People who often get UTIs and who use spermicide or a diaphragm for birth control should use a different type of birth control. Cranberry (juice or capsules) may decrease the number of infections, but some people cannot use cranberries for long periods of time. Gastrointestinal (stomach) upset occurs in more than 30% of people who regularly drink cranberry juice or take capsules. As of 2011, probiotics used intravaginally (in the vagina) require further study to determine if they are helpful.
For people who keep getting infections, taking antibiotics for a long time is helpful. Drugs frequently used include nitrofurantoin and trimethoprim/sulfamethoxazole. If infections are related to sexual intercourse, some women find it useful to taking antibiotics after sex. In post-menopausal women, using topical vaginal estrogen (a hormone applied to the skin of the vaginal) has been found to reduce getting a UTI. Unlike topical creams, the use of vaginal estrogen from pessaries (medical devices put in the vagina is not as useful as low-dose antibiotics. A number of vaccines are being developed (as of 2011).
There is little evidence that using preventative antibiotics decreases urinary tract infections in children. It is rare for people who have no problems with their kidneys to develop kidney problems from frequent UTIs. Having frequent urinary tract infections as a child causes less than a third of a percent (0.33%) of chronic kidney disease in adults.
In most cases, UTIs can be diagnosed just from the symptoms and there is no need for laboratory testing. Urinalysis (testing the urine) can be used to confirm the diagnosis in complicated cases. The urine is tested for urinary nitrites, white blood cells (leukocytes), or leukocyte esterase. Another test, urine microscopy, looks for red blood cells, white blood cells, or bacteria. Urine culture is considered positive if it shows a bacterial colony count of greater than or equal to 10 colony-forming units per mL of a typical bacteria that causes infections of the urinary tract. Cultures can also be used to test which antibiotic will work. However, women with negative cultures can still improve with antibiotic treatment. UTI symptoms in old people can be vague, and diagnosis can be difficult as there is no really reliable test.
A urinary tract infection in the lower urinary tract is known as a bladder infection. A UTI in the upper urinary tract is known as pyelonephritis or kidney infection. If the urine has significant bacteria, but there are no symptoms, the condition is known as asymptomatic bacteriuria.
A urinary tract infection is said to be complicated if:
Otherwise if a women is a healthy and before menopause, the infection is said to be uncomplicated. When children also have a fever, the urinary tract infection is considered to be an upper urinary tract infection.
To diagnose a urinary tract infection in children, a positive urinary culture is required. Contamination poses a frequent challenge so a cutoff of 10 CFU/mL is used for a "clean-catch" mid-stream sample, 10 CFU/mL is used for catheter-obtained specimens, and 10 CFU/mL is used for suprapubic aspirations (a sample drawn directly from the bladder through the stomach wall with a needle). The World Health Organization does not like the use of “urine bags” to collect samples because there is a high rate of contamination when that urine is cultured. Catheterization is preferred if an individual is unable to use a toilet. Some medical groups, such as the American Academy of Pediatrics, recommend renal ultrasound and voiding cystourethrogram (watching a person's urethra and urinary bladder with real time X-rays while they urinate) in all children who are younger than 2 years old and have had a urinary tract infection.Other medical groups such as the National Institute for Clinical Excellence recommend routine imaging only in babies younger than 6 months old or who have unusual findings.
In women with cervicitis (inflammation of the cervix) or vaginitis (inflammation of the vagina) and in young men with UTI symptoms, a "Chlamydia trachomatis" or "Neisseria gonorrheae" infection may be the cause. Vaginitis may also be due to a yeast infection. Interstitial cystitis (chronic pain in the bladder) can be the cause for people who have UTI symptoms many times, but whose urine cultures remain negative and do not improved with antibiotics. Prostatitis (inflammation of the prostate) may also be considered in the differential diagnosis.
Phenazopyridine can be used in addition to antibiotics to help ease the burning pain of a bladder infection. However, phenazopyridine is no longer commonly recommended due to safety concerns. It can cause methemoglobinemia, which means there is higher than normal level of methemoglobin in the blood. Acetaminophen can be used for fevers.
Women who keep getting simple UTIs can benefit from self-treatment; these women should get medical treatment medical only if the initial treatment fails. Health care providers may also prescribe the antibiotics by phone.
Simple infections can be diagnosed and treated based on symptoms alone. Oral antibiotics such as trimethoprim/sulfamethoxazole (TMP/SMX), cephalosporins, nitrofurantoin, or a fluoroquinolone will shorten the time to recovery. All these drugs are equally effective. A three-day treatment with trimethoprim, TMP/SMX, or a fluoroquinolone is usually enough. Nitrofurantoin needs 5–7 days. With treatment, symptoms should improve within 36 hours. About 50% of people will get better without treatment within a few days or weeks. The Infectious Diseases Society of America does not recommend fluoroquinolones as first treatment because of concerns that overuse will lead to resistance to this class of drugs, making these drugs less effective for more serious infections. Despite this precaution, some resistance has developed to all of these drugs because to their widespread use. In some countries, trimethoprim alone is deemed to be equivalent to TMP/SMX. Children with simple UTIs are often helped by a three-day course of antibiotics.
Pyelonephritis (kidney infection) is treated more aggressively than a simple bladder infection using either a longer course of oral antibiotics or intravenous antibiotics. Seven days of the oral fluoroquinolone ciprofloxacin is typically used in geographic areas where the resistance rate is less than 10%. If the local resistance rates are greater than 10%, a dose of intravenous ceftriaxone often is prescribed. People with more severe symptoms are sometimes admitted a hospital for ongoing antibiotics. If symptoms do not improve following two or three days of treatment, it can mean that the urinary tract is blocked by a kidney stone.
Urinary tract infections are the most frequent bacterial infection in women. They occur most frequently between the ages of 16 and 35 years. Ten percent of women get an infection yearly; 60% have an infection at some point in their lives. Nearly half of people get a second infection within a year. Urinary tract infections occur four times more frequently in females than males. Pyelonephritis (a kidney infection) occurs between 20–30 times less frequently than bladder infections. Pyelonephritis is the most common cause of hospital acquired infections, accounting for approximately 40% of hospital-acquired infections. Rates of asymptomatic bacteria in the urine increase with age from 2% to 7% in women of childbearing age to as high as 50% in elderly women in care homes. Rates of aysmtomatic bacteria in the urine among men over 75 are 7-10%.
Urinary tract infections can affect 10% of people during childhood. Urinary tract infections in children are the most common in uncircumcised males younger than 3 months of age, followed by females younger than one year. Estimates of frequency among children, however, vary widely. In a group of children with a fever, ranging in age between birth and 2 years, 2- 20% were diagnosed with a UTI.