Urinary Tract Infections (UTIs)
A urinary tract infection (UTI) includes the urethra (the tube that carries urine from the bladder to the outside), ureters (the tubes that carry urine from the kidneys to the bladder), bladder (the organ that stores urine), and kidneys (the organs that filter the blood to produce urine). UTIs are the most common type of bacterial infection affecting the human body and most commonly affect patients with a vagina.
An infection in the urethra is called urethritis. If the infection is in the bladder, it is called cystitis. If the infection affects the kidneys, it is called pyelonephritis. It is possible to have an infection of any or all parts of this system.
Urethritis is an inflammation of the urethra. Patients with a penis are more susceptible to inflammation and infection than others due to their longer urethra. The most common causes of urethritis are bacteria from gonorrhea and chlamydia infections. If left untreated, urethritis can cause prostatitis, an infection of the prostate gland.
Urethritis symptoms for patients with a penis include:
- Discharge from the penis
- Pain when urinating
- Tenderness in the urethra, and often in the surrounding organs such as testes and bladder
- Increase in the frequency of urination
- A feeling of urgency or feeling the need to urinate but only producing a few drops
In patients with a vagina, the symptoms are similar to those for cystitis (described below).
Cystitis is usually caused by bacteria entering the urinary system, moving up the urethra, and multiplying in the urine. Chronic constipation, enlarged prostate, kidney stones, pregnancy, and use of the contraceptive diaphragm can all contribute to having cystitis because they cause blockage of the urethra. Blockage makes it difficult to empty the bladder fully and therefore enables bacteria to resist being flushed out while urinating. Cystitis can occur at any age. Patients with a vagina get cystitis more often than others because their urethra is short and relatively close to the rectum. This makes it easy for bacteria from the rectum and surrounding tissues to enter the urethra during sexual intercourse and after going to the bathroom
Cystitis symptoms include:
- Increase in the frequency of urination
- Pain in the lower abdomen
- Stinging or burning with urination
- Foul smelling, cloudy, or bloody urine
- Pain in the lower abdomen
Pyelonephritis is an infection that is caused by bacteria moving up to the kidney, usually from a bladder infection that has not been treated. It is potentially more serious than urethritis or cystitis. If left untreated, it can cause permanent damage to the kidney. Like cystitis, pyelonephritis is much more common in patients with a vagina. It is also a frequent complication of pregnancy, labor, and delivery.
Pyelonephritis symptoms include:
- Any and/or all the symptoms listed for cystitis
- Flu-like symptoms which include headache, achiness, chills, and feve
- Lower back, flank, and abdominal pain
- Vomiting
Considerations and Treatment
Patients with symptoms of a UTI are advised to seek medical evaluation, as prescription medications are generally necessary for treatment. In some instances, additional follow-up, diagnostic testing, and partner treatment is required. Patients with recurrent UTIs or urinary symptoms should maintain close follow-up and communicate with their primary medical provider.
UTI symptoms should improve and/or resolve 3-4 days after treatment begins. It is imperative to take all prescribed medication(s) as directed, even if the symptoms have resolved. Incomplete therapy can cause recurrence of symptoms and worsening infection and may lead to the development of drug-resistant bacteria and other potentially serious complications. Management may also include over-the-counter pain relief options as recommended by the medical provider.
Factors that increase the risk for developing a UTI include:
- Having frequent sexual intercourse
- Having insertive anal sex
- Having diabetes
- Being uncircumcised
- Using spermicide for contraception
- Having a bladder or kidney infection in the past 12 months
- Having a condition that blocks or changes the flow of urine in the kidneys
Prevention
Prevention of UTIs includes the following recommendations:
- Wipe front to back after urinating to keep rectal bacteria from entering the urethra.
- Drink plenty of water; adults should drink at least 64 ounces of water a day.
- Urinate as soon as the need arises and after sexual intercourse.
- Completely empty the bladder when urinating.
- Avoid vaginal intercourse after anal intercourse.
- Always use condoms.
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