urinary tract infection#Classification

File:Pyuria2011.JPG) as seen from a person with sepsis due to a urinary tract infection.]]

Lower urinary tract infection is also referred to as a bladder infection. The most common symptoms are burning with urination and having to urinate frequently (or an urge to urinate) in the absence of vaginal discharge and significant pain. These symptoms may vary from mild to severe and in healthy women last an average of six{{nbsp}}days. Some pain above the pubic bone or in the lower back may be present. People experiencing an upper urinary tract infection, or pyelonephritis, may experience flank pain, fever, or nausea and vomiting in addition to the classic symptoms of a lower urinary tract infection. Rarely, the urine may appear bloody or contain visible pus in the urine.{{cite book| vauthors = Arellano RS |title=Non-vascular interventional radiology of the abdomen|publisher=Springer|location=New York|isbn=978-1-4419-7731-1|page=67|url=https://books.google.com/books?id=au-OpXwnibMC&pg=PA67|url-status=live|archive-url=https://web.archive.org/web/20160610151717/https://books.google.com/books?id=au-OpXwnibMC&pg=PA67|archive-date=10 June 2016|date=19 January 2011}}

UTIs have been associated with onset or worsening of delirium, dementia, and neuropsychiatric disorders such as depression and psychosis. However, there is insufficient evidence to determine whether UTI causes confusion.{{cite journal | vauthors = Chae JH, Miller BJ | title = Beyond Urinary Tract Infections (UTIs) and Delirium: A Systematic Review of UTIs and Neuropsychiatric Disorders | journal = Journal of Psychiatric Practice | volume = 21 | issue = 6 | pages = 402–411 | date = November 2015 | pmid = 26554322 | doi = 10.1097/PRA.0000000000000105 | s2cid = 24455646 }}{{cite journal | vauthors = Krinitski D, Kasina R, Klöppel S, Lenouvel E | title = Associations of delirium with urinary tract infections and asymptomatic bacteriuria in adults aged 65 and older: A systematic review and meta-analysis | journal = Journal of the American Geriatrics Society | volume = 69 | issue = 11 | pages = 3312–3323 | date = November 2021 | pmid = 34448496 | pmc = 9292354 | doi = 10.1111/jgs.17418 }}{{cite journal | vauthors = Balogun SA, Philbrick JT | title = Delirium, a Symptom of UTI in the Elderly: Fact or Fable? A Systematic Review | journal = Canadian Geriatrics Journal | volume = 17 | issue = 1 | pages = 22–26 | date = March 2014 | pmid = 24596591 | pmc = 3940475 | doi = 10.5770/cgj.17.90 }}{{cite journal | vauthors = Mayne S, Bowden A, Sundvall PD, Gunnarsson R | title = The scientific evidence for a potential link between confusion and urinary tract infection in the elderly is still confusing - a systematic literature review | journal = BMC Geriatrics | volume = 19 | issue = 1 | pages = 32 | date = February 2019 | pmid = 30717706 | pmc = 6360770 | doi = 10.1186/s12877-019-1049-7 | doi-access = free }} The reasons for this are unknown, but may involve a UTI-mediated systemic inflammatory response which affects the brain.{{cite journal | vauthors = Rashid MH, Sparrow NA, Anwar F, Guidry G, Covarrubias AE, Pang H, Bogguri C, Karumanchi SA, Lahiri S | title = Interleukin-6 mediates delirium-like phenotypes in a murine model of urinary tract infection | journal = Journal of Neuroinflammation | volume = 18 | issue = 1 | pages = 247 | date = October 2021 | pmid = 34711238 | pmc = 8554965 | doi = 10.1186/s12974-021-02304-x | doi-access = free }}{{cite journal | vauthors = Jiang Z, Liang F, Zhang Y, Dong Y, Song A, Zhu X, Zhang Y, Xie Z | title = Urinary Catheterization Induces Delirium-Like Behavior Through Glucose Metabolism Impairment in Mice | journal = Anesthesia and Analgesia | volume = 135 | issue = 3 | pages = 641–652 | date = September 2022 | pmid = 35389369 | pmc = 9388475 | doi = 10.1213/ANE.0000000000006008 }} Cytokines such as interleukin-6 produced as part of the inflammatory response may produce neuroinflammation, in turn affecting dopaminergic and/or glutamatergic neurotransmission as well as brain glucose metabolism.

In young children, the only symptom of a urinary tract infection (UTI) may be a fever. Because of the lack of more obvious symptoms, when females under the age of two or uncircumcised males less than a year exhibit a fever, a culture of the urine is recommended by many medical associations. Infants may feed poorly, vomit, sleep more, or show signs of jaundice. In older children, new onset urinary incontinence (loss of bladder control) may occur. About 1 in 400 infants of one to three months of age with a UTI also have bacterial meningitis.{{cite journal | vauthors = Nugent J, Childers M, Singh-Miller N, Howard R, Allard R, Eberly M | title = Risk of Meningitis in Infants Aged 29 to 90 Days with Urinary Tract Infection: A Systematic Review and Meta-Analysis | journal = The Journal of Pediatrics | volume = 212 | pages = 102–110.e5 | date = September 2019 | pmid = 31230888 | doi = 10.1016/j.jpeds.2019.04.053 | s2cid = 195327630 }}

Urinary tract symptoms are frequently lacking in the elderly. The presentations may be vague and include incontinence, a change in mental status, or fatigue as the only symptoms, while some present to a health care provider with sepsis, an infection of the blood, as the first symptoms. Diagnosis can be complicated by the fact that many elderly people have preexisting incontinence or dementia.

