Key Information About Urinary Tract Infection

Urinary tract infection (UTI) is an infection that can occur in any area of the urinary tract, including the ureters, bladder, kidneys, or urethra.

An estimated 50 percent of women report having had a UTI at some point in their lives, and nearly 30-40 per cent of these infections relapse within six months.

Virtually every person with a vagina will experience a urinary tract infection at least once in their lives, in part because of biological reasons.

Urinary tract infection occurs when bacteria enters into urinary system and multiply.

Cystitis (bladder infection) is usually caused by E. coli and other bacteria. E. coli also causes acute pyelonephritis (kidney infection). Urethritis (urethra infection) can be caused by herpes, gonorrhea, chlamydia and mycoplasma.

Dehydration is linked to an increased risk of UTIs.

UTIs are More Common in Women

Urinary tract infections are more common in girls and women than in boys and men.

Urinary tract infections occur more frequently in travelers to low- and middle-income countries. Travelers’ diarrhea was a significant risk factor, according to results of a study in Travel Medicine and Infectious Disease.

Estrogen

"Under the influence of estrogen, vagina remains elastic, moist and multi-layered. As estrogen levels dip, it thins down and dries up. Lactobacillus (good bacteria) is present in vagina before menopause. Vaginal walls release a kind of glucose known as glycogen. Lactobacilli ferment this glycogen, producing lactic acid, which in turn prevents other types of bacteria from growing and blocks pathogens. Various studies have indicated how reduced levels of estrogen during menopause results in lower levels of lactobacilli and elevated pH. This altered ecosystem is a breeding ground for microbes. A study from Sweden in 2013 had shown how estrogen acts on the epithelium in a way that the gaps between the cells lining the bladder lumen are healed. In other words, estrogen glues them together. This makes it more difficult for bacteria to break this protecting shield and reach the underlying cells,” says gynaecologist Dr Amrinder Bajaj, Senior Consultant, FMRI (Fortis Memorial Research Institute) Gurgaon.

According to Dr Jagriti Varshney, an obstetrician and gynaecologist, in women, the urethral opening and anus are anatomically located close to each other, making it easy for the intestinal bacteria to invade the urethra. “This is why women are more prone to urinary tract infections,” she said.

A research study conducted in June 2024 on women with a history of UTIs found that more than 70 percent of the participants had intestinal dysbiosis, an imbalance of the gut microbiome, which was associated with recurrent UTIs.

Chills, fever, back pain, groin pain, nausea, flank pain, vomiting, cloudy, dark, bloody, or foul-smelling urine and frequent, painful urination are some symptoms of acute pyelonephritis.

Symptoms of cystitis include traces of blood in the urine, dark, cloudy, or strong-smelling urine, pain just above the pubic bone, in the lower back, or in the abdomen, burning sensation when urinating, and urinating frequently or feeling the need to urinate frequently.

The main symptom of urethritis is pain while urinating. Other symptoms include feeling the frequent or urgent need to urinate and difficulty starting urination.

Ciprofloxacin, fluoroquinolone, amoxicillin-clavulanate potassium, cephalosporin and trimethoprim-sulfamethoxazole are used to treat acute pyelonephritis.

Antibiotics

Antibiotics are the first line of treatment for cystitis caused by bacteria. Which drugs are used and for how long depend on the patient's overall health and the bacteria found in the urine.

Shorter IV antibiotic courses of ≤7 days and ≤3 days with early switch to oral antibiotics is the treatment for infants aged ≤90 days with bacteremic and nonbacteremic UTI, respectively, after excluding meningitis.

Some common treatments for urethritis include azithromycin, doxycycline, erythromycin, ofloxacin and levofloxacin.

In November 2019, FDA approved cefiderocol an antibiotic, for patients with severe UTI.

To properly treat a UTI, you need to commit to taking the antibiotics every day as prescribed, ideally at the same time, even if your symptoms have cleared and you are feeling OK.

Cases of urinary tract infection which do not get cured with the usual antibiotics are becoming more common.

