Urinary Tract Infections

1. Causes of urinary tract infections

Urinary infections are caused by bacteria normally found in the vagina and intestine. They are more common in women than in men. In the female body, the anus is very close to the opening of the urethra, the tube which carries urine out of the body.

The proximity of these two apertures facilitates the passage of bacteria from the anus to the vagina and urethra and from then onto the bladder. They can also be carried to the bladder during intercourse, because of the movement.

2. How common are they?

Some studies say that about 43% of women between the ages of 14 and 61 will have at least one urinary tract infection. These infections are more common in sexually active women between 20 and 50 years old or in those with diabetes or other diseases that lead to decreased immunity.

3. Does the urinary system protect us from infections?

The urinary system rids the body of some toxins produced daily. The urine is filtered by the kidney, moves on into the ureters and then on to the bladder and the urethra. The wellbeing of the urinary tract is essential in women of all ages to prevent infection and enable intercourse.

Spermicides and diaphragms can increase the risk of urinary tract infection. If you use any of these methods, talk to your doctor about the possibility of using other types of birth control.

4. What are the symptoms of a urinary tract infection?

The most common symptoms of a urinary tract infection include:

• Sudden urge to urinate;
• Need to urinate more frequently than usual;
• Burning sensation, cramps or uncomfortable pain when urinating or immediately afterwards.

Urinary tract infections, particularly in older women, often affect the lower urinary tract; these are called bladder infections or cystitis. Urinary incontinence can also be a symptom.

5. How serious are urinary tract infections?

In most cases, urinary tract infections are easily and quickly treated. However, an untreated infection can become a serious situation when the kidney becomes involved. As such, women with recurrent urinary infections (i.e., more than three episodes per year) should take antibiotics for longer periods of time or may require intravenous antibiotics.

6. Should I seek medical attention?

You should seek a doctor to perform a correct diagnosis and treatment of the disease. Several diseases, namely sexually transmitted diseases, may present symptoms similar to urinary tract infections but require different treatments.

A urine test (microbiological examination of urine) may be necessary to confirm if there is an infection or to analyze which microorganism is responsible.  If the infection is infrequent or rare, this may not be necessary.

7. Which is the most appropriate antibiotic?

In general, the best antibiotic for a urinary tract infection is one that heals and has few side effects. The decision to choose one antibiotic over another depends on several factors, including the effectiveness of the antibiotic, side effects, price and bacterial resistance.

Your doctor will likely ask you several things before prescribing it, specifically:

• Are you on the pill?

• Are you trying to get pregnant?

• Are you pregnant or nursing?

• Are you allergic to penicillin or other drugs?

• Have you experienced side effects from antibiotics in the past?

• Have you ever taken an antibiotic that was not effective?

• Are you taking any other medication?

• Do you have other coexisting medical conditions (namely kidney, liver or lung issues)?

8. Will I experience side effects?

Like any other drug, antibiotics produce side effects, although they are rare and short-lived. The most common are nausea, headache, dizziness and light sensitivity. Antibiotics can unbalance the level of bacteria that we usually have in the body, causing diarrhoea or infections, for example, or fungi. It is important that you notify your physician of any side effects that may arise and discuss the problem with them.

9. Do I have to take all the medication?

In isolated or sporadic infections the physician prescribes one to three days of therapy and in more frequent infections the oral antibiotic therapy may be prescribed for two weeks or more, depending on the type of drug selected. The treatment is carried out for eight weeks to six months when prophylaxis of new urinary infections is done.

You should drink plenty of fluids during the treatment. Check if the antibiotic should be taken with food or on an empty stomach and do not stop the medication before the end of the treatment, even if you feel better after a few days, as the infection may not be totally quelled and you may develop another.

10. How to prevent urinary tract infections.

Here are some suggestions for preventing urinary infections:

• Drink at least eight cups of water per day, to dilute the concentration of bacteria in the urinary tract (this is particularly important for women who work outside the home and tend to restrict fluid intake during the day);

• Urinate often (every 2 or 3 hours) or whenever you feel the need;

• Avoid using tight clothes and use cotton underwear;

• Maintain a sound daily hygiene: clean the area around the vagina and anus after urination and defecation, taking care to wipe from front to back to avoid contamination;

• If you are going through menopause ask your doctor about estrogen treatments for vaginal and urethral atrophy, in an effort to reduce the risk of urinary infections. Sexually active women should take some precautions: wash your hands and pubic area before sex and urinate afterwards.

11. How is the urine sample collected for microbiological examination?

While it is best if the sample collected is from the first urine of the morning, it may be collected at any time.

Due to the possibility of contaminating the urine with bacteria and skin cells from the surrounding areas during collection (particularly in women), it is important to first clean the genitals.

As you start to urinate, let some urine fall into the toilet (this first portion of the flow washes by dragging most of the impurities in the urethra), then collect the middle portion of urine in the sterile container provided (the middle portion represents the bladder’s flora), and reject the rest into the toilet. This type of sampling is known as midstream specimen.

12. The lab called to inform me they need a new urine sample because the first one was contaminated. What happened?

If the skin and genital area are not cleaned thoroughly before the collection, the urine culture may develop three or more different types of bacteria, which is assumed to be contamination. The culture will be rejected because it is not possible to determine if the bacteria originated in the urinary tract or outside.

A contaminated sample can be avoided by following the instructions to clean thoroughly before sampling and collect the urine through the midstream specimen technique.

13. My doctor said I had symptoms of a urinary tract infection and prescribed antibiotics without doing a urine culture. Why?

The reason for this is that most urinary tract infections are caused by bacteria known as Escherichia coli (E. coli).

This microorganism is usually sensitive to a range of antibiotics such as trimethoprim/sulfamethoxazole, ciprofloxacin, and nitrofurantoin. In most patients with uncomplicated urinary tract infections, this will be resolved after empiric therapy with one of these antibiotics.