Unraveling UTIs: The Complete Breakdown

 

Urinary tract infections (UTIs) are among the most common types of infections that people experience worldwide [1]. They happen when harmful microbes, mostly bacteria including Klebsiella pneumonia, Proteus mirabilis, Staphylococcus saprophyticus, and Enterococcus faecalis, infect any part of the urinary system, which includes the kidneys, bladder, or the tubes that carry urine. UTIs can cause discomfort like a burning feeling when urinating and might lead to more serious health issues if not treated properly.

UTIs are a significant health issue that affects millions of people every year. For example, around 150 million people globally suffer from UTIs annually, leading to millions of doctor visits. Countries in Asia and Africa are especially impacted. These infections not only affect individuals' health but also have a broad impact on global health systems and economies. In the United States, the cost related to healthcare expenses and lost productivity from work due to UTIs is estimated to be about $3.5 billion each year.

This common health problem can significantly affect everyday life, emphasizing the need for awareness and effective management to reduce its impact on individuals and communities.

What Are the Classifications, Common Causes, and Clinical Symptoms of Urinary Tract Infections?

UTIs can vary greatly, depending on where they occur and how serious they are. They are generally grouped into two categories: upper and lower UTIs, and complicated and uncomplicated infections [5]. Upper UTIs impact the upper part of the urinary system, including the kidneys and the tubes that carry urine from the kidneys to the bladder. Lower UTIs affect the bladder and the urethra, which is the tube that carries urine out of the body.

In an uncomplicated UTI, the infection occurs without any other problems in the urinary tract's structure or function. On the other hand, complicated UTIs happen alongside a problem in the urinary system, like a blockage or a malfunction.

Both types of bacteria, known as gram-positive and gram-negative, along with some fungi, can cause UTIs. These organisms are particularly troublesome because they cling to and grow on the surfaces of the urinary tract. The majority of both simple and more complex UTIs are caused by a type of bacteria called uropathogenic Escherichia coli (UPEC). This bacteria is responsible for about 80% of UTIs that begin outside of hospitals and about 65% of those that patients acquire in hospitals [2]. These bacteria typically live in the colon but can grow excessively and disrupt the normal balance of microbes in the urinary tract

Epidemiology of Uropathogen in UTIs [3]

Pain during urination is a common and early sign of lower urinary tract infections, which often cause discomfort in the lower belly area. For infections higher up in the urinary tract, symptoms can include a high fever (over 100 degrees Fahrenheit), nausea, chills, vomiting, and pain in the side or back. Fever usually points to more severe types of UTIs.

While these symptoms are typical of UTIs, they alone do not confirm an infection is present. A proper examination by a healthcare provider is necessary to accurately diagnose a UTI. People who have had UTIs before are more likely to correctly identify their symptoms, with chances of it being a UTI ranging from about 84% to 90%.

If UTIs are not treated, they can lead to more severe issues like painful bladder inflammation, itching, blisters in the genital area, and ongoing pain in the lower belly area.

Other clinically described symptoms of UTIs include:

Symptoms	Meaning
Urgency	An unstoppable urge to urinate due to sudden involuntary contraction of the bladder muscles
Frequency	Urinating too often and at frequent intervals
Bacteriuria	The presence of bacteria in urine is called bacteriuria, while the presence of >105 bacterial colonies/mL of urine is termed as significant bacteriuria
Pyuria	The presence of pus cells (WBCs) in the urine
Dysuria	Feeling of pain, discomfort, or burning sensation while urinating
Nocturia	Frequently waking up at night to urinate because of UTI or bladder infection
Urinary incontinence	Loss of control of the bladder from a slight loss of urine following coughing, sneezing, or laughing

 

Spotting a UTI: Symptoms and Prevention; Source: Osmosis under Common Creative Rights

How Does Urinary Tract Infections Progress in Patients?

UTIs often begin when harmful bacteria from the gut stick to and grow in the urinary tract, which includes parts like the bladder and urethra. This process starts when bacteria move from the gut to the urethra, the tube through which urine exits the body, causing contamination around the urethra [4]. Once bacteria establish themselves in the urethra, they can move up to the bladder, leading to more complex interactions with the body's defenses.

For example, UPEC can attach to the walls of the bladder and start to produce harmful substances that break down tissues to extract nutrients. This not only helps the bacteria to grow and multiply but also allows them to evade the body's immune system. If not treated, these bacteria can travel further up to the kidneys and produce more toxins that can damage tissues. In severe cases, the bacteria can enter the bloodstream, leading to more widespread infection.

