A comprehensive insight into urinary tract infections (UTIs)

Urinary tract infections (UTIs) are common bacterial infections affecting the urinary system.

Here, Dr Aneta Obloza, renowned consultant urogynaecologist in Leicester, offers her expert insight into UTIs, including diagnosis, treatment and prevention.

What are UTIs?

Urinary tract infections (UTIs) are a common health concern. More than 50 per cent of women experience a UTI in their lifetime, with 20 to 40 per cent suffering recurrences and requiring multiple short and long-term dosing of antibiotics. UTIs represent the most frequent infection in older adults and the primary reason for antibiotic treatment.

What are the typical symptoms?

Symptoms include a burning sensation during urination, frequent urges to urinate, and lower abdominal pain. UTIs can be both painful and disruptive. In more severe cases, UTIs can involve a fever and feeling generally unwell.

How are UTIs diagnosed, including laboratory tests and cultures?

Most UTI are diagnosed by taking a careful history and performing a urine dipstick that detects changes in the urine composition that is consistent with bacterial infection (i.e. leucocytes, blood cells and nitrates). All urine samples from symptomatic patients should be sent to the laboratory, where culture and sensitivity are obtained to determine a more targeted/specific antibiotic treatment.

What are the recommended treatments for UTIs?

For the confirmed bacterial infection, a short course of antibiotics should suffice. Sometimes, a longer course of a low-dose antibiotic can be considered.

Are there any complications or risks associated with untreated UTIs?

An untreated/neglected UTI can lead to sepsis i.e. severe infection called urosepsis that can be life-threatening.

Can recurrent UTIs be prevented, and what lifestyle changes or precautions are advised?

Recurrent UTIs are defined as three or more UTIs within a 12-month period or as two or more UTIs within a 6-month period.

Women are more prone to UTIs due to the following factors:

• Anatomy: The female urethra is shorter, allowing bacteria easier access to the bladder.
• Proximity to the anus: The urethral opening’s closeness to the anus can lead to the transfer of bacteria, especially E.coli.
• Catheterisation: Pushes bacteria into the bladder causing colonisation of the bladder.
• Antibiotics: Reduce vaginal lactobacilli (the natural bacteria of the vagina that prevent colonisation by other bacteria).
• Sexual activity: Intercourse can introduce bacteria into the urinary tract. The application of spermicidal gel raises vaginal pH levels, rendering women more susceptible to UTIs.
• The menopause: Reduced oestrogen levels can make the urinary tract more vulnerable to infections.
• Poorly-controlled diabetes.

These steps could reduce the frequency of UTIs:

• Keeping hydrated.
• Taking over-the-counter preparations: D-mannose, cranberry tablets.

Urogynaecology specialists can consider the following:

• A low dose of antibiotics for a few months. However, this can lead to building antibiotic resistance; thus, future infections may be more difficult to treat successfully.
• Hiprex - Bacteriostatic medication that is as effective as antibiotics but with less side effects.
• Vaginal oestrogen pessaries or cream in women who undergo the menopause.
• UROMUNE vaccine - An oral immunostimulant for the prevention of UTIs that works by stimulating the immune system by increasing resistance against UTIs. The vaccine is composed of the inactivated whole bacteria of the four most common bugs causing UTIs: Klebsiella pneumoniae (25%), Escherichia coli (25%), Enterococcus faecalis (25%), and Proteus vulgaris (25%). Rather than being injected, the vaccine is administered daily over three months via a pineapple flavoured spray. Upon administration, it engages with the immune system, providing the patient with long-term protection against UTIs. The vaccine is well tolerated by patients, and only few described adverse reactions such as rash, itching or stomach upset.
• laluril - Bladder installation, a liquid that contains components that build a protective inner layer of the bladder; thus, helping to restore its protective function. This treatment consists of several self-administered installations into the bladder in a pre-planned course of treatment.

If you require assistance for a UTI, don’t hesitate to reach out to Dr Aneta Obloza via her Top Doctors profile today.