Urinary tract infection

Introduction

Urinary tract infection (UTI) refers to the presence and multiplication of bacteria in the urinary tract. It can affect the bladder (cystitis), urethra (urethritis), prostate (prostatitis), or kidney (pyelonephritis). It is one of the most common bacterial infections in consultation: about one in two women will have at least one cystitis in her lifetime. Although the majority of urinary tract infections are benign, some forms can be serious, notably pyelonephritis and prostatitis, which expose patients to septic complications.

If you have burning urination, an urgent need to urinate, or lower back pain, first contact your treating doctor. If they are unavailable, Docadom offers an emergency consultation by a home doctor : call 021 845 45 45 or use our application available on the App Store and Google Play.

Who is at risk?

Women are particularly exposed due to anatomy (short urethra). Risk factors include: sexual activity, pregnancy, menopause, history of urinary tract infections, diabetes, immunosuppression, urinary malformations, urinary lithiasis, urinary catheterization, prostate enlargement in men, lack of hydration, chronic constipation, and inappropriate intimate hygiene. In young men, urinary tract infections are rarer and should prompt a search for an underlying cause.

Symptoms of Urinary Tract Infection

Symptoms vary according to the location of the infection. The presentation of cystitis is very different from that of pyelonephritis.

Cystitis (lower urinary tract infection)

• Burning on urination : pain or burning when urinating.

• Frequency (pollakiuria) : frequent and urgent needs to urinate, sometimes for only a few drops.

• Urgency : urgent and compelling need to urinate.

• Suprapubic pain or discomfort above the pubis.

• Cloudy, foul-smelling urine, sometimes hematuria (blood in the urine).

• Absence of fever in simple cystitis.

Pyelonephritis (upper urinary tract infection)

• High fever (often > 38.5 °C), chills.

• Unilateral back pain , sometimes radiating to the groin.

• Nausea, vomiting, significant fatigue.

• Lower urinary symptoms (burning, frequency) sometimes present.

• Altered general state.

Prostatitis (men)

• Fever, chills, pelvic or perineal pain.

• Urinary burning, frequency, dysuria.

• Sometimes acute urinary retention .

• Very painful digital rectal examination.

When to seek urgent medical attention?

An emergency consultation is necessary in the following situations:

• Fever, chills, back pain (suspected pyelonephritis).

• Presence of severe pain, vomiting, or an altered general state.

• Urinary tract infection in a pregnant woman, a man, a child, an elderly person, a diabetic, an immunosuppressed patient, or one with a urinary catheter.

• History of urinary malformations or urinary lithiasis.

• Urinary retention.

• Signs of sepsis : mottling, hypotension, confusion — call 144.

What to do before calling Docadom? Drink plenty of water and first contact your treating doctor, who can prescribe a urine dipstick and an appropriate treatment. If they are unreachable or if you need a home doctor outside of business hours, call Docadom at 021 845 45 45 or make your request directly from our smartphone application (App Store and Google Play). In case of signs of severity (high fever with chills, confusion, hypotension), dial 144 without delay.

Causes of Urinary Tract Infection

The vast majority of urinary tract infections are caused by bacteria from the digestive tract that colonize the perineum and then ascend the urethra. The main germ is Escherichia coli (responsible for 70 to 80% of cases), followed by Staphylococcus saprophyticus, Klebsiella, Proteus, Enterococcus. More rarely, some infections are due to fungi (urinary candidiasis) or viruses.

Contributing Factors

• Female anatomy : short urethra, proximity of the urethral meatus and the anus.

• Sexual intercourse (post-coital cystitis, also known as "honeymoon cystitis").

• Pregnancy : hormonal changes and compression of the urinary tract.

• Menopause : estrogen deficiency, mucosal atrophy.

• Anatomical or functional abnormalities of the urinary tract.

• Urinary lithiasis, post-void residual.

• Diabetes, immunosuppression.

• Urinary catheterization, endoscopic procedures.

Diagnosis of Urinary Tract Infection

The diagnosis combines symptoms, a biological exam, and sometimes imaging.

Diagnostic Methods

• Urine dipstick : first-line test, looking for leukocytes and nitrites. A positive dipstick indicates the diagnosis.

