What are the other Names for this Condition? (Also known as/Synonyms)

• UTI (Urinary Tract Infection)

What is Urinary Tract Infection? (Definition/Background Information)

• Urinary Tract Infection (UTI), as the name suggests, is an infection of the urinary tract. The cause of infection is a microbe, typically a bacterium. Occasionally, fungi and parasites can cause such infections as well
• In females, the urinary tract includes the kidneys, ureters, urinary bladder, and urethra. In addition to the above, in males, the urinary tract includes the testes and prostate glands as well
• The infection is classified on the basis of its location in the urinary tract:
  • Urethritis - infection in the ureter
  • Cystitis - bladder infection
  • Pyelonephritis - infection of the kidneys
  • Prostatitis in men - infection of the prostate
  • Orchitis in men - infection of testicles
  • Epididymitis in men - infection of the epididymis
• Men, women and children of all ages are prone to Urinary Tract Infections. However, individuals who are immunocompromised, use of urinary catheters, kidney stones, and those with poor glycemic control in diabetes all have a higher risk of infection
• Females have a higher risk of UTI than males, chiefly because of the anatomy of their urinary tract system, with a shorter distance between their urethra and anus. This feature allows easier access of bacteria to the urinary tract
  • Among females, those who use birth control measures, such as diaphragms, post-menopausal women, and those who are sexually-active with multiple partners face an increased risk of infection
  • Among males, being above the age of 50 and being uncircumcised are factors that increase one’s risk
• Bacteria, such as Escherichia coli, Klebsiella sp., Pseudomonas sp., and Staphylococcus sp., are typically involved. In rare cases, some fungal species, such as Candida sp. and Aspergillus sp., as well as parasites that include threadworms and fluke, can cause infection of the urinary tract
• Some symptoms of Urinary Tract Infections include changes in the frequency of urination, burning sensation or pain during urination, fever and chills, changes in the smell and color of urine, and pain during sexual intercourse
• The condition is diagnosed based on a physical examination with evaluation of symptoms and medical history, urine test and urine culture, with blood and imaging tests, if needed
• The spread of infection to the bloodstream and consequent sepsis, kidney failure and recurrent infections are some potential complications of Urinary Tract Infections 
• Once the pathogen causing the infection is identified, either oral or IV antibiotics are prescribed to combat the infection. Additionally, treatments to repair structural damage to the kidneys or other urinary tract organs, if any, may be warranted
• Certain measures to prevent Urinary Tract Infections include maintaining sanitary conditions, cleaning up properly after urination, not swiping back to front after a bowel movement (particularly in females), seeking treatment for underlying conditions, such as for diabetes, and increasing fluid intake
• The prognosis of Urinary Tract Infections is generally good, with the affected individuals beginning to recover within 48 hours of starting treatment. In some cases, with delayed or lack of treatment, the infection can spread to the kidneys and then blood, making recovery more difficult

Who gets Urinary Tract Infection? (Age and Sex Distribution)

• Urinary Tract Infection can occur in individuals of all ages and both genders
• Children between the ages of 6-12 months, adult women, and men over the age of 50 years are more prone to the condition
• About 30% of women who get UTIs are between the ages of 20 and 40 years; approximately 20% of all women are reported to have had an UTI, at some point in their lives
• The condition is known to occur globally, without any racial or ethnic bias

What are the Risk Factors for Urinary Tract Infection? (Predisposing Factors)

The following are some risk factors for developing Urinary Tract Infection:

• Being female
• Inadequate fluid intake
• Use of urinary catheters
• Being immune-compromised; having weak immune system
• Malformed kidneys owing to congenital abnormalities
• Blockages in the urinary tract, such as due to kidney stones
• Poorly-controlled diabetes

Some specific risk factors pertaining to the following categories include:

• In children:
  • Being a girl
  • Cleaning back to front after bowel movement
  • Uncircumcised boys
• In women:
  • Being sexually-active, particularly with multiple partners
  • Use of certain contraceptive methods such as diaphragm and spermicidal agents
  • Being post-menopausal
  • Wiping back to front after a bowel movement
• In men:
  • Being over 50 years of age
  • Being uncircumcised
  • Sexual intercourse with an infected individual
  • Anal sex

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Urinary Tract Infection? (Etiology)

Urinary Tract Infections are caused by certain microorganisms.

• It is most often caused by bacteria, such as Escherichia coli, Klebsiella sp., Staphylococcus sp., and Pseudomonas sp.
• Rarely, fungal species belonging to Candida and Aspergillus may be involved
• Rarely, parasites, such as threadworm and fluke, may be involved

When microbes come in contact with the urethra, they can travel through it into the bladder, while multiplying at the same time. The infection then spreads to the ureters and the kidneys.

Note: In females, the distance between the urethra and anus is shorter than it is in males. This anatomical feature allows microbes a faster access to the bladder, making females more prone to the condition.

