This article was written by on of The Food Medic team; London-based GP – Dr Nirja Joshi
What is a UTI?
UTI stands for urinary tract infection. A UTI occurs when an infection (often caused by bacteria), affects the urinary tract. The urinary tract is made up of the kidney, ureters, bladder and urethra.
What are the symptoms of a UTI?
Typically, a ‘simple’ UTI affects the lower urinary tract and can be referred to as ‘cystitis’ (1). This means that the infection will impact the bladder primarily. Patients may report symptoms including burning or stinging passing urine (known as dysuria), blood in the urine (haematuria), cloudy urine, strong smelling urine, fever, nausea and discomfort in the pelvis. In older adults, patients may also experience confusion or dizziness. Children present with fever, abdominal pain and vomiting.
If the urinary tract infection affects your kidneys, this is known as ‘pyelonephritis’ (2), you may also experience pain in the back, just under your ribs on one side. Sometimes the pain radiates from ‘loin to groin’. Fever is more common with these patients. In addition, nausea and vomiting may occur.
What causes a UTI?
Women are more likely than men to get UTI’s because they have a shorter urethra (the tube that connects the bladder to the outside). A female urethra is around 3cm, whereas a male urethra is around 20cm. This means that a female bladder has a much shorter connection to external bacteria. Apart from being female, other risk factors for a UTI include; pregnancy, being sexually active (YES honeymoon cystitis is a thing), post-menopause, have diabetes mellitus, have a weakened immune system or have abnormalities somewhere along the urinary tract.
How does sex increase the risk?
Due to the movement during sexual intercourse, it is much easier for bacteria to travel into the urethra and hence lead to a UTI. If you suffer with UTIs in relation to sexual activity, you can mitigate this by voiding your bladder before and immediately after sexual activity – spermicide may also increase the risk (1). If you have a new sexual partner or are concerned about sexual infection, please ensure you have a sexual health screen to rule out other infections which could mimic a UTI such as Chlamydia.
How is it diagnosed?
Your doctor can diagnose a urine infection from your symptoms and a simple dip of your urine (to look for white blood cells + nitrites).
Could those symptoms be anything else?
In some cases, particularly in young women, you may have symptoms of a UTI which can mirror sexual infection such as Chlamydia (4). If you have had unprotected sex with a new partner or you are concerned about a potential risk of sexual infection, do ask your GP for a sexual health check which may be done by testing a urine sample or vaginal swab. You can also order sexual health testing kits online which will arrive in the post.
Sometimes you may have symptoms such as discomfort in your pelvis or burning or discomfort passing urine, and this may represent something different. One such common condition is vaginal thrush. Thrush may present with inflammation of the vulva and white thick discharge and itching (5). It can be difficult sometimes to tell the difference between a urine infection and thrush. You may, of course, have both. Equally Bacterial Vaginosis (6), otherwise known as BV is caused by an overgrowth of bacteria in the vagina which can lead to watery discharge with an odour and discomfort.
How are UTIs treated?
Although women seem to pull the short straw when it comes to cystitis, we tend to also have a less complicated infection which means it is easily treatable. Most women are given a three-day course of antibiotics (or a delayed prescription). Men, pregnant women and people with more serious symptoms may need a slightly longer course.
It is very important when you have a UTI to drink plenty of water. An adult should be aiming to drink between 2-3 litres of water per day. The best way to check that you are taking in enough water is to check that your urine is a pale yellow/clear colour (1).
Some patients choose to take sachets (containing cranberry or d-mannose) which are available over the counter. There is variable medical evidence to support the use of these sachets, although anecdotally, some patients find these helpful. It is important to be aware of the sugar content of these products and patients who are pregnant or on warfarin should avoid these products (3). You can also take paracetamol or ibuprofen for the pain.
Who can treat a UTI?
Traditionally, only GP surgeries would be able to treat UTIs, however, sexual health clinics may be the appropriate place to treat your infection, if you are very unwell for example with fever and back pain, patients may need to present to A+E. Some pharmacies are now offering treatment for simple and uncomplicated UTIs and this may be helpful, particularly out of normal working hours. It would be reasonable to call a service such as 111 if your GP is not available.
If you feel that you suffer from frequent UTIs, your GP may ask to see you for further evaluation. You may require further testing of your urine. Sometimes, frequent UTIs may represent another condition to do with your urinary tract or other organs (1).
Your GP may test your urine, and perhaps send it off to the laboratory for further testing.
Some patients may require ultrasound scans of their kidney, ureters and bladder to check that they are voiding urine completely.
In some cases, patients benefit from having prophylactic antibiotics. This means taking a lower dose of the antibiotic each day to prevent infection. This would only be necessary in severe cases.
Tips to prevent a UTI
- Wipe front to back after using the toilet
- Urinate after sex, and avoid using spermicide.
- Avoid soap, perfumed bubble bath around your genitals
- If you have gone through the menopause, vaginal oestrogen may be helpful at reducing recurrent bouts of cystitis
- Some women with recurrent UTI may wish to try D‑mannose or cranberry products if they are not pregnant (please note the sugar content of these products) (7).
If you have symptoms of a UTI, you can consult your GP, or a healthcare professional in some pharmacies. If you are unable to do this, 111 would be the best place to consult. If you have had recent sexual contact and are concerned you could have a sexual infection, do consult a local sexual health service for a more comprehensive check.
If left untreated UTIs can become more severe, so please do not wait to seek medical attention. If you ever notice blood in your urine, with or without pain, you must speak to a healthcare professional (7).
- NHS. Urinary Tract Infections – UTIs [Internet]. 2022 [cited 2022 Apr 19]. Available from: https://www.nhs.uk/conditions/urinary-tract-infections-utis/
- NHS. Kidney infection [Internet]. 2021 [cited 2022 Apr 19]. Available from: https://www.nhs.uk/conditions/kidney-infection/
- National Institute of Clinical Excellence. Urinary-tract infections [Internet]. [cited 2022 Apr 19]. Available from: https://bnf.nice.org.uk/treatment-summary/urinary-tract-infections.html
- NHS. Chlamydia [Internet]. 2021 [cited 2022 Apr 19]. Available from: https://www.nhs.uk/conditions/chlamydia/
- NHS. Thrush [Internet]. 2020 [cited 2022 Apr 19]. Available from: https://www.nhs.uk/conditions/thrush-in-men-and-women/#:~:text=Thrush%20is%20a%20common%20yeast,sexually%20transmitted%20infection%20(STI).
- NHS. Bacterial Vaginois [Internet]. 2018 [cited 2022 Apr 19]. Available from: https://www.nhs.uk/conditions/bacterial-vaginosis/
- NICE Urinary tract infection (recurrent): antimicrobial prescribing . Available at: https://www.nice.org.uk/guidance/ng112/chapter/recommendations
- NHS. Blood in Urine [Internet]. 2020 [cited 2022 Apr 29]. Available from: https://www.nhs.uk/conditions/blood-in-urine/
The lowdown on cystitis was last modified: May 18th, 2022 by