Urinary Tract Infection (UTI): Common Questions and Myths
Urinary tract infections (UTIs) are one of the most common infections in women and people assigned female at birth (AFAB), but anyone can have a UTI.
A UTI can occur anywhere along the urinary tract, including in the kidneys and along the tubes (ureters) that connect the kidneys to the bladder. More commonly, though, infections involve the lower urinary tract: the bladder (where urine is stored) and the urethra tube that empties urine.
“UTIs are very common, and if needed, antibiotics can clear the infection relatively easily,” says Lori Jones, MD, a Mass General Brigham urologist who cares for patients at Massachusetts General Hospital. “However, there are a lot of misconceptions about UTIs, including what causes them and how they’re treated. It’s important to be armed with the facts about UTIs so you know when to seek care.”
Dr. Jones answers frequently asked questions and addresses common myths about UTIs.
What are the early signs and symptoms of UTI?
For patients, the first question is when to see a health care provider after feeling the initial symptoms. Typically, these symptoms are:
- Burning or pain with urination
- Urgency and frequency of urination, even if your bladder is empty
- Cloudy or bloody urine
- Pressure or pain in the groin or lower belly
The smell or appearance of your urine alone may not be a sign of infection, so be sure to also consider any other symptoms.
Your body can sometimes get rid of a UTI on its own. But if your symptoms don’t get better within a couple of days, contact your primary care provider (PCP). Antibiotics may relieve symptoms shortly after you begin taking them.
What are symptoms of a complicated UTI?
See a health care provider right away if you have:
- Fever or chills
- Lower back pain or pain on the side of the body
- Nausea or vomiting
These may be signs that your body may be fighting more than an uncomplicated UTI, like a kidney infection. Your provider might advise you to visit an urgent care or go to the hospital for treatment. If your symptoms worsen drastically, trust your instincts and seek emergency care.
What are common causes of UTI?
UTIs generally are caused by bacteria (often E. coli) that live in the colon, especially the rectum. The short length of the urethra places its opening close to bacterial reservoirs (the anus and vagina), making women and people AFAB more vulnerable to infection.
You may have heard that certain practices are risk factors for UTIs, particularly for women. But UTIs are not caused by tampon use, or by wearing tight clothes.
A very common risk factor particular to women is hormonal change with age. Until menopause, vaginal flora (microbes that normally live in the vagina) includes protective bacteria. But when estrogen drops during menopause, the pH of the vagina changes, and the good flora cannot thrive there as easily. Without these good bacteria, the “bad” bacteria can more easily flourish in postmenopausal women.
Can men get UTIs?
Men and people assigned male at birth aren’t immune to UTIs, but they are less likely to have them. This is because their longer urethras present a challenge to bacteria entry. However, as men age and begin to empty their bladders less efficiently due to prostate enlargement, urinary tract infections can become more common.
A trigger for UTIs in both men and women is use of any medical instrument near the urethra, including a catheter to drain urine. You may need a catheter to empty your bladder before or after a surgery, during childbirth, or if you have trouble peeing on your own.
Can you get a UTI from sex?
Sexual intercourse can be a strong trigger for a UTI, as can any activity that has the potential for putting infection-causing bacteria near the urethra.
“Any sexual activity near the vagina can trigger a UTI,” explains Dr. Jones. “Your partner and their anatomy can transfer bacteria that usually live in the bowel to your urethra, causing an infection.”
Use of spermicides with or without barrier contraceptives like condoms has been shown to increase the risk of urinary tract infections in sexually active women. Women may consider other birth control methods, like intrauterine devices (IUDs) or birth control pills, if they experience UTIs after sex. “Some patients may benefit from a low- dose antibiotic taken after sex as a preventative measure,” Dr. Jones adds.
What type of UTI test is right for me?
For patients with recurrent urinary tract infection (3 or more infections within 12 months, or more than 2 infections within 6 months), your provider likely will culture your urine to determine the specific type of bacteria causing your infection. A culture is more informative than a dipstick urine test that reveals only whether an infection is likely to be present.
The right test is particularly important for someone who has recurring infections. It helps your provider understand what’s causing your UTI, including the type of bacteria, so they can prescribe the right antibiotic for you.
Do I need a long course of antibiotics for UTI?
Typically, providers prescribe a short course of antibiotics for symptoms confined to the lower urinary tract in patients who have no fever or flank pain. A longer course may be required for someone who has more severe symptoms of an infection or if the infection is in the bladder.
“If you have mild symptoms, a longer course of antibiotics won’t help your UTI clear up faster — it can actually increase your risk of becoming resistant to the antibiotic,” says Dr. Jones. “Your provider prescribes the best antibiotic for you based on your symptoms and medical history.”
Always follow all instructions and take antibiotics for the number of days prescribed, even if your symptoms go away.
How can I prevent UTI?
The body’s best defense against urinary bacteria is adequate urine flow to wash away bacteria. Stay hydrated and avoid holding your pee to help prevent UTIs.
Other strategies include:
- Cranberry supplement taken after sex
- Avoiding douches, sprays, or powder in the genital area
Increasingly, doctors are advocating probiotics via diet (yogurt, kefir, fermented foods) or supplements. While there is no evidence that probiotics alone offer sufficient protection against UTIs, they can be effective when used along with other prevention strategies by promoting healthy vaginal and bowel flora.
Should I drink cranberry juice for UTI prevention?
You may hear or read about prevention strategies for UTI, with cranberry supplements among the most popular. While the data is mixed about the role of cranberry to prevent UTI, using a daily cranberry supplement is a safe strategy that may help reduce your risk of E. coli UTIs.
What if I get frequent UTIs?
Women who experience recurrent UTIs can discuss possible medical prevention tips with their provider, such as low-dose antibiotics and vaginal estrogen replacement after menopause.
