Urinary Tract Infections are one of the most common infections, especially in women.
About 40% of women develop a urinary tract infection (UTI) at some point in their life. This condition is uncommon in boys and young men. Serious consequences can occur if a urinary tract infection affects the kidneys. Infections of the urinary tract are usually treated with antibiotics.
A Urinary tract infection (UTI) is an infection that affects any part of the urinary tract. The urinary system consists of the kidneys, ureters, bladder, and urethra. A Bladder infection, or cystitis, is the most common type of UTI. If the infection affects the kidney, it is called pyelonephritis which is a much more serious infection.
Women are especially prone to urinary tract infection. This is due to the shortness of the female urethra. In addition, women are at particular risk of recurrent UTIs after menopause because of decreased levels of oestrogen, which reduces the number of lactobacilli. Lactobacilli are 'friendly' bacteria that inhabit the vagina of fertile women and prevent other bacteria from invading the urethra. Also, after menopause, the mucous lining of the urinary tract 'thins out' and its ability to resist bacteria invasion is reduced. In Singapore, about 4% of young adult females are affected. The incidence rises with age to 7% at 50 years.
During the first six months of life, UTIs are more common in boys. This is because more males are born with structural abnormalities of the urinary tract. In older children and adults, UTIs are more common in females.
Urine is normally sterile. An infection occurs when micro-organisms (usually bacteria from the gut) attach itself to the urethra and begin to multiply. The infection may remain in the lower urinary tract (urethra and bladder) or it may move higher up to the kidneys as well. There are also micro-organisms causing this condition that are transmitted sexually.
Causes & risk factors
Cystitis is caused by bacteria which enter the urethra and bladder and cause inflammation. Over 90% of cases of cystitis are caused by E. coli, a bacterium normally found in the intestine.
Other risk factors for cystitis include:
If cystitis is not successfully treated, the infection may go up causing kidney damage. Bacteria may also enter into the bloodstream and this can cause a serious blood infection called septicaemia.
Screening & diagnosis
If a person has symptoms of UTI, the doctor usually requests for a urine sample analysis. The urine is examined for the presence of nitrites and white blood cells. However, a urine culture to identify the bacteria is needed to confirm the diagnosis. This also allows the doctor to identify the micro-organism involved.
Urinary tract infections in certain groups like young children and adult men warrant further work up and may require special methods of investigation.
Antibiotics may be used to control the infection. The drug of choice and length of treatment depends on the patient's history and the urine test that identify the offending bacteria. It is imperative that the patient finishes the entire course of prescribed antibiotics. For infection that spread to the kidneys , stronger antibiotics given intravenously may be indicated.
Surgery is generally not indicated in the presence of a urinary tract infection. Preventive measures may reduce symptoms and prevent recurrence of infection.
Follow-up measures may include urine cultures to ensure that bacteria are no longer present in the bladder. Appropriate hygiene and cleanliness of the genital area may help reduce the chances of introducing bacteria through the urethra.
Text adapted from Singapore Health Promotion Board
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