A urinary tract infection (UTI) is a bacterial infection that affects any part of the urinary tract. Although urine contains a variety of fluids, salts, and waste products, it usually does not have bacteria in it. When bacteria get into the bladder or kidney and multiply in the urine, they cause a UTI. The most common type of UTI is a bladder infection which is also often called cystitis. Another kind of UTI is a kidney infection, known as pyelonephritis, and is much more serious. Although they cause discomfort, urinary tract infections are usually quickly and easily treated by seeing a doctor promptly.

Symptoms & Signs

For Bladder Infections

• Frequent urination along with the feeling of having to urinate even though there may be very little urine to pass.
• Nocturia: Need to urinate during the night.
• Urethritis: Discomfort or pain at the urethral meatus or a burning sensation throughout the urethra with urination (dysuria).
• Cystitis: Pain in the midline suprapubic region.
• Pyuria: Pus in the urine or discharge from the urethra.
• Hematuria: Blood in urine.
• Pyrexia: Mild fever
• Cloudy and foul-smelling urine
• Increased confusion and associated falls are common presentations to Emergency Departments for elderly patients with UTI.
• Some urinary tract infections are asymptomatic.

For Kidney Infections

• The above symptoms.
• Emesis: Vomiting is common.
• Back, side (flank) or groin pain.
• Abdominal pain or pressure.
• Shaking chills and high spiking fever.
• Night Sweats.
• Extreme Fatigue.

Diagnosis

A patient with dysuria (painful voiding) and urinary frequency generally has a spot mid-stream urine sample sent for urinalysis, specifically the presence of nitrites, leukocytes or leukocyte esterase. If there is a high bacterial load without the presence of leukocytes, it is most likely due to contamination. The diagnosis of UTI is confirmed by a urine culture.

If the urine culture is negative:

• symptoms of urethritis may point at Chlamydia trachomatis or Neisseria gonorrheae infection.
• symptoms of cystitis, may point at interstitial cystitis.
• in men, prostatitis may present with dysuria.

In severe infection, characterised by fever, rigors or flank pain, urea and creatinine measurements may be performed to assess whether renal function has been affected.

Prevention

The following are measures that studies suggest may reduce the incidence of urinary tract infections. These may be appropriate for people, especially women, with recurrent infections:

• Cleaning the urethral meatus (the opening of the urethra) after intercourse has been shown to be of some benefit; however, whether this is done with an antiseptic or a placebo ointment (an ointment containing no active ingredient) does not appear to matter.
• It has been advocated that cranberry juice can decrease the incidence of UTI (some of these opinions are referenced in External Links section). A specific type of tannin found only in cranberries and blueberries prevents the adherence of certain pathogens (eg. E. coli) to the epithelium of the urinary bladder. A review by the Cochrane Collaboration of randomized controlled trials states 'some evidence from trials to show cranberries (juice and capsules) can prevent recurrent infections in women. Many people in the trials stopped drinking the juice, suggesting it may not be a popular intervention'.
• For post-menopausal women, a randomized controlled trial has shown that intravaginal application of topical estrogen cream can prevent recurrent cystitis. In this study, patients in the experimental group applied 0.5 mg of estriol vaginal cream nightly for two weeks followed by twice-weekly applications for eight months.
• Often long courses of low dose antibiotics are taken at night to help prevent otherwise unexplained cases of recurring cystitis.
• Acupuncture has been shown to be effective in preventing new infections in recurrent cases. One study showed that urinary tract infection occurrence was reduced by 50% for 6 months. However, this study has been criticized for several reasons. Acupuncture appears to reduce the total amount of residual urine in the bladder [citation needed]. All of the studies are done by one research team without independent reproduction of results.

The following measures seem sensible, but have not been studied:

• Cleaning genital areas prior to and after sexual intercourse.
• Men engaging in anal sex should wear condoms to protect themselves from bacteria found in the bowels. Similarly, women engaging in anal sex should ensure that their partner does not penetrate their vagina after removal from the anus without cleaning themselves first with anti-bacterial soap.
• For sexually active women, and to a lesser extent men, urinating within 15 minutes of sexual intercourse to allow the flow of urine to expel the bacteria before specialized extensions anchor the bacteria to the walls of the urethra.
• Having adequate fluid intake, especially water.
• Not resisting the urge to urinate.
• Taking showers, not baths, or urinating soon after taking a bath.
• Practicing good hygiene, including wiping from the front to the back to avoid contamination of the urinary tract by fecal pathogens.

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