CARPENTER: Urinary tract infections

Dr. Jay Carpenter

Urinary tract infections are one of the most common bacterial infections in women. Approximately 50-60% of women report at least one UTI in their lifetime, and one in three will have at least one symptomatic UTI necessitating antibiotic treatment by age 24. Men also suffer from UTIs, however far less than women. Currently, the societal costs of these infections, including health care costs and time missed from work, are approximately $3.5 billion per year in the United States alone. The reasons why some women have recurrent infections can be elusive.

The reason women suffer more commonly with UTIs as compared to men is simply the result of having a shorter urethra as compared to men. Other risk factors that contribute to these infections in women include sexual intercourse, the use of diaphragms and spermicides, as well as bacterial colonization of the vagina. Men who do suffer with frequent UTIs often have bladder obstruction from an enlarged prostate, stones in the bladder, or narrowing of the urethra. Other contributing factors for both men and women can be anatomic problems or kidney stones which may affect the way the kidneys drain.

For most patients, therapy usually begins once symptoms develop. Common symptoms include burning with urination, frequency, and lower abdominal and back pain. Many patients will be started on antibiotics for a short period of time and symptoms quickly improve. For others, symptoms may never resolve or may return in a short period of time. Patients with recurrent UTIs, defined as more than two infections in 6 months or 3 infections in 12 months, can be more difficult to treat. For many of those patients other predisposing factors or medical conditions may be to blame.

When a patient fails to respond to a typical course of antibiotics there are several potential explanations. For one, the duration of treatment may have not been long enough. Also, some patients develop bacteria that are resistant to some of the more commonly prescribed antibiotics. Typically imaging of the kidneys and bladder are obtained and other medical conditions, such as diabetes, should be ruled out. It is also possible that the symptoms may be due to something other than an infection.

For women who have entered the post-menopausal years, the low estrogen state can lead to infections due to bacterial colonization of the vagina. Estrogen helps to keep the tissues of the vagina healthy and in turn allows “good” bacteria, such as lactobacillus, to grow in sufficient numbers. Following menopause, these “good” bacteria are no longer able to survive in the vagina which allows “bad” bacteria, such as E. Coli, to colonize the vagina and area surrounding the urethra. With these types of bacteria living near the urethra, the bladder can be more easily infected as the bacteria have a short distance to travel into the bladder and lead to infection.

UTI treatment and prevention focuses on treating patients appropriately with the correct dose and duration of antibiotics, as well as educating them on steps to take to minimize their risk. Not all patients with bacteria in their urine need to be treated. Over use of antibiotics, not only for UTIs but also for viral respiratory infections, has led to many bacteria becoming resistant to many of our oral antibiotic options. In fact, patients with long term catheters, residents of nursing homes, and patients that do not have symptoms of a UTI are often best served by not being treated even though a urine dipstick or culture shows the presence of bacteria.

There are several strategies that urologists and other specialists use to help patients with more complicated or recurrent urinary tract infections. Often the old saying of “more is not necessarily better” applies to antibiotic use in these patients and for some preventative strategies yield better long-term results.

Dr. Jay Carpenter is urology specialist with the Texas Center for Urology in Weatherford. Contact him at 817-796-9444.

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