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.