UTI - a problem for many

Urinary tract infections (UTI) are one of the commonest infections of the human body, says Dr Sanjay Sinha, Senior Consultant Urologist and Transplant Surgeon, Apollo Hospitals

The implications can vary from innocuous to life-threatening depending on the severity of the infection and the fitness of the person. Elderly, malnourished, small children, patients taking steroids or other immunosuppressive drugs, pregnant women, diabetics or those who have long-term catheters are more prone to serious infection. However, for most, simple outpatient medication can take care of the problem. Occasionally, admission and injectable antibiotics might be indicated. Let us consider specific groups of patients with urine infection.

UTI in special groups: 

1. Children: Urine infections are rare in children but when they do occur, one must search for congenital abnormalities that might have predisposed the child to infection (about 10%). Neglect of birth abnormalities can have serious long-term implications for the child.

2. Adult women: Urinary infections are very common in sexually active women. This is an ascending infection from bacteria that reside in the vagina. Initial evaluation is required to exclude diabetes or some other predisposing factor. Usually, simple medication suffices. In women with recurrent urinary infection, low dose prevention or post-intercourse preventive tablets can help. Although there is enthusiasm for home remedies such as cranberry juice, good quality evidence regarding its benefit is lacking.

3. Adult men: Infection may be associated with prostatic infection and this needs to be searched for and treated. Phimosis (tightening of the foreskin) may also be the culprit. In elderly men, age-associated BPH (benign prostatic hyperplasia) is a common trigger for urinary infection. 

4. Diabetics: These patients are especially prone to serious urinary infections. Good control of diabetes is the key to avoiding problems.

5. Pregnant women: Urine infection in pregnant women has a greater tendency to impact the kidneys (Pyelonephritis) and can lead to premature delivery. Screening for infection is an important standard part of obstetric care.

 Note of caution: Not all positive urine cultures are significant. Such culture reports can often originate from contamination. This is more likely if the colony count of bacteria is low or there is no corresponding abnormality on simple urine examination. It is important to judge the validity of the reports before embarking on costly and invasive tests. In fact, treating such individuals can be counterproductive replacing harmless bacteria with more virulent ones. 

Misconception 

Using public or common washrooms is the major cause of increasing urine infection — UTI among Indians.
“Actually that is a common misconception. Public bathrooms do not cause urinary tract infection. The only thing that women can catch from a dirty toilet seat is trichomonal infection of the vagina. Men don’t catch anything at all,” says Dr Sanjay Sinha, Senior Consultant Urologist and Transplant Surgeon, Apollo Hospitals.

It's a common notion that using public washrooms is associated with increased risk of urinary tract infection which is not actually true. “Bacteria commonly responsible for UTI can not survive in environment for long. However, using public toilets may cause worm infestation and it makes sense to cover the commode cover with clean paper before using it,” Dr Hari Kishan Boorugu, Consultant Physcian, Apollo Hospitals.