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Urinary tract infections

Overview of urinary tract infections

Urinary tract infections (UTIs) are one of the most common bacterial infections observed in women.

Young and elderly women, and those undergoing certain procedures of the genitourinary tract are affected frequently. In case of men, older individuals are more commonly affected than young adults. In case of children, it has been estimated that about 7% of the girls and 2% of the boys suffer from UTI at least once before they reach the age of 6 years. The UTI in all cases may be asymptomatic or symptomatic and complicated or uncomplicated. The infection may affect the kidneys (wherein it is referred as pyelonephritis), urethra (urethritis) or the bladder (cystitis).1–3

Signs and Symptoms of urinary tract infections

In most of the cases, individuals affected by UTI remain asymptomatic, while in others it may cause variable symptoms.

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The typical symptoms of UTIs are frequent, urgent and/or painful urination that may be associated with lower abdominal pain. These symptoms may appear abruptly in an otherwise healthy individual.

Infants usually present with generalized symptoms such as

In case of individuals who undergo certain procedures such catheterization, the symptoms may appear after a few days or weeks of the procedure.4,5

Causes of urinary tract infections

Several factors have been proposed to result in UTIs.

Below are some of the risk factors that have been associated with increased incidence in young women. Increasing age itself is a risk factor in older women.

  • Genetic factors,
  • maternal history of UTI,
  • previous UTI,
  • holding urine for a long time,
  • sexual intercourse,
  • use of diaphragms and spermicides,
  • young age at first UTI (below 15 years),
  • narrowed urethra,
  • prostate enlargement

In case of older men, the incidence of UTI is high in individuals with disease of the prostate and obstruction to the urinary outlet.

Surgical instrumentation for various procedures of the urinary tract in both men and women is a common risk factor.

In case of young men, UTI was frequently observed in those, whose sexual partners were infected, who had anal sex, who are not circumcised.

The UTI in children is usually a secondary infection from nearby regions.

Some of the microorganisms that cause UTIs are Escherichia coli, Staphylococcus saprophyticus, Proteus mirabilis and Klebsiella pneumoniae.1–3

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Diagnosis of urinary tract infections

The diagnosis is based on the signs and symptoms noted. Additional tests may be required to confirm the diagnosis in certain instances or to identify the causative microorganism. The tests that are advised include urine culture and urinalysis along with certain blood tests in some instances. Asymptomatic cases of UTI are usually detected during routine urinary investigations. Other specialized test such as ultrasound of the kidneys and X-ray studies may be advised to rule out any underlying disorders or conditions.1,3,5,6

Treatment of urinary tract infections

Urinary tract infection that remains asymptomatic may not require any treatment, as it tends to resolve after a few days, but may require to be monitored. In certain special cases such UTI in pregnant women need to be treated appropriately.

Symptomatic cases of UTI require treatment and antibiotics remains the mainstay of the treatment for UTI.

The antibiotics that may be advised include amoxicillin, cephalosporins, sulfisoxazole and trimethoprim/sulfamethoxazole. The severity and type of infection determines the particular group of antibiotic recommended. These antibiotics may be advised 1–4 times a day either as a short course for 3–5 days or as a long course for 7–14 days.

Treatment of the sexual partner may be necessary if he/she is also suffering form UTI.

In certain cases, wherein there is some anatomical defect that has given rise to the infection, surgical correction may be advised.3,4,6,7

Complications of urinary tract infections

The complications of UTIs include:

  • Recurrence of UTI
  • Long-term progress of the infection
  • Complicated type of UTI which may result in septic shock if untreated
  • Infection of the kidney

Prevention of urinary tract infections

  • Use of feminine hygiene products should be reduced
  • The genital area should be kept clean
  • Avoid using spermicidal creams and use other methods of contraception
  • Use undergarments made of cloth
  • Periodic changing of catheters in individuals with catheters

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References

1.Hummers-Pradier E, Kochen MM. Urinary tract infections in adult general practice patients. BJGP. 2002; 52: 752–761.

2.Orenstein R, Wong ES. Urinary tract infections in adults. Am Fam Physician. 1999; 59(5): 1225–1234, 1237.

3.Alper BS, Curry SH. Urinary tract infection in children. Am Fam Physician. 2005; 72: 2483–2488.

4.Williams DH, Schaeffer AJ. Current concepts in urinary tract infections. Minerva Urol Nefrol. 2004; 56: 15–31.

5.Kucheria R, Dasgupta P, Sacks SH, Khan MS, Sheerin NS. Urinary tract infections: New insights into a common problem. Postgrad Med J. 2005; 81; 83–86.

6.Mehnert-Kay SA. Diagnosis and management of uncomplicated urinary tract infections. Am Fam Physician. 2005; 72(3): 451–456, 458.

7.Walsh PC (ed.). Campbell’s Urology. 8th edn. Philadelphia, Pa: Saunders; 2002.

Written by: healthplus24.com team

Date last updated: december 29, 2014