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Urinary infection & recurrent UTI

A single infection is usually simple. Infections that keep coming back are a different question, and the answer is rarely another course of antibiotics.

Overview

What it is

Most urinary infections settle with a short course of the right antibiotic. The problem worth referring is the one that keeps returning — conventionally defined as two infections in six months or three in a year.

Recurrence is a signal, not a diagnosis. It may point to a stone acting as a reservoir for bacteria, a bladder that never empties completely, an enlarged prostate, a stricture, or a problem with the pelvic floor. The job is to find out which, because treating the cause is what stops the cycle. Repeated antibiotic courses without an explanation breed resistance and leave the underlying problem untouched.

Symptoms you may notice

  • Burning or stinging on passing urine
  • Needing to pass urine often, and urgently
  • Passing only small amounts each time
  • Cloudy or strong-smelling urine
  • Pain low in the abdomen or over the pubic bone
  • Blood in the urine during an infection
  • In older patients, confusion or a general decline without classic symptoms

Get seen promptly if

  • Fever, shaking chills or back pain — the infection may have reached the kidney
  • Infection alongside a known stone, or with a single functioning kidney
  • Infection in pregnancy
  • Being unable to pass urine, or passing very little
  • Infection that does not settle within 48 hours of starting antibiotics

How it is assessed

  • Urine culture taken before antibiotics are started — this is what identifies the organism
  • Ultrasound of the kidneys, ureters and bladder, with a post-void residual
  • CT KUB where a stone is suspected
  • Flexible cystoscopy where infections keep returning or blood is present
  • Blood sugar and kidney function
  • In men, assessment of the prostate and of bladder emptying
Treatment

What the options actually involve

Targeted antibioticsChosen from the culture result rather than empirically, for the shortest course that works.
Treating the causeClearing a stone, relieving obstruction, correcting a stricture or improving bladder emptying.
Non-antibiotic preventionFluid intake, bladder habit, and in appropriate cases vaginal oestrogen after the menopause.
ProphylaxisLow-dose or post-coital prophylaxis where the cause has been excluded and infections still recur.
Follow-up cultureTo confirm the infection has actually cleared, not just that symptoms have settled.

Have a scan or report about this already?

Send it before your appointment. The consultation then starts from your findings rather than from scratch.

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