Diagnosis and management of UTIs and rUTIs
Diagnosis and management of UTIs and rUTIs
OF A UTI
DIAGNOSIS
A lower UTI is a bladder infection caused by bacteria from the gastrointestinal tract entering the urethra and travelling up to the bladder.3,4,5 The condition is also referred to as cystitis.
More than 70% of cases are caused by Escherichia coli (E. coli).4 Although UTIs are frequently self-limiting, they can cause significant distress.2
Lower UTIs can be divided into:
Uncomplicated UTIs: caused by typical pathogens in people with a normal urinary tract and normal kidney function, with no predisposing co-morbidities.4
Complicated UTIs: associated with an increased likelihood of complications, such as persistent infection, treatment failure and recurrent infection. Risk factors include structural or neurological abnormalities of the urinary tract, urinary catheters, virulent or atypical infecting organisms, pregnancy, older age (post-menopause) and co-morbidities, such as poorly controlled diabetes mellitus or immunosuppression.4
Recurrent UTIs (rUTIs) refer to at least 2 episodes of infection within 6 months or 3 or more episodes in 12 months.5 They are more common in women and may occur due to relapse (infection with the same strain of organism) or reinfection (with a different strain or species of organism).4,6 After the first occurrence of a UTI, 27% of women have a symptomatic recurrence within the next 6 months.7
A UTI can be suspected in women with these typical symptoms (in the absence of vaginal discharge or irritation):4
- Dysuria - discomfort, pain, burning, tingling or stinging associated with urination
- Frequency - passing urine more often than usual
- Urgency - a strong desire to empty the bladder, which may lead to urinary incontinence
- Changes in urine appearance or consistency:
- Urine may appear cloudy or change colour or odour
- Haematuria may present as red/brown discolouration of urine or as frank blood (fresh, bright red)
- Nocturia - passing urine more often than usual at night
- Suprapubic discomfort or tenderness
Vaginal or urethral discharge, irritation or a skin rash may indicate a cause other than a UTI.4
If urinary symptoms are associated with fever, loin pain or rigors, it may indicate pyelonephritis (infection of one or both kidneys).4
Other conditions may present with urinary symptoms similar to a UTI, but without evidence of a UTI on urine culture. These will need to be investigated as alternative conditions can include sexually transmitted infections or more serious alternatives such as an ectopic pregnancy or a malignancy.4