Urinary Tract Infections (UTIs)

A urinary tract infection (UTI) is an infection in any part of the urinary system. It can occur in the kidneys, ureters, bladder and urethra.
They are one of the most common bacterial infections in women worldwide.

Signs & Symptoms of UTIs

Lower UTI Bladder

Upper UTI Kidney

Contact your doctor if you have signs or symptoms of a UTI

Possible Causes of UTIs

Frequent sexual
activity

Use of certain types of birth control (i.e. spermicides)

Hormonal changes due to menopause

Hormonal changes due to pregnancy

Physical anatomy and hygiene after urination

Antibiotics altering normal bacterial flora

Change in the
immune system

Interference with
urine flow

Prolonged use of bladder catheters

Causes of UTIs

Frequent sexual activity

Sexually active women tend to have more UTIs than women who are not sexually active¹. Having a new sexual partner may also increase the risk to UTIs.²

Use of certain types of birth control

Spermicide-based contraceptives such as coated condoms, diaphragms and cervical caps can be a risk factor for recurrent UTIs.³

Menopause

The decline in oestrogen levels in menopause causes several changes of the normal female physiology and leads to vaginal atrophy, modification of the normal vaginal flora an increase of the vaginal ph. All of these menopause induced changes are associated with an increased risk of developing UTIs in women.¹

Pregnancy

The increased risk of developing UTI’s during pregnancy are related to the increased pressure of the enlarged uterus on the urinary tract, impacting urine flow and bladder emptying¹. Hormonal changes during pregnancy also increase the risk.⁴

Hygiene after toilet use

Wiping from front to back after urinating and after a bowel movement helps prevent bacteria in the anal region from spreading to the vagina and urethra.²

Antibiotics altering normal bacterial flora

Our natural bacterial flora are an important defence mechanism against urinary tract infections. Antibiotics can have a negative effect on this flora and increase the risk of developing a UTI.⁵

Changes in the immune system

A suppressed immune system can impact a person’s natural defence mechanisms, making them more susceptible to infection.⁵

Structural or functional abnormalities of the urinary tract

Abnormalities in the urinary tract can impair urine flow.⁵

Prolonged use of bladder catheters

People who are unable to urinate on their own and use a tube (catheter) to urinate have an increased risk of UTIs. This may include people who are hospitalized and people with neurological problems that make it difficult to control their ability to urinate.²

The Diagnosis of a Urinary Tract Infection (UTI) is made based on the presence of clinical symptoms and a positive urine analysis or culture⁶

Types of UTIs

Cystitis

Cystitis is the inflammation of the bladder often caused by infection. Cystitis is the most common type of urinary tract infection⁶

Pyelonephritis

Pyelonephritis is the inflammation of the kidney often caused by infection. These are much less common than cystitis⁶

Urethritis & Prostatitis

Inflammation of the
urethra & prostate, respectively

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Uncomplicated Urinary Tract Infections (UTIs)

Urinary Tract Infections are classified into Uncomplicated and Complicated UTIs. Uncomplicated Urinary Tract Infections: These are the most common. They include UTIs in healthy non-pregnant, pre-menopausal women with a normal urinary tract.

These are frequently diagnosed urological disorders in women of any age. They are sporadic and community acquired episodes of acute cystitis in otherwise healthy individuals.

Uncomplicated Urinary Tract Infections (UTIs) are more common in women without known structural and functional abnormalities within the urinary tract.

Recurring Urinary Tract Infections (rUTIs)

Recurrent Uncomplicated Urinary Tract Infections (RUTIs) are a common presentation to urologists and family doctors.

Recurrent Urinary Tract Infections: Some people experience repeated episodes of urinary tract infections.

Having three UTIs in a year or two in six months is considered to be a recurrent urinary tract infection.

Complicated Urinary Tract Infections

Complicated Urinary Tract Infections: Are UTIs that occur in all other patients. They can require more specialised treatment and closer monitoring.

Contact your doctor if you have signs or symptoms of a UTI who will be advise on the most appropriate treatment options for your needs.

References

Guglietta A. Recurrent Urinary tract infections in women: risk factors, etiology, pathogenesis and prophylaxis. Future Microbiol . 2017 Feb; 12 (3)
https://www.mayoclinic.org/diseases-conditions/urinary-tract-infection/symptoms-causes/syc-20353447
Sihra N, Goodman A, Zakri R, Sahai A, Malde S. Nonantibiotic prevention and management of recurrent urinary tract infection. Nat Rev Urol. 2018 Dec;15 (12):750-776
Ramzan M, Bakhsh S, Salam A. et al.Risk factors in urinary tract infection. Med Sci. 2004;2:50–5
Guidelines on Urological infections – European Association of Urology, 2020
Geerlings SE. Clinical Presentations and Epidemiology of Urinary Tract Infections. Microbiol Spectr (2016) Oct; 4(5)