Half of all women report at the least one Urinary Tract Infection before their mid-thirties. Consultant Urological Surgeon Marco Bolgeri , at The Princess Grace Hospital, a part of HCA Healthcare UK reveals the symptoms to look out for and what treatments are avai 

Urinary Tract Infections (UTI’s) are probably the most common problems affecting patients. UTI’s are also essentially the most common reason for infection in hospitalised patients within the UK.

In truth, it’s estimated that half of all women report at the least one urinary tract infection by their mid-thirties, with reoccurrence rates of 25 to 50 per cent inside six months, which further increases in cases with multiple prior urinary tract infection.

The incidence of UTI symptoms in men is considerably lower than that in women, nevertheless with an estimated life- time prevalence of 13.7 per cent.

What’s a UTI?

Women aged under 65 years are diagnosed with a urinary tract infection (UTI) in the event that they have two or more key urinary symptoms and no other excluding causes or warning signs.

Key symptoms include:

• dysuria (burning pain when passing urine)
• latest nocturia (passing urine more often than usual at night)
• cloudy urine (urine cloudy to the naked eye)

Other symptoms may include frequency and urgency, suprapubic pain.

Other excluding causes are other possible genitourinary causes of urinary symptoms, corresponding to vaginal discharge, urethritis (urinary symptoms could also be as a consequence of urethral inflammation post sexual activity, irritants, or sexually transmitted infection) and genitourinary symptoms of menopause/atrophic vaginitis/vaginal atrophy.

Warning signs are signs of upper urinary tract infection (pyelonephritis) or sepsis (corresponding to loin pain, temperature >38°C, rigors) and possible signs of cancer corresponding to haematuria.

Urinary Tract Infections (UTI’s) are probably the most common problems affecting patients

A recurrent UTI is defined as repeated infection with a frequency of two or more UTIs within the last six months, or three or more UTIs within the last 12 months. A recurrent UTI could also be as a consequence of relapse (with the identical strain of organism), or reinfection (with a special strain or species of organism).

Persistent or chronic UTI defines those patients who’ve chronic UTI symptoms despite initial antibiotic treatment.

Mental Health and UTI’s

Not only are UTI’s physically frustrating and uncomfortable, but they also can play havoc in your mental health.

Lower physical and mental health scores have been recorded in patients experiencing UTIs when put next to unaffected controls, with negative emotional responses including anxiety and depression.

Patients often miss work, study and social commitments, or can’t function at their best as a consequence of the symptoms (pain, urinary frequency) but in addition the embarrassment of frequent toilet visits or a possible accident.

Difficulties in accessing the doctor for treatment, including the necessity to take day without work work and the long waits, also can cause additional stress and frustration, and ultimately leading to patients avoiding or delaying looking for medical help.

Patients often miss work, study and social commitments, or can’t function at their best as a consequence of the symptoms

Patients with recurrent UTI symptoms reported not feeling listened to on the subject of discussing management options with doctors who will not be aware of their cases and possibly suggest treatments which have not previously worked, adding to frustration and avoidance of medical care.

What to inform the doctor is you think you may have a UTI…

The data offered to the doctor should include the precise symptoms experienced, the variety of occurrences and the duration of symptoms and which treatment, if any, had been tried and with what response.

Past medical and surgical history and drug history are also vital to ascertain possible underlying risk aspects and causes of infection.

information offered to the doctor should include the precise symptoms experienced

Lifestyle habits by way of hygiene practice but mostly sexual and gynaecological history must also be discussed. The presence of vaginal discharge or vaginal irritation substantially reduces the probability of a UTI, and vaginal infections and a few sexually transmitted diseases can mimic UTI symptoms.

More worrying symptoms and signs suggesting more serious infection or possible cancer (particularly haematuria) needs to be reported as more likely to need urgent secondary care referral.

Similarly, men with a recurrent UTI, and girls with a recurrent lower UTI where the cause is unknown or a recurrent upper UTI are referred for specialist advice.

How are UTI’s treated?

Non-pharmacological management includes behavioural measures corresponding to hygiene practices (wiping front to back and avoiding strong/scented intimate detergents), voiding before/after sexual activity and refraining from contraceptive methods that include spermicide creams.

Adequate hydration and avoidance of constipation are also advisable.

Various non-antibiotic agents can be found for prevention of recurrent UTIs. Some act by stopping bacterial adhesion to the urinary tract, like cranberry (each in tablet or juice form) or D-mannose.

Others block bacterial growth either directly (Methenamine hippurate) or by strengthening the natural defences (probiotics, topical estrogen). The scientific evidence regarding nearly all of these is proscribed and sometimes conflicting, and the price to the patient not insignificant as often not available on the NHS.

Similar considerations apply to other strategies corresponding to intravescical instillations of glycosaminoglycan analogues and UTI vaccines, the latter being agents that stimulates the patient’s immune system against essentially the most common uro-pathogens.

Antibiotics stays the predominant stem of UTI treatment

Antibiotics stays the predominant stem of UTI treatment. For acute uncomplicated UTIs in women, a 3-day course is advisable by the foremost guidelines, whereas more at-risk categories corresponding to male patients and pregnant women warrant a 7-day course.

Complicated infections, in addition to antibiotic treatment, require diagnosis and management of the underlying cause, common examples being urinary tract obstruction, stones or foreign bodies.

For recurrent or chronic UTIs, low dose antibiotic prophylaxis for 3 to six months is essentially the most established regime, with reported reduction in the chance of infection as much as 95 per cent.

The emerging challenge of multi-drug bacterial resistance has nonetheless highlighted the necessity to limit widespread antibiotic use, hence the event of the choice agents mentioned above, but in addition alternative strategies corresponding to post-coital prophylaxis (single dose of antibiotic immediately after sexual intercourse) or intermittent self-start therapy.