Fighting urine infections

Fighting urine infections

Vaccination is an effective alternative to antibiotics, say doctors, when episodes are recurrent

Carmen Barreiro

Friday, 26 May 2023, 12:36


Teresa is no stranger to urinary infections. She has been suffering from them for years, and is fed up.

"I get cystitis every now and then and that's a real nuisance, with the discomfort, the visits to the doctor, the tests and the medication every time," says this 54-year-old administrator from Bilbao.

Urinary tract infections (UTIs) are the second most common infection in the population in general, after respiratory infections.

"And women are more likely to suffer from them. Practically half of all women will have an episode at least once in their life and in one in four women the infections are recurrent," says Dr María Fernanda Lorenzo, the head of the urology department at the University Hospital of Salamanca, who is recognised as an expert in treating this type of health problem.

Men also suffer from urinary infections (10%) but as their urinary apparatus is more 'protected' than that of women - the female urethra is shorter and that means the bacteria can reach the bladder more easily - they are "less common but still important. In men over the age of 50, they tend to be associated with prostate problems," adds Dr Francisco José Brenes, a member of the Nephrology and Urinary Tract working group at the Spanish Society of General Practitioners (Semergen).

Bacteria is the origin of urinary infections in both men and women, but not all infections are the same and nor is their cause.

Family history

The factors that most increase the risk of women getting this type of infection are family history on the mother's side, an active sex life (coitus facilitates the bacteria reaching the bladder), the use of spermicides and poor feminine hygiene, whether too little or too much.

"They are also common during menstruation, pregnancy, birth and the menopause. Urinary tract infections are pretty unusual in young men and are nearly always related to sexual activity," explains Dr Brenes.

Lower and upper tract

The location of the infection is also very important. There are two types: lower tract infections (cystitis, urethritis), which affect the bladder and urethra and tend to be mild, and those of the upper tract or pyelonephritis, which occurs when the germ reaches the kidney - or the kidney or prostate in the case of men - and can be very serious.

Burning sensation

"Until a few years ago it was thought that the urinary tract and urine were sterile, but it has now been demonstrated that that is not so. There is always the possibility that someone has bacteria but they may not have any symptoms. So when should we be worried? Only when it creates problems for our health: a burning sensation when urinating, pain, a continual need to go to the bathroom, for example. In addition to those symptoms, if there is fever it means that the bacteria has reached the kidney or prostate and then we have a problem," says Dr Lorenzo.

Resistance to antibiotics

The treatment is usually antibiotics, but in cases of recurring urinary infections - more than two in six months or more than three in one year - vaccines are the most effective solution and they are available under the Spanish health service.

The vaccine reduces and in some cases puts an end completely to troublesome urinary tract infections such as cystitis. Studies have shown that 75 per cent of women who have had the vaccine suffered far fewer infections in the following year and a half.

"The vaccines are a very good alternative to antibiotics, because many bacteria are resistant to the drugs," says Dr Lorenzo, who has been awarded the first prize from the European Urology Association for her study into vaccines to combat urinary infections.

A common pathology in girls and serious in babies

Pediatrician Lucía Galán says infection of the urinary tract is also one of the most common bacterial illnesses that she sees in her young patients that visit her clinic.

“And when it happens, the age of the child determines the treatment, the monitoring and the prognosis. In fact, urinary infections in babies under three months old can be serious and they may have to be admitted to hospital so that antibiotics can be administered intravenously,” she explains in a book she has written, El Gran Libro de Lucía, Mi Pediatra.

“In babies, pyelonephritis presents as fever with no associated symptoms (such as cough, mucus or diarrhoea) and on occasions they may refuse to eat, vomit or be irritable.

“In older children, infections of the upper tracts produce a high fever, a general feeling of being unwell, back pain around the area of the kidneys, and chills, while with cystitis the most common symptoms are pain or a burning sensation when urinating, feeling the need to keep going to the bathroom and pain in the lower part of the abdomen. And no fever,” she says.

To diagnose a urinary tract infection (UTI), in adults and in children, a urine test is needed.

“At first we usually do an immediate and quick test with a reactive strip in the urine sample. That can give us clues, but without a further test it can’t be confirmed,” says Dr Galán.

Urologist María Fernanda Lorenzo also says that when these urine infections keep recurring “it is important to rule out congenital malformations. To do that, we carry out an ultrasound scan to evaluate the child’s urinary apparatus and ensure that they don’t have any pathology that favours urinary tract infections, and we will also check that the child is emptying their bladder fully,” she explains.

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