Urinary Tract Infection (UTI) Symptoms, Causes & Treatment
How common are UTIs?
Urinary Tract Infections (UTIs) are very common in women, and it is estimated that cystitis (bladder infection) will affect at least 60% (Urology Care Foundation) of women at some time in their life. Untreated urine infections can cause septicaemia (bacteria into the blood), but most of the time they are localized to the bladder and result in irritating and bothersome urinary symptoms.
Types of UTIs
UTIs are classified by where the infection occurs in the urinary system. Lower tract infections affect the bladder (cystitis) and urethra (urethritis). Upper tract infections affect the kidneys (pyelonephritis) and ureters. Upper tract infections are less common but more serious and require prompt medical assessment.
What are the symptoms of a UTI?
Symptoms include:
- passing of small and frequent amounts of urine
- pain on urination which can be severe “like passing razor blades”
- cloudy or smelly urine
- bladder pain
- feeling unwell
If a UTI is suspected, it can be confirmed by urine testing with an MSU (mid-stream specimen of urine). This urine specimen is sent to the laboratory to confirm growth of the bacteria that cause UTIs and also to check the sensitivity of the bacteria to various antibiotics.
What Causes a urinary tract infection
Most urinary tract infections are caused by bacteria entering the urinary tract through the urethra. The most common cause is Escherichia coli (E. coli), a bacteria normally found in the bowel. Other potential contributing factors include sexual activity, which can introduce bacteria into the urethra; urinary catheters; a weakened immune system; and structural abnormalities in the urinary tract that prevent the bladder from emptying fully. Women are more susceptible than men due to a shorter urethra, which allows bacteria to reach the bladder more easily.
Urinary tract infections in women
Women are significantly more likely to develop a UTI than men, largely due to a shorter urethra, which allows bacteria to reach the bladder more easily. Hormonal changes are also a factor — declining oestrogen levels after menopause reduce the urinary tract’s natural defences, making recurrent infections more common in post-menopausal women. Recurrent UTIs require specialist assessment rather than repeated courses of antibiotics, as an underlying cause is often identifiable.
Women experiencing recurrent UTIs may also benefit from assessment for related conditions including prolapse and painful bladder syndrome / interstitial cystitis.
Recurrent urinary tract infections
Some women are plagued by frequent urinary tract infections. Overall women are more at risk of UTIs because of their short urethra (tube draining the urine out of the bladder) and proximity of the urethra to the bowel. Individual women’s anatomy may make them more prone to infection as can the ability of the immune system to clear certain bacteria from the urinary tract. While urinary tract infections are rarely life threatening, their impact on a woman’s quality of life cannot be underestimated.
Investigations for recurrent urinary tract infections
Women who experience frequent UTIs require investigation to identify any underlying abnormalities in the urinary tract and to exclude conditions that can mimic infection. Investigations may include:
- Urinalysis: a rapid test of a urine sample to detect signs of infection such as blood, bacteria, or white blood cells.
- MSU (mid-stream urine): a urine specimen collected at the time of symptoms, before starting antibiotics, to confirm an infection is present.
- Urine culture: laboratory analysis of the MSU sample to identify the specific bacteria causing the infection and determine the most effective antibiotic treatment.
- Ultrasound: imaging of the kidneys and bladder to identify structural abnormalities, incomplete bladder emptying, or other issues predisposing to infection.
- Cystoscopy: a telescope examination of the urethra and bladder to directly visualise the urinary tract and exclude abnormalities that may contribute to recurrent infection.
It is important to collect an MSU specimen at the time of symptoms and before beginning any antibiotic treatment, as this ensures an accurate diagnosis and guides the most appropriate course of care.
