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Urinary tract infection: definition, symptoms, causes, diagnosis and treatment

By Cristiano Antonino On May 14, 2023

One of the most common reasons for people to consult a specialist and undergo a urological examination is a urinary tract infection, a disorder that can be caused by a variety of factors and, if not treated properly, can impair normal everyday life

What is a urinary tract infection?

Urinary tract infections are quite common and manifest themselves with various symptoms, all of which are very bothersome and can affect adult men and women as well as children.

They are infections that affect the urinary tract in its various parts, generally at first the lower urinary tract, i.e. the urethra and bladder, and then, in more severe cases, the upper urinary tract, i.e. the ducts that transport urine, and the kidneys.

Furthermore, urinary infections can be divided into

acute infections, when only one episode occurs
recurrent, when they occur more than twice in six months or more than three times in a year
chronic, when symptoms are continuous and persistent over time

Different types of urinary tract infections

As we said, urinary tract infections usually affect the lower part, the part that is ‘exposed’ to the outside.

But they can also travel up the ducts and infect other organs, with even serious consequences.

Cystitis

Cystitis is the most common infection and involves the bladder.

It is more frequent in women, for whom it is often triggered by sexual intercourse.

In men, cystitis is usually due to an ascending infection from the urethra or prostate, especially in the case of chronic bacterial prostatitis.

Urethritis

Urethritis is an infection of the urethra and can be caused by bacteria, but also by protozoa, fungi or viruses.

Among the most frequent causes that trigger it and that are common to both genders are sexually transmitted diseases, such as chlamydia, gonorrhoea, trichomoniasis and herpes.

Ureteritis

When it comes to ureteritis, the infection reaches the duct that connects the renal pelvis to the bladder.

Again, it affects female persons more easily, due to the anatomy of the genital organs themselves.

Pyelonephritis

Pyelonephritis is an infection that reaches the kidneys through the urinary tract.

In men it is often caused by functional and anatomical defects, while in women it is more common during pregnancy when ureteral peristalsis is inhibited.

Asymptomatic bacteriuria

When no symptoms are present but there is a positive urine culture, we speak of asymptomatic bacteriuria.

It is therefore most likely to be detected during screening or in checks of high-risk patients, such as pregnant women or those who have undergone a kidney transplant.

Urinary tract infections can also be distinguished between

uncomplicated, depending on the type of infection and the patient affected, but generally occur without other risk factors
complicated, when they affect children and pregnant women or when they occur in the presence of features such as a structural or functional abnormality of the urinary tract, a co-morbidity or a recent operation or application of instruments to the urinary tract

Symptoms of a urinary tract infection

In the majority of cases, urinary tract infections bring with them very unpleasant symptoms that prompt one to seek medical advice in the first instance, especially if it is an isolated case.

The symptoms can then differ depending on the urinary tract affected.

The most common for cystitis and urethritis are

difficulty urinating despite urge
pollakiuria (frequent urination)
stranguria (painful urination)
haematuria (blood in the urine)
urgent need to urinate
pain in the pelvic and lumbar region

When the infection has spread to the upper urinary tract there is also

fever
chills
nausea and vomiting
chest pain

In some cases urinary tract infections have no symptoms.

This is referred to as asymptomatic bacteriuria, i.e. the presence of bacteria in the urine that causes no discomfort to the patient, but is discovered through screening in at-risk patients.

Causes of a urinary tract infection

Urinary tract infections are caused by bacteria that travel up through the urethra into the bladder and, in severe cases, into other parts of the urinary tract.

In most cases, these are bacteria that are present in the intestines and, due to their proximity to the urethra, are able to contaminate it.

The bacteria that cause infections of the different urinary tracts are

enteric bacteria, usually Gram-negative (the most common)
Gram-positive bacteria

Escherichia coli accounts for 75-95% of the causes of urinary infection, but it is not the only Gram-negative that can cause it.

