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Treating Urinary Tract Infections

July 1, 2016 | Dr. Ray Bologna

It’s not uncommon for women to have two to three urinary tract infections (UTIs) each year, so understanding treatment options and prevention is the best opportunity to reduce incidence. Sometimes treatment options are simple, but there can be many causes and corresponding treatments for UTIs. [Read more about the most common causes for UTIs here.]
If you’re experiencing symptoms of a UTI on a regular basis, start to take preventive measures and contact your doctor to discuss what treatment option may be right for you.. Here’s some insight on what to expect at your doctor appointment.

What to expect
UTIs can be caused by or related to other health issues, so your doctor will probably ask a lot of questions to get a better understanding of your health history. He or she will want to make sure that your symptoms are indeed UTI-related and rule out related issues like upper UTIs, kidney infections, vaginal atrophy or vaginal infections.  Here are some questions your doctor may ask you:

  • How many infections have you had in the past 12 months?
  • Have you had a fever with these infections?
  • Have you had any urine cultures done to determine the source of the infection?
  • What antibiotics have you been on and for how long?
  • Was there anything associated with the infections, such as sexual activity or recent onset of menopause?
  • Have you had previous bladder or pelvic surgery?
  • Have you had an ultrasound of your kidneys or bladder?
  • Do you have any symptoms of incomplete bladder emptying or difficulty urinating?

Your doctor will also conduct a pelvic exam and check how well your bladder empties. In some cases, he or she may also take a catheterized urine specimen, which is key to distinguishing an infection from other irritating bladder symptoms. For example, some women experience irritating bladder symptoms after sex, secondary to vaginal atrophy, or Interstitial cystitis (a bladder pain syndrome), which may be unrelated to UTIs.

If symptoms warrant, your doctor may order an ultrasound to check for kidney stones or conduct a cystoscopy. A cystoscopy is five-minute procedure in which a small camera is inserted into the urethra to evaluate the bladder and check for any abnormalities. This procedure is not painful and can be done at your doctor’s office.

UTI treatment options
Once you’ve been diagnosed with a UTI, your doctor is likely to treat the infection with antibiotics, but the type and course will depend on your specific symptoms and circumstances.

Antibiotics are generally step one. Five to ten days of the correct antibiotics can often resolve the issue, but recurrences are common if the correct antibiotics were not initially prescribed. The choice of antibiotic should be based on a urine culture.

Repeat cultures help confirm that the infection has completed cleared, and are particularly helpful for those patients who suffer from frequent infections.

Long-term course of treatment may be prescribed if you have recurrent urinary tract infections. This is defined as ≥2 infections in six months or ≥3 infections in one year. Long-term treatment for recurrent UTI could include a standing prescription for antibiotics that is filled whenever symptoms arise (self-start therapy), post-coital antibiotics (low-dose antibiotics taken after sex) or a low-dose daily antibiotic.  The long-term treatment recommendation depends on the clinical history and may be influenced by the patient’s preference.  The risk of developing antibiotic resistance to low-dose daily antibiotics is relatively low and is offset by the potential long-term bladder problems that can arise from repeated infections.  Few people develop yeast infections or any other side effects from taking low-dose daily antibiotics.

Self-start therapy is a good option for patients who have ruled out other potential issues, such as an anatomy problem, kidney stones and voiding dysfunction. This allows you to start an antibiotic when you are developing symptoms. Your doctor can call in a prescription for antibiotics and provide a slip for a urine culture to confirm the diagnosis. This may save you a trip to the doctor and jumpstart your recovery.

UTIs are not always a straightforward diagnosis. The symptoms are very similar to bladder irritation, which can be treated without antibiotics. Some patients take a dipstick urine check at home, in their primary care doctor’s office or an urgent care setting. These tests can be misleading; a patient may show a trace of blood in the urine and have the symptoms of a bladder infection, but get a negative result on the culture. In these situations, it’s helpful to see a urologist or urogynecologist who can help determine what’s really going on and how best to treat it.

Learn about the latest research on urine cultures and diagnosing urinary tract infections.

Find more articles on Urinary Tract Infections