What are the Signs and Symptoms of Urinary Tract Infection?

The common signs and symptoms of Urinary Tract Infection may include:

• Fever and chills
• Frequent urination
• Changes in consistency, smell, or color of the urine
• Pelvic pain

Additional signs and symptoms that may arise depend on the location of the infection, and these may include:

• Infection of the urethra (urethritis) resulting in discharge from the urethra
• Bladder infection (cystitis) causing abdominal discomfort and pelvic pressure
• Kidney infection (pyelonephritis) leading to high fever, chills, flank and back pain, nausea, and vomiting

In children, the following symptoms may be observed:

• Vomiting and diarrhea 
• Loss of appetite and poor feeding 

In women, the following additional symptom may be observed: Pain during intercourse

In men, additional symptoms can occur such as:

• Pain near the anus or groin region owing to prostate infection (prostatitis)
• Pain and swelling of the scrotum if epididymis is infected (epididymitis)
• Pain and swelling of the testicles if the testicles are involved (orchitis)

How is Urinary Tract Infection Diagnosed?

In order to diagnose Urinary Tract Infection in an accurate manner, a healthcare provider may need information from the following:

• A complete physical examination with assessment of symptoms
• An evaluation of medical history, such as presence of kidney stones, recent surgeries, and inborn structural defects in the urinary tract, if any
• Urine test with a dipstick and urine culture
• Blood tests that include complete blood count (CBC) and blood cultures
• Intravenous pyelogram (IVP), which is a series of X-rays using contrast dyes, to detect abnormalities in the urinary tract
• Ultrasonography to detect kidney stones
• CT scan of the abdomen and pelvis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Urinary Tract Infection?

The potential complications that can arise due to Urinary Tract Infections include:

• Severe discomfort while urinating
• Spread of infection to the kidney, resulting in kidney failure
• Spread of infection to the bloodstream, causing sepsis
• Possibility of recurrent infections (recurrent Urinary Tract Infection)
• UTI-induced infertility
• Increased risk of premature delivery in pregnant women
• Shrinking of the testicles in males, called testicular atrophy

How is Urinary Tract Infection Treated?

The treatment for Urinary Tract Infection depends on the location of infection within the tract, as well as the infecting microbe. Once the infecting agent has been identified, the following may be prescribed:

• Oral or IV antibiotics to specifically target the bacterium (or fungus) causing the infection may be prescribed
• It is important to complete the prescribed antibiotics course prescribed by the healthcare professional, even if one starts to feel better before completion of the course
• This will ensure the complete removal of the infecting agent from the body, thus avoiding the generation of drug-resistant microbial species
• Medication to treat parasites, if the infection is caused by parasites
• Hospital stay involving administration of IV fluids and antibiotics, if warranted
• Surgery to repair congenital abnormalities in kidney structure, which can lead to frequent infections 
• In men, surgery to repair twisting of the epididymis, if necessary

Note: Some infections are known to be self-limiting and may get better without any treatment.

How can Urinary Tract Infection be Prevented?

Urinary Tract Infection can be prevented by considering the following measures:

• Keeping fluid intake adequate by drinking plenty of water. This will increase urination and help flush bacteria from the urinary tract
• Maintaining cleanliness after urination
• Not cleaning oneself from back to front after bowel movement; girls and women have to particularly take care of this to lower their risk
• Changing contraceptive choices: Women may opt for oral contraceptive pills in place of diaphragm or spermicidal agents
• Emptying the urinary bladder after intercourse
• Maintaining personal hygiene, particularly before and after sexual activities
• Having safe sex such as by using condoms
• Avoiding multiple sexual partners
• Not postponing urination when there is an urge to urinate. This can help prevent pooling of urine within the bladder. Pooling of urine over a prolonged period of time can create an environment favorable for microbial growth
• Maintaining good glycemic index in individuals with diabetes
• Avoiding sexual intercourse with an infected partner; ensuring that sexual partners are also treated for Urinary Tract Infections

What is the Prognosis of Urinary Tract Infection? (Outcomes/Resolutions)

• In general, the prognosis for Urinary Tract Infection is excellent, if the condition is diagnosed properly and prompt treatment undertaken
• Typically, one may experience relief from symptoms after 48 hours of treatment. However, the recovery time may be longer, if the infection is localized to the kidneys
• In some rare cases, delayed or no treatment can lead to sepsis, which can even be fatal

Additional and Relevant Useful Information for Urinary Tract Infection:

The following links will help you understand Urinary Tract Infection in men, women, and children:

http://www.dovemed.com/diseases-conditions/urinary-tract-infection-men/

http://www.dovemed.com/diseases-conditions/urinary-tract-infection-women/

http://www.dovemed.com/diseases-conditions/urinary-tract-infection-children/