What is urinary tract infection?
Urinary tract infection (UTI) is defined as the presence of multiplying micro-organisms (bugs) in the tract through which urine flows from the kidneys via the bladder to the outside world. UTI is 50 times more common in women, with about 5 per cent per year developing symptoms. UTI is uncommon in men below 60 years of age, but the frequency is similar in men and women in older age groups. The condition ranges from cystitis (a mild but distressing inflammation that is limited to the bladder) to severe infections of the kidney such as pyelonephritis (when the infection has reached the kidney tissue itself). Treatment depends on how and why the infection shows itself. Most patients respond rapidly to antibiotic therapy and are unlikely to have any other urinary tract abnormality.
Good advice
UTIs are rare in men, so all cases require investigation.
Prostatitis, the infection or inflammation of the prostate (a gland beneath the
bladder that produces some components of semen), causes symptoms that can be
mistaken for UTI in men.
What causes UTI?
In healthy men, urine is sterile (contains no micro-organisms).
The most important factor in maintaining the sterility of the urinary tract is
emptying the bladder completely and frequently. The cause of most UTIs is
bacteria that initially settle (colonise) around the urethra (urine tube), and
then ascend into the rest of the urinary tract. Several factors can make this
process more likely to occur.
Neurological conditions:
Structural bladder disease:
Abnormal urine drainage:
Foreign body:
Underlying disease:
Hospital acquired infections are usually
What are the symptoms of UTI?
The symptoms of upper urinary tract infection are the same as
lower tract symptoms plus loin (flank) pain, fever and chills. The patient is
likely to be ill and might require hospital admission.
How is the diagnosis made?
A clean midstream urine sample should be sent to the laboratory
for a microscopy examination. A level of 100,000 bacteria per millilitre of
urine is regarded as a significant infection, especially if found together with
pus or white blood cells (leucocytes) on microscopy. Any infecting bacteria are
cultured in the laboratory to assess their sensitivity to common antibiotics.
How is UTI treated?
Antibiotic therapy
Antibiotics such as amoxycillin now have resistance levels of
50 per cent in the community, because of widespread use over many years. Based
on such experiences, many specialists are concerned about the possible overuse
of the more powerful antibiotics as first line therapy in the general
community.
Recurrent UTI
UTIs are classified as either community acquired or hospital
acquired. 70 per cent of infections are community acquired, usually caused by
the bacteria
Symptoms differ, depending on whether the infection affects the
lower (bladder and urethra) or upper (kidneys and ureters) parts of the urinary
tract. The symptoms of lower urinary tract infectoin are dysuria (burning on
passing urine), frequency (frequent need to pass urine) and urgency (compelling
need to urinate). The urine can be cloudy with an offensive odour. In older
men, generalised symptoms such as confusion and incontinence can be present.
Urine infections are much commoner in the elderly, due to poor bladder
emptying, an enlarged prostate, or incontinence associated with stroke or
dementia.
Test strips dipped into a urine sample can detect indirect signs
of infection such as blood, protein, white blood cells and nitrites (most
common bacteria convert nitrate, which is a chemical normally present in urine
into nitrites, which are not usually present).
This is the mainstay of treatment. Trimethoprim is currently
the first choice for lower UTI in the UK, because it is cost-effective, well
tolerated and works in 80 per cent of infections. Cephalosporins,
nitrofurantoin, and norfloxacin are reserved as second line drugs in patients
with lower UTI, but are first choices in patients with signs of upper UTI or
kidney infection.
If UTIs keep occurring, identification and treatment of the
underlying cause is essential. Patients who have the same infection coming back
can be managed successfully by attending to 'bladder toilet' (drinking 2-3
litres of fluid daily and always passing urine at bedtime and after sex).
Drinking 250-500ml of cranberry juice daily and avoidance of bubble baths may
also help. If these measures fail, six months of continuous therapy with low
dose antibiotics is usually required.
The documents contained in this web site are presented for information purposes only. The material is in no way intended to replace professional medical care or attention by a qualified practitioner. The materials in this web site cannot and should not be used as a basis for diagnosis or choice of treatment. Conditions for use
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