These also include:

Klebsiella or Proteus mirabilis
Psuedomonas aeruginosa

Gram-positive bacteria rarely cause urinary infections, the majority of which include Staphylococcus saprophyticus, which accounts for approximately 5-10% of cases.

Even rarer are other Gram-positive bacteria such as Enterococcus faecalis and Streptococcus agalactiae.

Finally, infections in a small percentage can be caused by certain yeasts, also present in the intestine, such as Candida albicans.

Factors contributing to urinary infections

There are certain factors that can increase the risk of contracting urinary tract infections, both in women – more predisposed by anatomy – and in men.

These are either external factors, which we can consider mechanical, or other factors related more purely to the state of health.

Mechanical causes that increase the risk of infection include:

use of contraceptives and intra-uterine devices
use of catheters
use of urinary or faecal incontinence aids

Health-related risk factors are instead

structural and functional abnormalities of the urinary tract
narrowing of the urethral canal
enlargement of the prostate
bladder stones
tumours
prolapse
diabetes
neurological diseases
lowered immune defences

Sexual intercourse is obviously a risk factor, particularly if unprotected and with casual partners, and especially in cases where anal penetration occurs.

Who is prone to a urinary tract infection

This type of infection affects men, women and children, but in females it has an incidence of 4 to 1 due to the very anatomy of the genital apparatus, which more easily exposes the urethra to intestinal bacteria due to its proximity to the anus.

It is estimated that 40-50% of women are affected at least once in their lifetime by urinary tract infections, while at least 20% suffer from chronic infections.

In men, however, they are more common in paediatric and geriatric age groups, and in those who practice anal sex without precautions.

Similarly, males with lower urinary tract abnormalities are more affected.

Children and urinary tract infections

In paediatric age, UTIs represent the second most frequent infection after airway infections.

Among toddlers, not only is bacterial contamination caused by nappy wearing common, but 30-45% of children are born with an anatomical abnormality called vesicoureteral reflux that can cause infections.

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Diagnosing urinary infections

The first thing to do if you experience discomfort that can be traced back to a urinary tract infection is to visit your doctor to assess the need for a urine test and possibly a urine culture.

Culture is not always planned, but is recommended in certain cases, such as for pregnant or postmenopausal women, in men, in prepubertal children, in patients suggesting pyelonephritis or sepsis, in those with urinary tract abnormalities or who have undergone recent instrumentation, but also for those with recurrent infections or major co-morbidities.

If it is not the first time symptoms occur or test results require a specialist’s opinion, it is a good idea to consult a urologist, who will assess the causes and treatment of the infection.

However, a urological examination is still the best solution in the case of urinary tract problems, so it should be preferred even when symptoms first occur.

How urinary tract infections are treated

Generally, urinary tract infections are treated with antibiotics.

To alleviate symptoms, painkillers can be used and a lot of drinking can be done.

In the case of so-called complicated UTI, more extensive tests are carried out instead.

If bacteriuria is not present, tests for sexually transmitted diseases must be carried out.

As a rule, uncomplicated and symptomatic cases are treated with antibiotic therapy; for everything else, further tests must be carried out to find out where the infection is, what specifically triggered it, and what caused it.

Complications

There are rare cases of complications of UTIs, but these are consequences that, when present, can carry very serious risks.

These certainly include pyelonephritis, when the infection reaches the kidneys and can impair their functioning, and urosepsis, when bacteria reach the blood, a condition that can lead to death.

Prevention

To avoid chronic infections, especially in high-risk patients (women of childbearing age, children and elderly males, patients with structural abnormalities and co-morbidities), it is good to follow some good rules such as drinking plenty of water, favouring a diet that helps the bowel function, taking care of intimate hygiene, not retaining urine, wearing comfortable and not too tight clothes, emptying the bladder after sexual intercourse and avoiding risk factors (such as unprotected intercourse or intra-uterine devices).

Urinary infection can be of different types and, if it initially affects the lower urinary tract, it can also involve other organs, such as the kidneys, and have serious consequences.

It is important to see a doctor and have a urological examination and urine test, especially in case of recurrent symptoms.

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