• Urine culture (ECBU) : indispensable in case of recurrent cystitis, suspected pyelonephritis, prostatitis, or infection in pregnant women, men, or children. It identifies the germ and its antibiotic susceptibility.

• Blood cultures in case of high fever or signs of sepsis.

• Biological evaluation : CBC, CRP, kidney function in case of pyelonephritis.

• Ultrasound or CT urogram in case of complicated pyelonephritis, recurrence, or pain suggesting obstructive lithiasis.

Alternative Diagnoses

• Urethritis linked to an STI (chlamydia, gonococcus, mycoplasma).

• Vaginitis or vulvitis in women.

• Urinary lithiasis, renal colic.

• Interstitial cystitis, chronic bladder pain.

• Tumor of the urinary tract.

• Acute appendicitis in children or in case of atypical abdominal pain.

Treatment of Urinary Tract Infection

Treatment is essentially antibiotic, adapted to the location and the germ.

Simple Cystitis

Short treatment:

• Fosfomycin-trometamol (Monuril®): single dose of 3 g.

• Pivmecillinam (Selexid®): 5 days.

• Nitrofurantoin : 5 to 7 days (avoid in late pregnancy).

• Fluoroquinolones are no longer recommended as first-line treatment.

Pyelonephritis

Empiric antibiotic therapy while awaiting susceptibility results: ceftriaxone (intramuscular or intravenous) or fluoroquinolone orally for 7 days. Hospitalization in case of signs of severity, pregnancy, comorbidity, or inability to ensure follow-up at home.

Acute Prostatitis

Prolonged antibiotic therapy (14 to 21 days): ceftriaxone initially, followed by ciprofloxacin or cotrimoxazole based on susceptibility results.

Associated Measures

• Abundant hydration (1.5 to 2 L/day).

• Pain relievers: paracetamol, phloroglucinol.

• Monitoring of symptoms and fever.

• Treatment of contributing factors (lithiasis, prostate hypertrophy, constipation).

Prevention of Urinary Tract Infection

• Abundant hydration : drink at least 1.5 to 2 liters of water per day.

• Urinate regularly and completely, without holding it in for long.

• Urinate after sexual intercourse.

• Gentle intimate hygiene, wiping from front to back.

• Avoid douching and harsh antiseptics.

• Treat chronic constipation.

• Prefer cotton underwear.

• Post-menopause: discuss local estrogen therapy with your doctor in case of recurrent cystitis.

• For patients with recurrent cystitis: cranberry, and sometimes antibiotic prophylaxis discussed with the doctor.

Possible Complications

Complications are rare in simple cystitis but possible in case of delayed management or high-risk background: pyelonephritis from neglected cystitis, septicemia and septic shock, renal or perirenal abscess, acute kidney injury, frequent recurrence. In pregnant women, a urinary tract infection can lead to a threat of premature labor. In men, prostatitis can progress to a chronic form.

When to Contact a Doctor for a Urinary Tract Infection

Any symptoms suggesting a urinary tract infection merit medical advice, particularly in high-risk situations:

• As a first resort : contact your treating doctor, who can prescribe a urine dipstick or culture and the appropriate treatment.

• If your doctor is unavailable (evenings, weekends, holidays), Docadom offers an emergency consultation by a home doctor. Call 021 845 45 45 or make your request via our mobile application, available for free on the App Store and Google Play.

• In case of signs of severity (high fever, chills, severe back pain, confusion, repeated vomiting), dial 144 without delay.

Conclusion: Do Not Ignore Symptoms, Treat Quickly

Urinary tract infection is a very common condition, especially in women. It is characterized by burning on urination, frequency, and cloudy urine, which can lead to complications like pyelonephritis, sepsis, or kidney failure in the absence of treatment. Urine culture and targeted antibiotic therapy allow for rapid recovery in the vast majority of cases. Prevention is based on hydration, appropriate intimate hygiene, and management of contributing factors.

At the slightest suggestive symptom, first consult your treating doctor. If they are not available, Docadom provides an emergency doctor at home 7 days a week: call 021 845 45 45 or use our mobile app (App Store, Google Play) to request an emergency consultation.