Urinary Tract Infection: Men

UTI in Men

Compared to women, Urinary tract infections in men are uncommon. This is due to the longer length of urethra and dryness of the urethral opening (called meatus). Prostatic secretions have antibacterial properties and hence these may prevent urinary tract infections. Non-circumcision is also a risk factor for UTI. The commonest organism is E coli.

UTI is common if there is an anatomic abnormality, obstruction, instrumentation of the urinary tract or prior surgery. In men after 50 years of age, prostatic enlargement can make a person prone to UTI.

As in the case of women, the infections of the urinary tract may involve urethra, bladder or kidney or a combination of all of them. In addition, the prostate gland can also be infected.

Symptoms :

Symptoms are similar to those in women. However, infections of the prostate can give rise to fever and pain in the perineum (the area between anus and scrotum).

Diagnosis of UTI is by its symptoms, physical examination and laboratory tests. The prostate is tender on digital examination of the rectum.

Urine shows increased pus cells, nitrate test is positive and midstream urine culture shows >105 bacteria /ml of urine. In case of recurrence, if no cause is apparent, tests are done to ascertain anatomical details of the urinary tract.

Treatment is started empirically. In case of no or poor response in 2-3 days, the drugs are modified based on culture results.

Urinary Tract Infections : Women

UTI in short, is a common illness in woman, especially during the reproductive period. The incidence in western countries is .5/woman /year.

It is commoner in women compared to men due to their shorter urethra (Tube from the lower end of the bladder to opening for urine). Bacteria from large intestines contaminate the skin around the anus, migrate to the vaginal opening and may ascend through the urethra to the bladder and sometimes via ureter to the kidneys.

Infections of the bladder are called cystitis, infections of urethra  urethritis and that of kidneys pyelonephritis.

Symptoms of UTI

In cases of urethritis, pain while passing urine (dysuria), more frequency, pus discharge from urine opening may occur.

In cases of cystitis, dysuria, frequency, urgency (inability to hold urine), lower abdominal pain or discomfort and sometimes blood in urine may occur.

In pyelonephritis the symptoms usually are : fever (temp above 38° C ), flank pain or discomfort, tenderness on touching at the angle of lower ribs with muscles( costovertebral angle) in addition to dysuria frequency etc. Nauusea and vomitings are also common. This can be a serious illness with fall of BP, shock and malfunction of other organs in the body.

Risk Factors In Women

Risk factors for UTI in a woman are previous UTI’s, abnormal anatomy, stones or other obstructions, sexual intercourse and use of spermicidal jellies. Women in some countries may not complain due to social taboos.

Diagnosis is based on history and finding of pus cells and bacteria in midstream urine. It can be confirmed by urine culture. Collection of proper midstream sample after proper cleaning and drying of genital areas is important to avoid false results.

Treament consists of short course of antibiotics in uncomplicated cases. Complicated cases may require hospitalisation and injectable antibiotics. Antibiotic selection depends on the usual causative agents in the area. Treatment of repeated UTI is different. In urethritis the organisms are often different and require other chemotherapeutic agents.