Recurrent Urinary Tract Infections

A urinary tract infection (UTI) is an infection involving the bladder and the urethra. While sometimes UTIs can go unrecognized and the body can clear them without medications, recurrent urinary tract infections are defined as occurring more than once in a 6-month period, or more than twice per year.

It is important to have a specialist manage recurrent UTIs to help avoid kidney infections and prevent permanent kidney damage. The experienced team at The University of Kansas Health System offers advanced treatment options for even the most stubborn recurrent UTI symptoms.

Recurrent urinary tract infections are diagnosed when a person gets 3 or more UTIs in a 1-year period. In some cases, these infections can be resistant to treatment, so it’s important to accurately identify the type of bacteria responsible for causing the infection. This allows your doctor to prescribe the most effective antibiotic for your particular type of urinary tract infection.

• Cystitis: This is the most common type of UTI and affects the bladder. It often causes symptoms such as frequent and urgent urination, a burning sensation during urination, cloudy or bloody urine and lower abdominal discomfort.
• Pyelonephritis: This is a more severe UTI that affects the kidneys. It can lead to symptoms like high fever, chills, nausea, vomiting and severe back pain. Pyelonephritis requires prompt medical attention as it can lead to serious complications.
• Urethritis: Urethritis is an infection of the urethra, which is the tube that carries urine from the bladder to the outside of the body. It can cause symptoms like burning or itching in the urethral area and discharge.

Symptoms of UTIs may vary depending on which part of the urinary tract is affected. Common symptoms include:

• A strong, persistent urge to urinate
• A burning sensation when urinating
• Passing frequent, small amounts of urine
• Cloudy, dark, bloody or strong-smelling urine
• Pain or pressure in the lower abdomen or back
• Feeling tired or shaky
• Fever or chills (a sign that the infection may have reached the kidneys)

If urinary tract infections are not treated, they could in some situations lead to infections involving the kidneys. Signs of kidney infections include flank pain (pain below the ribs and to the sides of the body where the kidneys are located) as well as new or worsening confusion (which, in older people, can also occur with UTIs).

UTIs are primarily caused by the introduction of bacteria into the urinary tract. The most common culprit is the bacterium Escherichia coli (E. coli), which is normally found in the digestive system.

Common causes and risk factors include:

• Bacterial entry: Bacteria can enter the urinary tract through the urethra and travel upwards. This can happen due to poor hygiene, sexual activity or the use of certain contraceptives.
• Gender: Women are more prone to UTIs because their urethras are shorter, allowing bacteria easier access to the bladder.
• Age: UTIs can occur at any age, but they are more common in older adults due to weakened immune systems or urinary tract abnormalities.
• Obstruction: Any blockage or obstruction in the urinary tract, such as kidney stones or an enlarged prostate in men, can increase the risk of UTIs.
• Catheter use: Individuals with urinary catheters are at a higher risk of developing UTIs as the catheter can introduce bacteria into the urinary tract.
• Weakened immune system: Conditions like diabetes, HIV/AIDS or any condition that weakens the immune system can make individuals more susceptible to UTIs.

Urinary tract infections are diagnosed by urinalysis or urine culture. Sometimes, a urinalysis (where the urine is tested and results are immediately reported) may help to identify an infection. However, for people with recurrent UTIs, it is important to know the specific bacteria responsible, as this determines which antibiotics will appropriately treat it. This process requires a urine culture. A urine culture can take up to 3 days after a sample is provided.

If there is suspicion of a more severe UTI or complications, imaging studies such as ultrasound, CT scans or MRI may be recommended to assess the condition of the kidneys or urinary tract.

The primary treatment for UTIs involves antibiotics. However, recurrent urinary tract infections are UTIs that keep happening despite treatment. With time, some bacteria may stop responding to an antibiotic. This is called antibiotic resistance, which makes effective UTI treatment more difficult.

To ensure the best possible treatment for your UTI symptoms, our specialists will inspect your bladder and urethra and possibly your whole urinary tract system to ensure treatment with antibiotics alone will control the infection. There are times when your physician will work with other specialists if your treatment requires specific antibiotic therapy.

With recurrent UTIs, it is important to make sure that the antibiotic used has completely cleared the UTI. To check this, a urine culture is repeated. This is called a test of cure (TOC) because it ensures that the treatment has been effective. A TOC is a urine culture that is performed within 7 to 14 days after completing the last pill of the treatment antibiotic.

Some people with recurrent urinary tract infections may need to take a daily antibiotic for 6 to 9 months to help prevent another infection after completing the treatment course. This is called a suppression or prophylaxis antibiotic. It is usually a low dose of an antibiotic that has minimal long-term side effects.

Physicians prefer to prevent infections from reaching the kidneys and treat UTIs before they have the potential for causing systemic spread. Recurrent urinary tract infections that involve the kidneys can be serious, requiring strong antibiotics and sometimes even a stay in the hospital. If admitted, the internal medicine team will administer intravenous antibiotics for a few days.