Urinary Tract Infection (UTI)

A urinary tract infection is an infection that can occur in any area of the urinary tract, including the ureters, bladder, kidneys, or urethra. Bladder infections (cystitis) and urethra infections (urethritis) are the most common.

There are two categories of urinary tract infections: simple and complicated.

• Simple UTIs occur in healthy people with normal urinary tracts. This type of UTI occurs most frequently in women. Cystitis is another name for a urinary tract infection.
• Complicated UTIs occur in individuals with abnormal urinary tracts or when underlying medical conditions make treatment failure more likely. Men and children are more likely to have this type of UTI.

Some individuals have bacteria in their urine without signs and symptoms (asymptomatic bacteriuria). These patients may not need antibiotic treatment and should discuss treatment options with their doctor.

When bacteria enter the urinary system, this can result in an infection.  A urine culture can help isolate the bacteria responsible for a particular UTI.

Escherichia coli (E. coli) is the Gram-negative bacteria that cause the vast majority of UTIs. However, other bacterial pathogens can also cause UTIs.

Urinary tract infections are not contagious, and you can't acquire a UTI from someone else.

Risk factors for developing urinary tract infections include the following:

• Wiping from back to front following a bowel movement, particularly in women, can introduce bacteria into the urethra
• Sexual intercourse can push bacteria from the vaginal area into the urethra
• Holding the urine too long: When someone holds it in, more bacteria have a chance to multiply, which can cause or worsen a UTI
• Kidney stones can make it hard to empty the bladder completely, which can also lead to urine remaining in the bladder for too long
• Certain types of birth control devices (contraceptives), including diaphragms or condoms with spermicides
• Hormonal changes and changes in the vagina following menopause
• Using urinary catheters, which are small tubes inserted into the bladder to drain urine, can predispose someone to catheter-associated UTIs.
• Surgery of the genitourinary tract may introduce bacteria into the urinary tract, resulting in a UTI.
• Women tend to get UTIs more frequently than men because the urethra in women is shorter and located closer to the rectum.
• Use of douches
• Older adults
• Taking oral antibiotics
• Diabetes or other illnesses that compromise the immune system
• Urinary incontinence
• Spinal cord injuries
• Multiple sclerosis
• Parkinson's disease
• Previous urinary tract infection
• Enlarged prostate (benign prostatic hyperplasia [BPH])
• Structural abnormalities of the genitourinary tract
• Uncircumcised men

Symptoms and signs of a urinary tract infection include:

• pain or burning when urinating (dysuria);
• frequent urination;
• sudden urge to urinate (bladder spasm);
• frequent or persistent urge to urinate without much urine passing when you go;
• sense of incomplete emptying of the bladder;
• loss of bladder control (urinary incontinence);
• a feeling of pressure or pain in the lower abdomen or pelvis;
• foul-smelling urine;
• urine that is milky, cloudy, reddish, or dark in color;
• blood in the urine;
• back pain, flank (side) pain, or groin pain;
• fever or chills;
• pain during sexual intercourse;
• fatigue;
• a general feeling of being unwell (malaise);
• vaginal irritation; and
• in elderly patients, subtle symptoms such as altered mental status (confusion) or decreased activity may be signs of a UTI.

Vaginal itching is not a typical symptom of a UTI. It may be a sign of bacterial vaginosis or a vaginal yeast infection.

If one is experiencing fever or back pain, this may be a sign of a kidney infection (pyelonephritis), which can be a serious medical issue. Seek medical attention immediately.

If one is experiencing any of the signs or symptoms of a urinary tract infection, see a healthcare provider for diagnosis, as some types of UTIs can lead to life-threatening conditions. Make an appointment with a provider within 24 hours of the onset of symptoms, or go to a hospital's emergency department.

Go to an emergency department immediately for symptoms of a urinary tract infection along with any of the following:

• Fever and shaking
• Nausea, vomiting, and the inability to keep down clear fluids or medications
• You are pregnant
• You have diabetes or another condition that affects the immune system
• You are taking medications that suppress the immune system, such as cancer or chemotherapy

Infants, children, and the elderly should seek medical care as soon as possible if they experience symptoms of a UTI.

Your doctor will usually be able to diagnose a urinary tract infection with a simple point-of-care "dipstick" urine test or a urinalysis from clean catch urine.

