Half of all women report at least one urinary tract infection by age thirty. Consultant urological surgeon Marco Bolgeri, at The Princess Grace Hospital, part of HCA Healthcare UK, reveals the symptoms to look out for and what treatments are available.
Urinary tract infections (UTIs) are among the most common problems faced by patients. UTIs are also the most common cause of infection in hospitalized patients in the UK.
In fact, it is estimated that half of all women report at least one UTI by age thirty, with a recurrence rate of 25-50 percent within six months, which increases further with more than one previous UTI. .
The incidence of UTI symptoms in men is significantly lower than in women, however, with an estimated lifetime prevalence of 13.7 percent.
What is a UTI?
Women under the age of 65 are diagnosed with a urinary tract infection (UTI) if they have two or more major urinary symptoms and no other exclusionary causes or warning signs.
The main symptoms include:
- dysuria (burning pain during urination)
- new nocturia (urinating more often than usual at night)
- cloudy us (cloudy us with naked eye)
Other symptoms may include frequency and urgency, postural pain.
Other possible causes of genitourinary symptoms such as vaginal discharge, urinary tract inflammation (urinary tract symptoms may be due to inflammation of the urinary tract after intercourse, irritants, or sexually transmitted infection) and genitourinary symptoms of menopause/atrophic vaginitis/abdominal atrophy are other exclusionary causes.
Warning signs are signs of upper urinary tract infection (pyelonephritis) or sepsis (such as low back pain, temperature >38°C, rigors) and possible signs of cancer such as hematuria.
Urinary tract infections (UTIs) are among the most common problems faced by patients
Recurrent UTI is defined as recurrent infection with a frequency of two or more UTIs in the past six months, or three or more UTIs in the past 12 months. A recurrent UTI can be due to a relapse (with the same strain of organism) or reinfection (with a different strain or type of organism).
Persistent or chronic UTI defines patients who have chronic UTI symptoms despite initial antibiotic treatment.
READ MORE. From Menopause to UTI Symptoms – A Doctor’s Guide to Everyday Women’s Health Concerns
Mental health and UTIs
A UTI is not only physically frustrating and uncomfortable, but it can also take a toll on your mental health.
Lower physical and mental health scores were reported in patients with UTI when compared to unaffected controls, with negative emotional responses including anxiety and depression.
Patients often miss work, school, and social obligations or are unable to function at their best because of symptoms (pain, urinary frequency) as well as frequent toilet visits or possible accidents.
Difficulties in seeing a doctor for treatment, including the need to take time off work and long waits, can also cause additional stress and frustration and ultimately lead to patients avoiding or delaying seeking medical care.
Patients often miss work, school, and social obligations or are unable to function at their best because of symptoms
Patients with recurrent UTI symptoms reported not feeling listened to when it came to discussing management options with doctors who may not be familiar with their cases and may have recommended treatments that have not worked in the past, increasing frustration. and avoiding medical care.
What to tell the doctor if you suspect you have a UTI…
Information provided to the physician should include the specific symptoms experienced, number of cases and duration of symptoms, and what treatment, if any, was tried and with what response.
Past medical and surgical history and medication history are also important to identify possible underlying risk factors and causes of infection.
Information offered to the physician should include specific symptoms
Lifestyle habits in terms of hygiene practices, but mainly sexual and gynecological history should also be discussed. The presence of vaginal discharge or vaginal irritation greatly reduces the likelihood of a UTI, and vaginal infections and some sexually transmitted diseases can mimic the symptoms of a UTI.
More worrisome symptoms and signs suggestive of a more serious infection or possible malignancy (particularly hematuria) should be reported as potential for urgent secondary care referral.
Similarly, men with recurrent UTI and women with recurrent lower UTI where the cause is unknown or with recurrent upper UTI are referred for specialist advice.
READ MORE. Feeling dry down there? A gynecologist reveals why collagen helps with vaginal dryness
How are UTIs treated?
Non-pharmacological management includes behavioral measures such as hygienic practices (wiping from front to back and avoiding strong/scented intimate cleaners), abstinence before/after intercourse, and abstinence from contraceptive methods that include spermicidal creams.
Adequate hydration and avoiding constipation are also recommended.
Various non-antibiotic agents are available to prevent recurrent UTIs. Some work by preventing bacteria from sticking to the urinary tract, such as cranberry (both in pill or juice form) or D-mannose.
Others block bacterial growth either directly (Methenamine hippurate) or by enhancing natural defenses (probiotics, topical estrogen). The scientific evidence for most of these is limited and often conflicting, and the costs to the patient are not negligible as they are not usually available on the NHS.
Similar considerations apply to other strategies, such as intravenous injections of glycosaminoglycan analogs and UTI vaccines, the latter of which are agents that stimulate the patient’s immune system against the most common uro-pathogens.
Antibiotics remain the mainstay of UTI treatment
Antibiotics remain the mainstay of UTI treatment. For acute uncomplicated UTIs in women, basic guidelines recommend a 3-day course, while higher-risk categories such as male patients and pregnant women warrant a 7-day course.
Complicated infections, as well as antibiotic treatment, require diagnosis and management of the underlying cause, such as urinary tract obstruction, stones, or foreign bodies.
For recurrent or chronic UTIs, low-dose antibiotic prophylaxis for 3 to 6 months is the most established regimen, with up to a 95 percent reduction in infection risk.
The emerging challenge of multidrug resistance in bacteria, however, has highlighted the need to limit the widespread use of antibiotics, hence the development of alternative agents mentioned above, as well as alternative strategies such as postcoital prophylaxis (a single dose of antibiotic immediately after sexual activity). or intermittent self-initiated therapy.
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