Urinary tract infections (UTIs) are bacterial infections of any part of the urinary tract, which includes the bladder, ureters, and kidneys. However, an infection below the bladder (urethritis) is generally not classified as a UTI. UTIs are commonly categorised into two types: uncomplicated and complicated.

Types of UTIs

• Uncomplicated UTI: This is a simple bladder infection, mostly occurring in females. Symptoms may include frequent urination, a burning sensation, bladder pain, and occasionally blood-stained or foul-smelling urine. Fever is rare with uncomplicated infections.
• Complicated UTI: This involves infection reaching the kidneys or ureters and may be associated with additional conditions like kidney stones, obstructions, or structural abnormalities. Symptoms may be more severe, often including fever, and require further imaging, a urine culture, and antibiotics.

Women are particularly prone to UTIs due to their shorter urethra, which allows bacteria easier access to the bladder. Almost half of all women will experience cystitis (bladder infection) in their lifetime, with a higher risk among those who are sexually active, use spermicides, or have a family history of UTIs.

Recurrent UTIs in Women

A recurrent UTI is defined as three or more infections per year or two infections within six months. Risk factors include menopause, pregnancy, sexual intercourse, and certain points in the menstrual cycle. Preventative measures may help reduce recurrence, such as increasing water intake, timely urination after intercourse, and wiping from front to back. In some cases, genetic factors may predispose women to recurrent E. coli infections.

While personal hygiene is important, the role of soaps and hygiene products is often overemphasised and may have a smaller impact than we might think.

UTIs in older women are more commonly linked to factors like constipation, post-menopausal changes, and living in a care facility. As oestrogen levels drop after menopause, the natural Lactobacilli (good bacteria) in the vaginal area decrease, creating an environment where harmful bacteria can thrive. 

UTIs in Men and Children

• In Men: A bladder infection in men often involves the prostate and is treated as a prostate infection. Generally, UTIs in men are classified as complicated and require specific antibiotic treatment.
• In Children: A simple bladder infection (cystitis) in a child is not typically dangerous but requires treatment. However, a kidney infection (pyelonephritis) in children can harm developing kidneys. Children with fever-accompanied UTIs, repeated infections, or specific gender-related UTI patterns should be evaluated by a urologist, as underlying conditions like vesico-ureteric reflux may require attention.

Treatment for Recurrent UTIs

Managing recurrent UTIs often involves lifestyle changes, such as increased fluid intake, and possibly low-dose preventive antibiotics for a period of three to six months. Other options include bladder instillations, hormonal therapy post-menopause, immunisations, vaginal probiotics, Methenamine Hippurate, and D-Mannose supplements.

Cost-Effective UTI Management Approach

According to Pretoria based urologist, Dr Julius Jacobs, for a first UTI in women, symptoms alone with a positive dipstick test can guide treatment, typically with a short three day course of urinary antiseptics (Nitrofurantoin) or Fosfomycin (Urizone).Routine cultures are not usually necessary unless symptoms persist or recur.

This information provides a general understanding of UTIs, their types, risk factors, and treatment options. For specific concerns or recurrent infections, consulting with a healthcare provider is advised for personalised care.