They can confirm a UTI with the results of a urine culture showing the growth of bacteria in numbers large enough to indicate an infection. If your doctor suspects a kidney infection or other illness, they may order or perform other tests (including blood work or imaging).

Antibiotics are the most commonly used treatment for urinary tract infections. The duration of treatment with antibiotics for UTIs varies according to the part of the urinary tract that is infected.

• If you have a bladder infection (cystitis), you will need to take antibiotics for 3 to 7 days.
• If you have a kidney infection, you will need to take antibiotics for up to 2 weeks. In certain cases, one may also require hospitalization and intravenous antibiotics.

UTI symptoms and signs usually begin to improve shortly after starting antibiotic medications, but it is important to take the full course prescribed by a healthcare professional so that the infection is fully eradicated and does not return.

What Antibiotics Are Used to Treat Urinary Tract Infections?

For most antibiotics, there is more than one treatment regimen for a UTI. Make sure to discuss the right dosage and treatment frequency with your healthcare provider. Antibiotics that treat UTIs include:

• trimethoprim/sulfamethoxazole (Bactrim, Septra),
• nitrofurantoin (Macrobid, Macrodantin),
• fosfomycin (Monurol),
• ciprofloxacin (Cipro),
• levofloxacin (Levaquin),
• norfloxacin (Noroxin),
• cephalexin (Keflex),
• cefadroxil (Duricef),
• cefuroxime (Ceftin),
• ceftriaxone (Rocephin),
• loracarbef (Lorabid),
• cefixime (Suprax),
• amoxicillin/clavulanic acid (Augmentin),
• cefotetan (Cefotan),
• cefazolin (Ancef),
• ceftazidime (Fortaz, Tazicef),
• cefotaxime (Claforan),
• ampicillin/sulbactam (Unasyn),
• trimethoprim (Primsol),
• amoxicillin (Amoxil),
• cefpodoxime (Vantin),
• ampicillin,
• cefoxitin by injection (Mefoxin),
• gemifloxacin (Factive), and
• gentamicin (Garamycin).

Antibiotic-resistant bacteria can cause cystitis, and the first antibiotic you start on may not be the one that is right for your infection. Urine culture results, which are available between 48-72 hours after the sample is given, help in determining the most effective antibiotic for the isolated bacterial organism.

For fever and pain, one may take pain medications such as acetaminophen (Tylenol) or anti-inflammatory drugs such as ibuprofen (Motrin, Advil).

What Is the Treatment for Recurrent Urinary Tract Infections?

Certain women who have recurrent urinary tract infections (three or more per year) may require preventive management such as antibiotic prophylaxis. One may need to take low doses of antibiotics daily to prevent infections, or one may need to take a course of antibiotics after sex or after noticing the signs and symptoms of a new UTI. A provider may also provide the individual with urine dipsticks to use at home to self-diagnose UTIs.

A physician may also need to perform additional tests to see if there is an underlying medical or anatomic cause for the recurrent UTIs.

Doctors may prescribe topical hormone replacement for postmenopausal women who have frequent or chronic UTIs. Vaginal estrogen is available in a cream form (Premarin, Estrace), a small tablet (Vagifem), or a flexible ring inserted into the vagina and worn for three months (Estring).

• Your primary care provider (PCP) can diagnose and treat a urinary tract infection.
• Women may also see a board-certified obstetrician/gynecologist (OB/GYN) for a UTI.
• If your UTIs are recurrent or chronic, you may be referred to a urologist, a specialist in the urinary tract.
• In an emergency situation, you may see an emergency medicine specialist in the emergency department.

An individual should always have a urinary tract infection diagnosed and treated by a healthcare professional, but there are some home remedies to try that may ease symptoms and help prevent future UTIs:

• Drink plenty of water. Medical professionals recommend that you drink 6 to 8 glasses of water per day.
• Reduce or eliminate processed foods, fruit juices, alcohol, and sugar.
• Use a heating pad.
• Take non-antibiotic supplements such as vitamin C, beta-carotene, and zinc to help boost the immune system. Talk to a doctor to determine the right dose.

Cranberry juice, cranberry products, and other herbal remedies containing cranberry are widely touted as helping prevent bladder infections (cystitis), however, the current evidence does not fully support this.

Probiotics such as lactobacillus and acidophilus may help to protect against infections in the urinary tract, however, more studies are needed to definitively determine their efficacy.

Drinking a mixture of 1 tablespoon of apple cider vinegar plus 3 tablespoons of water is also touted as a natural remedy to cure a urinary tract infection. Some believe that the acidity of the vinegar will create more acidic urine, which will help slow or stop the growth of bacteria. However, more acidic urine may cause a burning sensation when you urinate. Talk to your health care provider before trying this or any other home remedy to treat a UTI.

Talk to your doctor before using any home remedy as they may have unwanted side effects or unexpected interactions with medications you take.

Simple urinary tract infections will usually improve with a course of antibiotics. With complicated UTIs, after finishing the course of antibiotics, have a urine culture sent to make sure the UTI is gone. If the symptoms do not improve within 48-72 hours of starting antibiotics or worsen acutely, one may need a different medication because of bacterial resistance to some antibiotics. If symptoms do not resolve completely after a full course of antibiotics, one may need a second round or a different antibiotic altogether.

About 20% of young women who get a urinary tract infection will have a reoccurrence. While men are less likely to develop a UTI in the first place, the bacteria that causes them often remains inside the prostate gland, therefore men who develop a UTI are very likely to have another UTI.

Some individuals get recurrent or chronic urinary tract infections (three or more per year). In this case, an individual should consider seeing a urologist to find out why he/she is having recurrent UTIs. Other tests may be needed to look for structural abnormalities in the urinary tract. Some individuals may need to be on antibiotic prophylaxis (regular daily doses of antibiotics) to keep recurrent cystitis from happening.

There are also over-the-counter self-testing methods that can be used at home and a healthcare provider may recommend diagnosing and treating recurrent or chronic UTIs at home.

• In some cases, the infection can spread to the kidneys and result in pyelonephritis.
• Severe cases of pyelonephritis can lead to kidney scarring.
• In rare cases, the bacteria causing the urinary tract infection can enter the bloodstream and lead to sepsis, a very serious condition that can sometimes result in death.

If a pregnant woman suspects that she has a urinary tract infection, she should see a healthcare provider.

In most cases, pregnant women who have UTIs can be safely treated with antibiotics at home. However, certain pregnant patients who develop pyelonephritis may require hospitalization and intravenous antibiotics.

Simple urinary tract infections usually resolve with a course of antibiotics with no serious complications.

Complicated urinary tract infections carry a higher risk of treatment failure, although most individuals treated with the appropriate antibiotic in a timely manner will have a favorable outcome. Individuals who develop sepsis as the result of a urinary tract infection carry a more guarded prognosis, as sepsis is a serious condition that can sometimes result in death. This is a rare occurrence in healthy individuals.

Elderly individuals or those who have kidney stones, diabetes, sickle cell disease, cancer, or chronic kidney diseases are more likely to have complications or a poor outcome resulting from a urinary tract infection.

Prevention of urinary tract infections is similar to some of the home remedies mentioned previously.

• Drink plenty of water to flush out bacteria.
• After urinating, and especially after having a bowel movement, always wipe from front to back. Teach children to wipe correctly.
• Urinate before and after intercourse to wash away bacteria, and avoid intercourse while being treated for a UTI.
• Urinate as soon as one feels the need, and empty the bladder completely.
• Use lubrication during intercourse if one is dry.
• If one tends to get recurrent UTIs, avoid using a diaphragm as a contraceptive. Talk to a healthcare provider about other birth-control options.
• Do not use strongly perfumed soaps, douches, feminine hygiene sprays, or powders.
• Wear a new pair of clean underwear or pantyhose each day.
• Wear all cotton or cotton-crotch underwear and pantyhose.
• Wear loose-fitting pants.
• Do not soak in a bath for more than 30 minutes at a time, and do not give children bubble baths.
• Uncircumcised men should wash their foreskins regularly, and teach uncircumcised boys how to wash their foreskins properly.

For more information about urinary tract infections, call WomensHealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

American College of Obstetricians and Gynecologists
Phone: 202-638-5577

American Urogynecologic Society
Phone: 202-367-1167

Urology Care Foundation
Phone: 800-828-7866, 866-746-4282, or 410-689-3700

National Kidney and Urologic Diseases Information Clearinghouse, NIDDK, NIH, HHS
Phone: 800-891-5390 (TDD: 866-569-1162)