Urinary tract infection

Urinary System

Ask your ZCP: UTI
(Urinary Tract Infection)

A 24 year old woman university student came in with symptoms of burning on urination, blood in the urine and having to go to the bathroom frequently. These symptoms developed suddenly over the previous 24 hours and felt like her past urine infections. She has had 3 such infections since the age of 20.

This young woman presents with a typical constellation of symptoms indicating a urine infection. Urine tract infections (UTI) are one of the most common acute conditions experienced by adult women. When we say urine infection here, we mean an infection in the urine that is limited to the urinary bladder. Up to 60% of women have at least one UTI during their lifetimes.

The classic symptoms of a UTI include:

These symptoms can be bothersome to the point of limiting activity and preventing the patient from working.

Why do women get UTIs?

The main cause appears to be a combination of microbiology, anatomy, and certain risk factors. First the microbiology and anatomy: a UTI can occur when bacteria from the gastrointestinal tract reach the urethra, which is the tube leading from the bladder to the outside world. Once the bacteria reach the urethra, they can climb up and establish an infection in the bladder. In women, the rectum is very close to the urethra, which makes it easier for normal fecal bacteria to get into the bladder.

No, it's not pretty. But that's nature. Finally, certain normal behaviors increase the chance that the bacteria reach the bladder. One of the most important risk factors is sexual intercourse. Especially in younger woman, the number of urine infections appears to increase with the number of sexual intercourse events per week. However, it is important to understand that UTIs are NOT a sexually transmitted disease transmitted through sexual contact. Instead UTIs are caused by the woman's normal fecal bacteria reaching her bladder. This process appears to be facilitated due to sexual intercourse.

Another situation or condition that increases the chance of getting a UTI includes the use of spermicide-containing contraceptives. These spermicides appear to alter the normal protection against infection in woman. Diabetes, immune deficiency conditions, and previous frequency of urine infections also increase the chance of further infections. Finally, some people are just more predisposed to getting urine infections, because of genetics and anatomy.

Here we are concentrating on women getting an UTI. Men too may get urine infections. But because of obvious differences in anatomy, the approach and treatment is somewhat different. We will discuss their situation in future ZoomNews editions. (Children and pregnant women also deserve separate consideration).

How do doctors diagnose UTI?

UTI are diagnosed by a combination of interpreting the symptoms and performing a simple test. The main diagnostic approach is having a doctor assess the symptoms and perform an examination. Our patient above came in with the classic symptoms. But an astute doctor will remember that other conditions can cause similar symptoms.

Although UTIs are not alone dangerous they can lead to complications that can cause disability and even death. For that reason, if you experience symptoms like this, it could be that you have a urine infection, which should be evaluated and treated. The most common, serious immediate consequence of a urine infection is a kidney infection. This occurs when the infection in the urine of the bladder climbs up from the bladder and reaches the kidneys. Your doctor evaluates for this possibility even when you come in for a simple urine tract infection by asking about more serious symptoms, such as back pain, nausea, vomiting, high fever - that may indicate a kidney infection.

Simple urine tract infections are usually rapidly treated with oral antibiotics. In a woman with an uncomplicated UTI, a three-day course of an antibiotic is usually fully curative. The best options for a three-day course of antibiotic include, Trimethoprim-Sulfamethoxazole (Bactrim or Septra), or an antibiotic such as ciprofloxacin. The exact choice of an antibiotic will depend on patterns of antibiotic resistance in your area and the individual patient's condition and history.

With rapid diagnosis and effective treatment, the patient's symptoms started improving in one day and she was back to normal in three days. This is a very typical pattern. There are no complications or disabilities that occur due to a simple, acute urine infections in young woman like this. But some woman get frequent, recurring urine infections. What to do about these is a topic for future discussion.

- Dr. Albert DiPiero MD, MPH