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Urinary Tract Infections in Women

Recent interview done with Dr Sam Peh on Community Acquired Urinary Tract Infections in Women. Medical Grapevine Magazine April 2016 issue.

What is UTI?

Urinary tract infections (UTI) refer to infection of the urine in the bladder. Symptoms associated with UTI include pain when passing urine, frequent urination and blood in the urine. It is one of the most common medical problems and affects mainly otherwise healthy women. It accounts for a large number of attendances at medical facilities. Young sexually active women, those that are pregnant and postmenopausal ones are the most susceptible. The vast majority of these infections are caused by E. Coli. This is a bacterium that lives in our own colon. The reason why women are vulnerable is due to their short urethra and therefore proximity to the anal region.

There are inherent protective mechanisms in women that reduce the risk of urine infection. The voiding of urine dilutes the concentration of bacteria in the urine and makes it easier for the bladder’s immune system to work. Natural acidity of urine has an antibacterial effect. Bacteria that grow naturally in a women’s vagina like lactobacillus acts as a protective barrier and prevents migration of E. Coli into the bladder. Sexual intercourse transiently disrupts this barrier and also allows E. Coli to enter the bladder more easily. The presence of spermicide in some condom lubricants has the same effect on the protective vaginal flora and so do use of tampons. Unnecessary use of panty liners allows an alternative route for E Coli to gain access to the urethra and then the bladder. In post-menopausal women, the absence of oestrogen makes the vaginal lining dry and inhospitable to the naturally protective bacteria that live there. Even in the presence of these factors, most women’s immune system are effective and they do not get UTIs.

It has been demonstrated that 20% to 30% of UTIs in women resolve on their own without antibiotic therapy. The problem is, 5% of untreated UTIs may progress to infection of the kidney resulting in a more serious condition which may require hospitalisation.

The majority of UTIs in otherwise healthy women is caused by a type of E. Coli which possess certain attributes that allows it to persist in the bladder once it gains entry. This E. coli is called Uropathogenic E. coli (UPEC). These attributes include the ability to stick to the wall of the bladder and therefore negating the effect of bladder emptying as a protective mechanism. This E. Coli can also hide in the cells lining the bladder and therefore delay natural protective inflammatory response. This ability to remain dormant in the cells ning the bladder also explains why UPEC can cause recurrent urine infection.

Treatment of UTIs

It has been demonstrated that 20% to 30% of UTIs in women resolve on their own without antibiotic therapy. The problem is, 5% of untreated UTIs may progress to infection of the kidney resulting in a more serious condition which may require hospitalisation. Initial strategies like drinking more water and taking cranberry extracts may work without resorting to antibiotics. Finally, most women with urine infection will need to see a doctor.

Prevention of UTIs

  • Avoid use of tampons and panty liners.
  • Use condoms that do not contain spermicide in the lubricant.
  • Empty the bladder after sex.
  • UTI is not a hygiene problem and therefore do not wash excessively this may disrupt the “good” bacteria that lives in the vagina.
  • Preventive low dose antibiotics for up to six months. This allows the E. Coli strains that live in our colon to change to less aggressive one. It also allows for the shedding of cells in the bladder which have been colonised with UPEC.
  • Post sexual intercourse antibiotics in women whose urine infection occurs after sex.

What is in the future?

Many centres are working on vaccines that can immunise women against urine infection. None of these vaccines are available commercially yet. If these efforts come to fruition then we can look forward to a future of less urine infection and less antibiotic resistance.

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