Adult Urinary Tract Infections (UTIs)

Urine is normally sterile and does not contain infectious agents. However, UTIs can occur when bacteria (e.g. E. coli and Klebsiella) migrate from the skin, vagina, or rectum, and enter the external opening of the urethra (pee hole), thereafter spreading to various parts of the urinary system.

A urethritis occurs when the urethra is infected. The most commonly infected area is the urinary bladder; this is called cystitis. A kidney infection is referred to as a pyelonephritis.

Factors/ situations that increase the chances of developing a UTI

Being sexually active
Urolithiasis (kidney stones)
Diabetes
Suboptimal genital hygiene
Incomplete emptying of the bladder
Being female
Sex toys
Oral sex
Enlarged prostate
Bladder prolapse
Using non-lubricated condoms, and diaphragms.
Having a new sexual partner
Menopause
Recent medical instrumentation of the urinary system
Current or recent use of a urinary catheter
Vesicoureteric reflux.

Those at higher risk for recurrent UTIs or complications from UTIs

Diabetics
Frequent sexual encounters
Multiple sexual partners
Pregnant women
Older individuals
Previous history of UTIs
Immune compromised
Pelvic radiation
First UTI before the age of 16
Current and past use of topical spermicidal contraception
Urinary retention
A bladder with a reduced capacity
If one’s mother suffered from UTIs

Symptoms associated with cystitis/ urethritis

Frequent passage of small quantities of urine
Urgency when feeling to urinate
Burning on urination (dysuria)
Urinary incontinence
Cloudy urine
Lower abdominal pressure, discomfort, or pain
Urine with a “foul odour”
Blood in urine
Generally feeling unwell

Symptoms associated with pyelonephritis

Flank and or lower back pain
Fever.
Nausea and vomiting
Mental confusion
In addition to the symptoms associated with cystitis/urethritis – listed above.

Reducing the chances of (recurrent) UTIs

Find a bathroom to pass urine whenever there is the urge to urinate
Women should always wipe from front to back after urinating or stooling. After a single wipe, the tissue should always be discarded.
Empty bladder before going to bed.
Consume copious quantities of fluids.
Pass urine just before and immediately after any sexual activity.
Wash the genital area with warm water before sex.
Consume cranberry products (e.g. juice, dried cranberries, supplements).
For frequent UTIs prophylactic antibiotics can be prescribed
Avoid using perfumed products in the genital area.
Take a probiotic.
When menstruating use pads instead of tampons.
Avoid wearing non-cotton underwear.
If a lubricant is needed for sexual intercourse use a water-based one.

Possible complications from UTIs

Kidney infection (pyelonephritis)
Kidney abscess
Kidney damage (especially when recurrent)
Prostatitis
Acute epididymitis
Sepsis secondary to pyelonephritis
Premature labour (in pregnant women)
Narrowed urethra (especially when recurrent in males)
Death in rare instances

Diagnosis

The diagnosis of a UTI is made by way of:
A history and clinical examination
Office urine dipstick testing checking for nitrites, and white blood cells
Laboratory urinalysis, microscopy, urine culture, and antibiotic sensitivity
Rarely an ultrasound of the urinary system may be ordered.

Is a UTI a sexually transmitted disease (STD)?

NO! A UTI is NOT an STD. Sexual intimacy can facilitate the development of a UTI, however, it does not result in the transmission of the bacteria causing the UTI from one partner to the other.

Treatment

Antibiotics are the cornerstone of treatment. The more commonly prescribed include:

Nitrofurantoin
Augmentin
Septra/ Bactrim
Ciprofloxacin

What is antibiotic resistance?

Many UTIs do not respond to the antibiotic prescribed. This occurs when the bacteria causing the infection has developed resistance to the antibiotic. The ability to resist the antibiotic is acquired by the bacteria before the current infection. The bacteria pass on to their progeny this ability to resist the respective antibiotic. This makes it impossible for the antibiotic to destroy the corresponding antibiotic-resistant bacteria. Where this happens a urine culture helps with identifying the specific bacteria causing the infection along with pinpointing the antibiotic which will destroy the infecting bacteria.

When to see a doctor?

Because of the possibility of a UTI spreading to the kidneys and the prevalence of antibiotic resistance, it is recommended that anyone with symptoms of a UTI should see their healthcare provider as soon as possible. A UTI is an emergency if the person is having any of the symptoms of a UTI (listed above) in addition to the symptoms of a pyelonephritis (listed above)

Author: Dr. C. Malcolm Grant – Family Physician – Family Care Clinic, Arnos Vale – Former Tutor, Faculty of Medical Sciences, UWI, Cave Hill, Barbados. Host of the weekly radio show, Physician on Call. For appointments: clinic@familycaresvg.com, 1(784)570-9300 (Office), 1(784)455-0376 (WhatsApp)

Disclaimer: The information provided in the above article is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnoses, or treatment. Dr. C. Malcolm Grant, Family Care Clinic or The Searchlight Newspaper, or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided.