UTIs are one of the most common human bacterial infections. Although they could affect anyone, women are at greater risk.

Urine in the bladder does not typically contain infectious bacteria or organisms. A urinary tract infection (UTI) is defined as a positive culture (greater than 100,000 colony forming units per milliliter) that was appropriately collected in combination with bothersome symptoms (urgency, frequency, burning, lower abdominal pain).

Symptoms of UTIs can include:

  • Cloudy, malodorous urine
  • Burning sensation when passing urine
  • Frequently passing small amounts of urine
  • Urgency with urination or unable to hold urine resulting in urine leakage
  • Pelvic pain or discomfort in the lower abdomen
  • Nausea
  • Fever, chills, shaking
  • Back pain

UTIs may involve the lower urinary system including the bladder and urethra causing cystitis. When UTIs involve the kidneys it is called pyelonephritis and is a more serious infection associated with more severe systemic symptoms. UTIs that occur in younger healthy women are termed uncomplicated UTIs while those occurring in men, the elderly, or patients with abnormalities of their urinary systems are called complicated UTIs.

Recurrent UTIs are those that recur twice in 6 months or three times in 1 year and recur at least 2 weeks after initial successful treatment.

Causes and Risk Factors

Although there are several routes by which bacterial cells can enter the urinary tract, the most common is by ascending up from the urethra. The organisms that cause urinary tract infections include bacteria, fungi, parasites and viruses. Conditions that place patients at higher risk for UTIs include:

  • Menopause
  • Diabetes
  • Kidney stones
  • Other anatomical or functional abnormalities of the urinary system.

When to Speak with a Urologist about Urinary Tract Infections

Although simple UTIs in young healthy women can be managed by primary care doctors, patients other than young healthy women with UTIs should speak with a Urologist. You should also talk to a Urologist if you experience recurrent UTIs.

What to Expect when Seeking Treatment

In addition to a history and physical examination, initial assessment includes obtaining a urine sample for urinalysis and urine culture to check for presence of infection. Complicated or recurrent UTIs require further assessment with postvoid residual and renal-bladder ultrasound as well as possible cystoscopy to evaluate for dysfunctional voiding, urolithiasis, and anatomic abnormalities of the urinary tract.

Treatment Options

Antibiotics are the mainstay of treatment for UTIs. The specific choice of antibiotic depends on the given clinical situation. However, common antibiotics for uncomplicated UTIs may include nitrofurantoin twice daily or Bactrim DS twice daily for 3-5 days. Complicated UTIs may be treated with Levaquin or Bactrim DS for 7-10 days.

For recurrent UTIs in premenopausal women, additional treatments may be helpful. The use of Lactobacillus probiotic can normalize vaginal flora and oral D-mannose supplementation with cranberry supplement can prevent bacterial adherence in urinary tract. Furthermore, spermicides should be avoided to maintain vaginal pH. If associated with sex, an additional option includes a single prophylactic dose of nitrofurantoin 100mg following intercourse. Further options are self-start therapy with pre-prescribed antibiotic course or longer-term prophylaxis with low-dose daily cefazolin 100mg or nitrofurantoin 50mg daily for 6 months.

For recurrent UTIs in postmenopausal women, vaginal estrogen supplementation with topical cream in addition to cranberry extract supplementation can greatly decrease UTI recurrence. Additionally, Hiprex is a non-antibiotic medication that can be used to help prevent repeat infections.