People who take Lactobacillus supplements while they take antibiotics may have reduced antibiotic resistance.

Sublingual Vaccine Tablet

In November 2022, research scientists developed a sublingual vaccine tablet for urinary tract infections that dissolves under the tongue. They claim that it is as effective as high dose antibiotics in treating UTIs without negative side effects on the gut microbiome.

"You can treat and cure a UTI at home, if you catch it early. Drink lots of water and avoid coffee, caffeine, alcohol, and soda.

Vitamin C

Load up on Vitamin C to combat the UTI. The acid in the vitamin helps flush out the bacteria.

Eat lots of yogurt, which has probiotics. Probiotics are good bacteria. In particular, probiotics in the Lactobacillus group may help treat and prevent UTIs, according to some older 2017 research. They may do this by:

• preventing harmful bacteria from attaching to urinary tract cells
• producing hydrogen peroxide, a strong antibacterial agent, in urine
• lowering urine’s pH, making conditions less favorable for bacteria.

Half a teaspoon of baking soda also helps with the burning," says Dr. Manny Alvarez.

Methenamine Hippurate

An antiseptic pill, known as methenamine hippurate, kills off bacteria in the urine.

This medicine is broken down by the body into formaldehyde, a natural disinfectant.

This in turn ‘denatures’ proteins in the bacteria, breaking down their molecular structure, which kills them.

CD4-PP

In July 2022, research scientists at Karolinska Institutet in Sweden discovered that the synthetic peptide CD4-PP has a good bactericidal effect against urinary tract bacteria, even those resistant to antibiotics. The study was published in the journal Cellular and Molecular Life Sciences.

In the last few years it has become clear that the likelihood antibiotics like ciprofloxacin will kill most UTIs is dropping rapidly.

You may have read the New York Times article reporting one in three uncomplicated UTIs in young healthy women are Bactrim-resistant and one in five are resistant to five other common antibiotics.

There is no vaccine for acute pyelonephritis. Increase fluid intake to at least eight glasses per day to maintain bladder hygiene.

Always respond to initial urge to void. Void after intercourse to rid urethra of bacteria acquired during sex, and if there is a history of atypical anatomy or recurrent urinary tract infections.

To prevent cystitis do not use perfumed bubble bath, soap, or talcum powder around your genitals.

Have a shower, rather than a bath, to avoid exposing your genitals to the chemicals in your cleaning products for too long.

Empty your bladder fully when you go to the toilet. Do not wait to go if you need to urinate.

Cranberries

Although there is no conclusive research to suggest cranberries can treat or prevent urinary tract infection, some studies indicate that unsweetened cranberry juice, cranberry supplements, or dried cranberries can reduce the risk of this condition.

This is because cranberries contain proanthocyanidins which may stop bacteria from sticking to your urinary tract lining.

Sexual abstinence is the best way to prevent urethritis. Have sex with only one uninfected partner.

Practice good hygiene prior to sexual activity. Use mild, unscented soap. Showers are less likely to promote urethritis than baths.

Drink water prior to sexual intercourse and urinate within 15 minutes afterward. If necessary, use a water-soluble lubricant to decrease the risk of injury during intercourse.

Wipe front to back. Doing so after urinating and after a bowel movement helps prevent bacteria in the anal region from spreading to the vagina and urethra.

Avoid using diaphragms, spermicides, or other forms of birth control that can increase the risk of UTIs.

A clinical study conducted at the UK's Royal Berkshire Hospital indicated that recurring urinary tract infections can be prevented for up to nine years.

As part of the study 89 patients were given the treatment called MV140 with two sprays of the pineapple flavoured suspension under the tongue.

Results of the study were presented at the European Association of Urology Congress in Paris in 2024.

Urinary tract infection can affect ureters, bladder, kidneys, or urethra.

Herpes can cause urethritis.

Flank pain is a symptom of acute pyelonephritis.

Antibiotics are used to treat cystitis.

There are no vaccines for acute pyelonephritis.