Healthy Lifestyle

A urinary tract infection (UTI) is an infection of the urinary tract. An infection anywhere from the kidneys to the ureters to the bladder to the urethra qualifies as a urinary tract infection.

Symptoms & Signs

• urethritis: discomfort or pain at the urethral meatus or a burning sensation throughout the urethra with micturition (dysuria).
• cystitis: pain in the midline suprapubic region and/or frequent urination
• hematuria (bloody urine)
• cloudy and foul-smelling urine

Diagnosis

Testing
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. Pyelonephritis is ruled out by checking for costovertebral angle tenderness (CVAT). 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 gonorrhea infection.
• symptoms of cystitis, may point at interstitial cystitis.
• in men, prostatitis may present with dysuria.

Causative agents
Common organisms that cause UTIs include: Escherichia coli and Staphylococcus saprophyticus. Less common organisms include Proteus mirabilis, Klebsiella pneumoniae, and Enterococcus spp.

Epidemiology

UTI’s are most common in sexually active women, and increased in diabetics and people with sickle-cell disease or anatomical malformations of the urinary tract.

Women are more prone to UTIs than males because in females, the urethra is much shorter and closer to the anus than in males. The article on vulvovaginal health has some health tips for preventing UTIs. Men are also at a 10-times decreased risk if they are circumcised.

Treatment

Most uncomplicated UTIs can be treated with oral antibiotics such as ampicillin, co-trimoxazole (or stand-alone trimethoprim), macrodantin, or cephalexin. More aggressive treatments include ciprofloxacin.

If patient has symptoms consistent with pyelonephritis, intravenousantibiotics are indicated.

Patients with recurrent UTIs may need further investigation. This may include ultrasound scans of the kidneys and bladder or intravenous urography (X-rays of the urological system following intravenous injection of iodinated contrast material).