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Lower Urinary Tract Infection

The two forms of lower urinary tract infection (UTI) are cystitis (infection of the bladder) and urethritis (infection of the urethra). They're nearly 10 times more common in females than in males (except in elderly males) and affect 10% to 20% of all females at least once. UTI is prevalent in girls.

In adult males and in children, lower UTls typically are associated with anatomic or physiologic abnormalities and therefore need close evaluation. Most UTls respond readily to treatment, but recurrence and resistant bacterial flare-up during therapy are possible.


The urine is normally sterile. An infection occurs when bacteria get into the urine and begin to grow.  The infection usually starts at the opening of the urethra where the urine leaves the body and moves upward into the urinary tract.

  • The culprit in at least 90% of uncomplicated infections is Escherichia coli, better know as E coli. These bacteria normally live in the bowel (colon) and around the anus.
  • These bacteria can move from the area around the anus to the opening of the urethra. The two most common causes of this are poor hygiene and sexual intercourse.
  • Usually, the act of emptying the bladder (urinating) flushes the bacteria out of the urethra. If there are too many bacteria, this won't stop them.
  • The bacteria can travel up the urethra to the bladder, where they can grow and cause an infection.

Signs and Symptoms.

The symptoms of a UTI include:

  • Pressure in the lower pelvis
  • Pain or burning with urination
  • Frequent or urgent need to urinate
  • Need to urinate at night
  • Cloudy urine
  • Blood in the urine
  • Foul or strong urine odor

Young children with UTIs may only have a fever, or even no symptoms at all.

Diagnostic tests

Several tests are used to diagnose lower UTI. For example, microscopic urinalysis showing red blood cell and white blood cell counts greater than 10 per highpower field suggests lower UTI.

Clean-catch urinalysis revealing a bacterial count of more than 100,000/ml confirms UTI. Lower counts don't necessarily rule out infection, especially if the patient is urinating frequently, because bacteria require 30 to 45 minutes to reproduce in urine. Clean-catch collection is preferred to catheterization, which can reinfect the bladder with urethral bacteria.

Sensitivity testing is used to determine the appropriate antimicrobial drug. If the patient history and physical examination warrant, a blood test or a stained smear of urethral discharge can be used to rule out sexually transmitted disease.

Voiding cystourethrography or excretory urography may disclose congenital anomalies that predispose the patient to recurrent UTI.


Appropriate antimicrobials are the treatment of choice for most initial lower UTls. A 7- to 10-day course of antibiotics is standard, but studies suggest that a single dose or a 3- to 5-day regimen may be sufficient to render the urine sterile. (Elderly patients may still need 7 to 10 a days of antibiotics to fully benefit from treatment.) If a culture shows that urine isn't sterile after 3 days of antibiotic therapy, bacterial resistance probably has occurred, and a different antimicrobial is prescribed.

A single dose of amoxicillin or cotrimoxazole may be effective for females with acute, uncomplicated
UTI. A urine culture taken 1 to 2 weeks later indicates whether the infection has been eradicated. Recurrent infections from infected renal calculi, chronic prostatitis, or structural abnormalities may necessitate surgery. Prostatitis also requires long-term antibiotic therapy. In patients without these predisposing conditions, long-term, low-dose antibiotic therapy is the treatment of choice.

  • Keep your genital area clean.
  • Wipe from front to back.
  • Drink plenty of fluids.
  • Urinate after sexual intercourse.
  • Avoid fluids that irritate the bladder, like alcohol and caffeine.

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