What Risk Factors Predisposes People to UTIs?

Women are more likely than men to get urinary tract infections (UTIs), which can greatly impact their quality of life, especially during pregnancy and around the time of menopause. A 2020 study found that about 20-30% of women will experience at least one UTI in their lifetime.

The reason women are more prone to these infections has to do with anatomy. Women have a shorter urethra which makes it easier for bacteria to reach the bladder. In contrast, men have a longer urethra, which helps flush out bacteria before they can cause any harm.

Apart from gender, several other factors can increase the risk of developing a UTI. These include lifestyle factors like sexual activity and the number of sexual partners; genetic factors such as a person’s natural susceptibility to bacteria; age-related factors like changes in hormone levels affecting vaginal pH; and factors related to pregnancy.

Navigating UTI Treatments: From Symptoms to Solutions

 

What Prevention Strategies Can You Adopt?

The simple prevention practices out there include;

1. Practice Good Sexual Hygiene: Engaging in safe sex practices can significantly lower your risk of developing UTIs.
2. Drink Cranberry Juice: Regular consumption of cranberry juice can help prevent recurrent UTIs by making it harder for bacteria to stick to the urinary tract.
3. Stay Hydrated: Drinking plenty of water and avoiding beverages that can irritate the bladder, like caffeine and alcohol, helps flush bacteria from your system and reduces the risk of infections.
4. Take Probiotics: Using probiotics can support a healthy balance of bacteria in your urinary tract, which helps prevent harmful bacteria from gaining a foothold.
5. Urinate When Needed: Going to the bathroom when you feel the urge and always urinating after sexual activity can help clear bacteria from the urinary tract.
6. Wipe From Front to Back: After using the toilet, wiping from front to back prevents bacteria from the anal region from spreading to the urinary tract.

Treatment Strategies Available

Antibiotic therapy is the primary treatment for urinary tract infections (UTIs). It's important to know that the type of antibiotic used depends on the specific bacteria causing the infection, how severe the infection is, and whether the patient has other health issues. This is why it's crucial to only use antibiotics for UTIs when they are prescribed by a doctor.

When a doctor prescribes antibiotics for a UTI, they work by stopping the harmful bacteria from growing. These drugs do this in several ways: they can prevent the bacteria from building their protective wall, disrupt their structure, or stop them from producing the proteins they need to survive. 

Conclusion

Understanding, preventing, and treating UTIs is key to staying healthy and avoiding more serious problems. Knowing the symptoms and risks can help you take care of your health better. Here’s what you need to remember: UTIs are common, but they can usually be treated effectively if you act quickly.

Some practical steps to prevent UTIs include maintaining good personal hygiene, drinking plenty of water, and following your doctor's advice. These actions can help lower your chances of getting a UTI and lessen the impact if you do get one. If you think you might have a UTI, it’s important to see a healthcare provider who can offer advice that’s right for you.

By being proactive about prevention and understanding your treatment options, we can all help reduce the impact of UTIs in our communities. It’s all about taking the right steps to manage your health.

 

Written for TouchBio by: Dr. Adil Maqbool

 

References

1. Chu CM, Lowder JL. Diagnosis and treatment of urinary tract infections across age groups. Am J Obstet Gynecol. 2018 Jul;219(1):40-51.
2. Baldiris-Avila, R., Montes-Robledo, A. & Buelvas-Montes, Y. Phylogenetic Classification, Biofilm-Forming Capacity, Virulence Factors, and Antimicrobial Resistance in Uropathogenic Escherichia coli (UPEC). Curr Microbiol 77, 3361–3370 (2020)
3. Mancuso G, Midiri A, Gerace E, Marra M, Zummo S, Biondo C. Urinary Tract Infections: The Current Scenario and Future Prospects. Pathogens. 2023 Apr 20;12(4):623.
4. Zhou Y, Zhou Z, Zheng L, Gong Z, Li Y, Jin Y, Huang Y, Chi M. Urinary Tract Infections Caused by Uropathogenic Escherichia coli: Mechanisms of Infection and Treatment Options. Int J Mol Sci. 2023 Jun 23;24(13):10537
5. Bono MJ, Leslie SW, Reygaert WC. Uncomplicated Urinary Tract Infections. 2023 Nov 13. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–.