Urinary Tract Infections

Urinary Tract Infections (UTI)

Overview

A urinary tract infection (UTI) is an infection involving the kidneys, ureters, bladder, or urethra. These are the structures that urine passes through before being eliminated from the body.

Any part of this system can become infected. As a rule, the farther up in the urinary tract the infection is located, the more serious it is.

In the United States, urinary tract infections account for more than 10 million visits to medical offices and hospitals each year.

Causes and Risk Factors

The urine is normally sterile. An infection occurs when bacteria get into the urine and begin to grow. The bacterial infection usually starts at the opening of the urethra where the urine leaves the body and moves upward into the urinary tract.

The following people are at increased risk of urinary tract infection:

The following special groups may be at increased risk of urinary tract infection:

Symptoms of UTIs

Lower urinary tract infection (infections of the bladder or urethra)

Upper urinary tract infection (pyelonephritis, or kidney infection)

Symptoms develop rapidly and may or may not include the symptoms for a lower urinary tract infection.

In newborns, infants, children, and elderly people, the classic symptoms of a urinary tract infection may not be present. Other symptoms may indicate a urinary tract infection.

Pregnant women are at increased risk for an UTI. Typically, pregnant women do not have unusual or unique symptoms. If a woman is pregnant, her urine should be checked during prenatal visits because an unrecognized infection can cause pregnancy health complications.

Although most people have symptoms with a urinary tract infection, some do not.

The symptoms of urinary tract infection can resemble those of sexually transmitted diseases.

Diagnosis

Diagnosis of a urinary tract infection is based on information someone gives about his or her symptoms, medical and surgical history, medications, habits, and lifestyle. A physical examination and lab tests complete the evaluation.

A health care professional may simply perform a urine dipstick test in the office. Only a few minutes are needed to obtain results. Your health-care provider may also send a urine sample to the lab for culture testing (see below). These results take a few days to come back. This tells the doctor the exact bacteria causing the infection and to which antibiotics these bacteria have resistance or sensitivity. The culture is usually sent for special populations, including men, because they are less likely to get UTIs. It is not necessary to send a culture for everyone because the majority of UTIs are caused by the same bacteria.

For a culture specimen, the patient will be asked to give a clean-catch, midstream urine specimen. This avoids contamination of the urine with bacteria from the skin. Patients will be instructed in how to do this.

If someone cannot produce a urine specimen or is unable to follow instructions for a clean-catch specimen, a health-care professional may obtain a urine specimen by catheterization.

Depending on their symptoms, sexually active women could require a pelvic examination because pelvic infections can have similar symptoms as a urinary tract infection. Males will require a genital examination, and depending on the symptoms, most likely a prostate examination. A prostate infection (prostatitis) requires a longer course of antibiotics than a urinary tract infection.

Men will most likely require a rectal examination so that the prostate can be checked. A prostate infection (prostatitis) requires a longer course of antibiotics than a urinary tract infection.

Rarely, an imaging test may be indicated to detect any underlying problem in the urinary tract that could cause an infection. This is usually only necessary in repeat infections or special circumstances (unusual bacteria, suspected anatomic abnormalities).

Imaging tests are most often needed for the following groups:

Prevention

You can prevent getting another UTI with the following tips:

Treatment Options

The usual treatment for both simple and complicated urinary tract infections is antibiotics. The type of antibiotic and duration of treatment depend on the circumstances. Examples of common antibiotics used in treatment include, but are not limited to, amoxicillin, sulfamethoxazole/trimethoprim (Bactrim), ciprofloxacin, nitrofurantoin (Macrobid), and many others. Your health-care provider will chose the appropriate medication for your condition and the specific causative organisms.

Lower urinary tract infection (cystitis, or bladder infection)

Upper urinary tract infection (pyelonephritis)

A person may be hospitalized if he or she has symptoms of pyelonephritis and any of the following:

Urethritis in men and women can be caused by the same bacteria as sexually transmitted diseases (STDs). Therefore, people with symptoms of STDs (vaginal or penile discharge, for example) should be treated with appropriate antibiotics. Your doctor will have to evaluate you for STDs as well as UTIs if you experience any pain in the genital area.

Prognosis of UTIs

For people with uncomplicated cystitis or pyelonephritis, antibiotic treatment usually brings complete resolution of the infection.

If not treated promptly, urinary tract infections can cause permanent scarring of the urinary tract.

Recurrent urinary tract infections can become a problem and will require close monitoring by your health care provider.

Pyelonephritis, if not treated promptly, can spread to the bloodstream and cause a very severe infection.

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