Urinary Tract Infections and Infertility.
Background: Urinary Tract Infections in Women is an infection in any part of the urinary tract or the presence of pathogens in urine. The reproductive and urinary systems in women are closely associated with each other. UTI is more common in women than in men at a ratio of occurrence of 8:1. Reports depict that 25% of all microbial infections in women occur in their urinary tract. Further 50-60% of women develop at least one UTI in their lifetime with 20-30% women experiencing recurrent UTIs. The urinary system consists of a bladder, a pair of kidneys, ureters and the urethra.
As per scientific evidence Chlamydia trachomatis infection is the most commonly reported sexually transmitted bacterial infection in Indian population and worldwide. Majority of women are asymptomatic, however, untreated and persistent infections can lead to the pelvic inflammatory disease and infertility.
Most infections involve the lower part of the urinary tract. Some women experience UTIs regularly, a condition known as recurrent urinary tract infection (RUTIs). This can be caused by a range of pathogens but most commonly by Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis and Staphylococcus saprophyticus, the most frequent causative agent being E. coli.
An individual can develop a UTI irrespective of age or sex. However some people are more at risk than others. Several factors are responsible for the occurrence of UTIs, one of the most basic reasons being the lack of personal hygiene. This includes both personal and sexual hygiene. Use of dirty sanitary pads is one of the most prominent factors of UTIs in women. Bowel incontinence, obstructed urine flow due to kidney stones, a weak immune system as a result of chemotherapy or HIV infection and diabetes are some of the other causative factors of UTIs. Pregnant and menopausal women are at a higher risk of developing UTIs. Sexual intercourse especially if more frequent, intense or with multiple or new partners and the use of contraceptive diaphragms and spermicides may also enhance the risk of UTIs in women. The presence of a urinary catheter in the body and heavy use of antibiotics (which can disrupt the natural flora of the bowel and urinary tract) during hospitalization may also lead to UTIs.
Most UTIs although not life threatening, can lead to permanent damage to the urinary tract, particularly upper urinary tract infections and recurrent renal infections (chronic). Some unusual kidney infections (acute) can be life threatening, particularly if septicaemia (bacteria entering the bloodstream) occurs. The symptoms of a UTI can vary depending on age, gender and which part of the urinary tract has been infected. Common symptoms of UTIs include strong and frequent urge to urinate, cloudy, bloody, or strong smelling urine, pain or burning sensation when urinating, scalding pain in the urethra during micturition, lower back pain, nausea & vomiting and muscle & abdominal pains. People with catheters or kidney infections may also experience fever and side pain as symptoms.
Diagnostic tests vary depending upon the complexity and symptoms of the infection. Urine analysis involves inspection of urine colour and clarity as well as observation under the microscope. Urine culture is another test used to detect the type of bacteria that has caused infection. A doctor prescribes specific antibiotics based on the results of the above tests.
Prescription of medicines depends upon the cause and severity of infection as well as the health of the patient. For patients with frequent UTIs, low dose antibiotics are recommended for six months. A single dose of antibiotic post sexual intercourse is prescribed if infection is related to sexual activity. Vaginal estrogen therapy may be advised in postmenopausal women. For patients with severe UTIs, intravenous injections of antibiotics are prescribed. Doctors must compulsorily be consulted before taking any medication.
Several measures can be taken to prevent the risk of developing UTIs in women, the most significant one being proper personal hygiene. Pathogens may enter the urinary tract through the genital and anal routes during sexual intercourse through the urethra. This has been found to be another reason causing risk of UTIs in women. In order to prevent the occurrence of UTIs through sexual intercourse, one should urinate after sex, clean the genital and anal areas before and after sex, stay hydrated and drink plenty of water. All of the above help get rid of bacteria from the urinary tract. Using a diaphragm for birth control increases the risk of UTIs. The location of the diaphragm doesn’t allow the bladder to empty completely, thereby retaining urine and bacteria. Using spermicides also increases the risk of UTI from sex, as does inflammation of the genitals. One should therefore avoid the use of diaphragms and spermicides for birth control. Menopausal women could use estrogen creams around the vagina to reduce the risk of infections.
Cranberry juice may prevent the development of UTIs as it contains a compound that prevents E. coli from sticking to the walls of the digestive and urinary tract.
Uncontrolled diabetes increases the risk of infection in the urinary tract. When blood sugar increases, excess sugar is excreted from the body through urine which in turn creates a favourable environment for the growth of bacteria within the urinary tract. Therefore in order to prevent UTIs in individuals with diabetes, medicines to control high blood sugar levels should be taken. Use of sanitary products such as pads and tampons during menstrual period increases the risk of UTIs if these products are unclean and not changed at regular intervals.
Dr. Pooja Kumari, Ph.D
Department of Zoology, Aligarh Muslim University, India.
March 03, 2017
– Am J Clin Nutr. 2016 Jun;103(6):1434-42. doi: 10.3945/ajcn.116.130542. Consumption of a cranberry juice beverage lowered the number of clinical urinary tract infection episodes in women with a recent history of urinary tract infection. https://www.ncbi.nlm.nih.gov/pubmed/27251185