URINARY TRACT INFECTIONS

The term “Urinary Tract Infections” (UTIs) encompasses a wide range of clinical manifestations, from asymptomatic presence of bacteria in the urine to severe sepsis which can be life-threatening.

Depending on the location where urinary tract infections are detected, they are classified into:

  • Upper urinary tract infections (kidney, pelvis)
  • Lower urinary tract infections (bladder, urethra)
  • Reproductive tract infections (testicles, epididymis, prostate)

The classification has validity up to a point, given there is always the possibility of a localized infection spreading throughout the reproductive system.

Causes

Normally, the microorganisms entering the urinary tract via the urethra are excreted with voiding, without causing any symptoms.

However, when bacteria manage to overcome the defense mechanisms of the body, infection develops.

Typically, it is attributed to microorganisms commonly found in the bowel.

Escherichia coli (E.coli) is by far the most common pathogen responsible for urinary tract infections.

Risk factors

Risk factors contributing in the development of urinary tract infections include:

  • Poor hygiene
  • Sexual practices
  • Diabetes mellitus
  • Voiding postponement
  • Constipation
  • Neurological disorders
  • Use of contraceptive diaphragm
  • Urological catheter

Recurrent urinary tract infections

Women are particularly susceptible to urinary tract infections.

This is due to the short length of the female urethra and its location in relation to the vulva and anus, where normally a lot of microbes are present.

  • 50% of women will suffer at least one episode of urinary tract infection at some point in their life
  • After the first episode, 20% of these women will suffer recurrent urinary tract infections

A urinary tract infection occurring within two weeks after the end of the treatment and attributed to the same microorganism is called recurrent urinary tract infection.

Symptoms

Symptoms differ according to patient age and gender and can include the following:

  • Frequent voiding
  • Burning sensation during voiding
  • Lower abdominal pain
  • Hematuria
  • Fever (it may indicate the presence of kidney or prostate infection)

The disease requires immediate administration of medication or even hospitalization.

Diagnosis

The following are needed:

  • urinalysis: to detect any microbes or pyocytes in the urine
  • urine culture: it takes 48 hours for the results
  • antibiogram: to determine the antibiotic sensitivity of the microbes
  • additional tests may be required, such as an ultrasound

Treatment

Urinary tract infections caused by bacteria are managed with antibiotics.

If another urinary tract disease co-exists, such as prostate hypertrophy or bladder lithiasis, it should also be managed, subsequent to treatment for the urinary tract infection.

General preventive measures against urinary tract infections

  • avoidance of voiding postponement
  • adequate hydration throughout the day
  • voiding immediately after sexual intercourse
  • proper hygiene of the genital area

Apart from the general measures, treatment may include (depending on the case):

In women

Chemoprophylaxis, i.e. low doses of antibiotic medication for 6 months or more

Antibiotics taken prior to or after sexual contact

If a urinary tract infection develops during pregnancy, treatment is imperative since it entails risks both for the mother and the fetus.

Special care must be taken with antibiotics, because some are not safe when administered during gestation.

In men

In case of prostatitis, antibiotic medication may be required for three weeks up to 6 months.