Why are urine infections more common in women?
The explanation is simple and lies in anatomical issues, as the urethra is much shorter in women (2.5-5 cm) than in men (15 cm), making it easier for bacteria to reach the bladder.
How is cystitis produced?
Most cystitis are produced by intestinal bacteria (Enterobacteria) and the most frequent of them is the famous Escherichia coli, which from the rectum and after colonizing the vagina ascend to the bladder.
In normal circumstances these bacteria are eliminated with urination and antibacterial properties of urine, but if natural defense mechanisms fail they can adhere to the vesical wall and develop a typical infection and symptomatology of cystitis.
Therefore, urine infections are caused by germs of their own that reside in the intestine, and although sexual intercourse can favor infections in certain women, the myth must be broken because they are not contagious by the couple or sexually transmitted diseases.
Is it more common at certain ages?
The highest incidence of urinary infections in women is observed between the ages of 16 and 40, coinciding with the age of maximum sexual activity in women, with another peak of incidence after menopause, due to the modification that is generated in the vaginal flora with hormonal changes after menopause.
How is it diagnosed?
In general, unless we encounter the suspicion of complicated infection or special situations such as pregnancy, the diagnosis of presumption is usually clinical supported by urine analysis with reactive strip that can be performed in the same consultation.
Symptoms typical is the presence of stinging urination, urgency or a rush to go to urinate, increased urinary frequency or urinary frequency, suprapubic pain or lower abdomen, urgency, and even hematuria or presence of blood in the urine, which is not accompanied by fever and/or low back pain who would think of a kidney infection or pyelonephritis.
The definitive diagnosis is made by the culture of urine collected under appropriate conditions. In other words, prior genital washing is recommended, separating the lips and disposing of the initial jet to collect urine from the average jet, sending the sample to the Microbiology service within 1 hour. Urinoculture helps to identify the bacteria, the number of colonies, and the sensitivity to different antimicrobials.
UTI counts above 100,000 CFU/ml are generally considered to be urinary infection, although lower counts (1,000 CFU/ml) are also indicative of UTI if accompanied by symptomatology.
In general, in most cases it is not usually done for multiple reasons (it is not cost-effective, delays treatment up to 48 hours by delaying treatment in very symptomatic patients, difficulty in collecting and processing samples, etc.) and establishes empirical treatment or even patients with repeat infections self-treat.
And antibiotic urinoculture is reserved in cases where symptomatology persists after treatment or in special situations such as complicated UTIs, repeat infections, pregnant women or patients with a compatible clinic but urine test with reactive Strip That is not suggestive of urinary infection.
How are they treated?
Because of its characteristics, as mentioned above, usually mild and associated with the absence of complications, the choice of antibiotic treatment is generally empirical (unless urinoculture and antibiotic are available in which case the antibiotic that is sensitive will be treated).
Based on the knowledge that we have about the causes that predispose or generate such cystitis, the most frequently involved germs, as well as the bacterial resistance that is variable depending on the geographic area that resides.
Classic treatment regimens have been decreasing their duration over time, moving from antibiotic coverage regimens of 7 days a few decades ago to treatments of 3 or a single day, as clinical efficacy has been shown to be similar by decreasing adverse effects and therapeutic costs, with better therapeutic compliance.
Should all infections be treated?
A very common finding, which increases with age, is the presence of bacteria in the urine without generating symptomatology, what we call “asymptomatic bacteriuria”.
It is estimated that at 70 years of age 15% of women have asymptomatic bacteriuria, a figure that increases to 30-40% in elderly women hospitalized or admitted to geriatric institutions and almost 100% in carriers of permanent urinary catheter.
In general, antibiotic treatment of asymptomatic bacteriuria should be avoided as it does not bring any benefit and on the contrary generates bacterial resistance and the possibility of not having adequate antibiotic treatment when really needed.
A special situation is that of pregnant women, since there is a relationship between the presence of bacteriuria and its main complication in pregnancy, which is renal infection or pyelonephritis, so they should always be treated with antibiotics that are not contraindicated in pregnancy because of the damage they may develop in the development of the foetus.