kidney stone can sometimes cause symptoms similar to those of a UTI. The most common one is blood in the urine, often accompanied by back pain, and sometimes lower abdominal pain and and a need to urinate more frequently.
Bladder cancer is rare among younger patients; the average age of diagnosis is 73. The typical presenting symptom is painless hematuria (blood in urine), and occasionally other urinary symptoms (frequency, urgency, burning).
Testing and Treatment
Is testing always needed?
No. If symptoms are mild and straightforward—particularly if a patient has been treated successfully for a UTI in the past—antibiotics can be prescribed without a test.
When is testing most helpful or important?
Testing is helpful when a patient has symptoms of a UTI for the first time. In that case, it’s a good idea to make sure that’s what is really going on.
It’s also useful to test a person’s urine if they have recently been treated for a UTI and their symptoms return despite a full course of antibiotics.
Lastly, if someone thinks they may have been exposed to an STI (specifically, gonorrhea or chlamydia), their urine should be tested--some STIs can cause the same symptoms as a UTI. It’s also important to test those who are at risk of complications or more serious infections.
What are the best UTI medicine and what is a typical course of treatment?
The type of antibiotic used is selected based on which is most likely to work; if it doesn’t work, alternative antibiotics can be tried. A course of antibiotics typically lasts three-to-five days. It’s important to finish the entire course, even if symptoms have resolved.
If someone has a UTI, are there other treatment options besides antibiotics?
Unfortunately, no. A UTI is a bacterial infection that requires antibiotic medication for eradication of the microorganism causing the infection.
Prevention
Why are some women more prone to UTIs than others?
The reason for proclivity to UTIs is unclear, but it likely has something to do with the nuances in an individual’s anatomy. It may also be related to a person’s microbial balance. Science is uncovering more and more about the importance of healthy bacteria in a person’s system.
When do you recommend considering preventive treatment for recurrent UTIs?
There’s no hard and fast rule, but for women who frequently develop UTIs after sex, an antibiotic regimen called postcoital prophylaxis is an option worth considering. Many women find that taking one low dose of an antibiotic after sex effectively prevents recurrent UTIs.
Are there options for how to avoid UTIs besides antibiotics for prevention?
Some healthy lifestyle interventions include maintaining adequate hydration throughout the day, employing good hygiene measures (wiping front to back), and urinating after sex (there’s no great evidence to support postcoital voiding, but it makes sense and will not cause harm).
When (if ever) are cranberry, D-mannose, or probiotics useful—and what is the evidence?
Large-scale clinical trials have show neither cranberry juice nor D-mannose to be effective for the treatment or prevention of UTIs. That said, it’s probably ok to try one or both (or another alternative approach) in the early stages of developing symptoms–or for prevention in women who experience frequent infections. If symptoms worsen or persist beyond two days, consult with a healthcare provider.
There is some controversy over the role of probiotics. Recent studies have identified differences in the urinary microbiota between healthy populations and those with frequent UTIs and other urinary conditions. It’s still unclear if supplementing with probiotics can lower infection rates, but they may be worth considering as a first step to help regulate the healthy balance of bacteria in women prone to infection.
Is there anything else that you’ve found to be effective for women with UTIs?
In people who are able to detect early symptoms, some find that significantly increasing water intake at the earliest sign of a UTI may dissipate symptoms and stop a full infection from developing, as it flushes the bacteria out. Pyridium, a bladder pain relief medication, can be used in conjunction with (but not in place of) antibiotics to help alleviate symptoms during the first several days of antibiotics.
Related Topics
How can I treat a UTI at home?
Can a UTI go away on its own (without antibiotics)?
Is there a difference between a bladder infection and a UTI
Useful Links
UTI facts (US Dept of Health & Human Services)
Probiotics/cranberry for UTIs (University of Colorado Urogynecology)
UTI prevention (Harvard Health)
Connect with our physicians
Jamila Schwartz, MD and Nora Lansen, MD are both members of the Galileo Clinical Team. Connect with one of our physicians about Urinary Tract Infection (UTI) or any of the many other conditions we treat.