How to prevent recurrent urinary tract infections
General measures that a woman can take to help reduce the development of urinary tract infections include:
- Wipe from front to back after bowel movements– this helps reduce pushing bowel bacteria towards the urethra and vagina
- Passing urine after intercourse- which helps flush out any of a woman’s own skin bacteria that may have been pushed into the urethra during intercourse
- Use of lubricant gel with intercourse if the vaginal area is dry
- Avoid the use of spermicidal creams and condoms containing spermicides as these can encourage the growth of bacteria that cause UTIs. Some studies have also shown a greater rate of UTI in women using diaphragms for contraception
- Avoid products that may irritate the urethra such as douches, feminine hygiene sprays and excessive washing with soaps. Recurrent UTIs are not related to hygiene, and in fact overwashing the vaginal area can make problems worse
- Prevention of constipation which is a risk factor for urine infection
- Increased fluid intake at the time of a UTI can help flush out bacteria from the urinary tract
Treatments for UTI
Individualised treatment programmes can be tailored to help in early treatment and prevention of recurrent urinary tract infections once any significant abnormalities of the urinary tract have been excluded. A urologist may recommend different treatment regimes depending on the pattern of infections including:
“Self-start antibiotics” – starting antibiotics at home AFTER taking a urine specimen (MSU) to confirm infection.
Preventive antibiotics – a longer course of low dose antibiotics to help eradicate troublesome persistent urinary tract bacteria which can help break the cycle of recurrent urinary tract infection.
“Post-coital antibiotics” – antibiotics which are used after intercourse in women for whom the trigger for infection is sexual intercourse.
Vaginal oestrogen – in the form of a cream or vaginal pessary (NOT the same as hormone replacement therapy) can help prevent recurrent infections in post-menopausal women where the vaginal tissues are dry and prone to colonization by urinary tract bacteria.
UTI vaccine for recurrent urinary tract infections
Uromune (MV140) is a vaccine designed to reduce recurrent UTIs without relying on long-term antibiotics. It contains inactivated forms of the bacteria that most commonly cause urinary tract infections, including E. coli. It is taken as a spray under the tongue once daily for three months. The vaccine works by training the immune system to recognise and respond to these bacteria before an infection takes hold.
Clinical studies have shown a significant reduction in the number of UTIs in the months after treatment, and many patients need fewer courses of antibiotics. Protection may lessen over time, and a repeat course is sometimes recommended.
Uromune is not yet registered on the Australian Register of Therapeutic Goods. It can be accessed through the TGA’s Special Access Scheme when prescribed by a specialist. Our urologists can assess whether the UTI vaccine is suitable for you as part of an individualised plan to manage recurrent urinary tract infections.
When to see a Urologist
A GP can manage most urinary tract infections, but a referral to a urologist is recommended if you experience recurrent UTIs (three or more in a year), if symptoms persist despite antibiotic treatment, or if investigations suggest an underlying abnormality in the urinary tract. Early specialist assessment can identify the cause of recurrent infections and prevent long-term complications.
Frequently asked questions
What are the symptoms of a UTI?
The most common symptoms include a frequent or urgent need to urinate, a burning sensation when urinating, cloudy or strong-smelling urine, and pelvic discomfort. If you develop fever, chills, or back and flank pain, this may indicate the infection has reached the kidneys and requires prompt medical attention.
How common are UTIs in women?
One in two Australian women will experience a UTI in their lifetime. They are one of the most frequent reasons women seek medical care. SA Health
How are UTIs treated?
Most UTIs are treated with a short course of antibiotics. The specific antibiotic will depend on the bacteria identified in your urine culture. It is important to collect an MSU specimen before starting treatment to ensure the correct antibiotic is prescribed.
Can a UTI go away on its own?
Mild lower tract infections occasionally resolve without treatment, but this is not reliable. Leaving a UTI untreated risks the infection spreading to the kidneys, which is a more serious condition requiring more intensive treatment.
What causes recurrent UTIs?
Recurrent UTIs can result from incomplete bladder emptying, structural abnormalities in the urinary tract, hormonal changes after menopause, or bacterial strains that are resistant to standard antibiotics. Specialist investigation is recommended for anyone experiencing three or more UTIs in a year.
When should I see a urologist for a UTI?
You should seek a specialist assessment if you are experiencing recurrent UTIs, if symptoms persist after antibiotic treatment, or if your GP suspects an underlying cause. A urologist can investigate the urinary tract and recommend a longer-term management plan.
How can I prevent UTIs?
Practical measures include drinking adequate fluids, emptying the bladder fully each time you urinate, urinating after sexual intercourse, and wiping front to back. Post-menopausal women may benefit from vaginal oestrogen, which can reduce the frequency of recurrent infections.