It is reasonable to obtain a urine culture in those with signs of systemic infection that may be unable to report urinary symptoms, such as when advanced dementia is present.{{Citation |author1 = AMDA – The Society for Post-Acute and Long-Term Care Medicine |author1-link = AMDA – The Society for Post-Acute and Long-Term Care Medicine |date = February 2014 |title = Ten Things Physicians and Patients Should Question |publisher = AMDA – The Society for Post-Acute and Long-Term Care Medicine |work = Choosing Wisely: an initiative of the ABIM Foundation |url = http://www.choosingwisely.org/doctor-patient-lists/amda/ |access-date = 20 April 2015 |url-status = live |archive-url = https://web.archive.org/web/20140913011101/http://www.choosingwisely.org/doctor-patient-lists/amda/ |archive-date = 13 September 2014 }} Systemic signs of infection include a fever or increase in temperature of more than {{convert|1.1|C-change|F-change}} from usual, chills, and an increased white blood cell count.

File:UPEC adhered to BEC.jpg cells adhered to bladder epithelial cell]]

Uropathogenic E. coli from the gut is the cause of 80–85% of community-acquired urinary tract infections,{{cite journal | vauthors = Abraham SN, Miao Y | title = The nature of immune responses to urinary tract infections | journal = Nature Reviews. Immunology | volume = 15 | issue = 10 | pages = 655–663 | date = October 2015 | pmid = 26388331 | pmc = 4926313 | doi = 10.1038/nri3887 }} with Staphylococcus saprophyticus being the cause in 5–10%. Rarely they may be due to viral or fungal infections.{{cite journal | vauthors = Amdekar S, Singh V, Singh DD | title = Probiotic therapy: immunomodulating approach toward urinary tract infection | journal = Current Microbiology | volume = 63 | issue = 5 | pages = 484–490 | date = November 2011 | pmid = 21901556 | doi = 10.1007/s00284-011-0006-2 | s2cid = 24123416 }} Healthcare-associated urinary tract infections (mostly related to urinary catheterization) involve a much broader range of pathogens including: E. coli (27%), Klebsiella (11%), Pseudomonas (11%), the fungal pathogen Candida albicans (9%), and Enterococcus (7%) among others.{{cite journal | vauthors = Sievert DM, Ricks P, Edwards JR, Schneider A, Patel J, Srinivasan A, Kallen A, Limbago B, Fridkin S | title = Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009-2010 | journal = Infection Control and Hospital Epidemiology | volume = 34 | issue = 1 | pages = 1–14 | date = January 2013 | pmid = 23221186 | doi = 10.1086/668770 | s2cid = 7663664 | url = https://zenodo.org/record/1235706 | access-date = 2 July 2019 | archive-date = 16 March 2020 | archive-url = https://web.archive.org/web/20200316215808/https://zenodo.org/record/1235706 | url-status = live }}{{cite journal | vauthors = Bagshaw SM, Laupland KB | title = Epidemiology of intensive care unit-acquired urinary tract infections | journal = Current Opinion in Infectious Diseases | volume = 19 | issue = 1 | pages = 67–71 | date = February 2006 | pmid = 16374221 | doi = 10.1097/01.qco.0000200292.37909.e0 | s2cid = 23726078 }} During recent years of intensive care, Enterococcus spp. have several times been found as the primary cause of urinary tract infection, suggested related to broad treatment with cephalosporin antibiotics against which they are tolerant.{{Cite journal |last1=Karlsson |first1=Philip A. |last2=Pärssinen |first2=Julia |last3=Danielsson |first3=Erik A. |last4=Fatsis-Kavalopoulos |first4=Nikos |last5=Frithiof |first5=Robert |last6=Hultström |first6=Michael |last7=Lipcsey |first7=Miklos |last8=Järhult |first8=Josef D. |last9=Wang |first9=Helen |date=7 February 2023 |title=Antibiotic use during coronavirus disease 2019 intensive care unit shape multidrug resistance bacteriuria: A Swedish longitudinal prospective study |journal=Frontiers in Medicine |volume=10 |doi=10.3389/fmed.2023.1087446 |doi-access=free |issn=2296-858X |pmc=9941185 |pmid=36824610}}{{Cite journal |last1=Toc |first1=Dan Alexandru |last2=Mihaila |first2=Razvan Marian |last3=Botan |first3=Alexandru |last4=Bobohalma |first4=Carina Nicoleta |last5=Risteiu |first5=Giulia Andreea |last6=Simut-Cacuci |first6=Bogdan Nicolae |last7=Steorobelea |first7=Bianca |last8=Troanca |first8=Stefan |last9=Junie |first9=Lia Monica |date=7 June 2022 |title=Enterococcus and COVID-19: The Emergence of a Perfect Storm? |journal=International Journal of Translational Medicine |volume=2 |issue=2 |pages=220–229 |doi=10.3390/ijtm2020020 |doi-access=free |issn=2673-8937}}{{Cite journal |last1=Trześniewska-Ofiara |first1=Zuzanna |last2=Mendrycka |first2=Mariola |last3=Cudo |first3=Andrzej |last4=Szmulik |first4=Magdalena |last5=Woźniak-Kosek |first5=Agnieszka |date=11 July 2022 |title=Hospital Urinary Tract Infections in Healthcare Units on the Example of Mazovian Specialist Hospital Ltd |journal=Frontiers in Cellular and Infection Microbiology |volume=12 |doi=10.3389/fcimb.2022.891796 |doi-access=free |issn=2235-2988 |pmc=9309389 |pmid=35899043}} Urinary tract infections due to Staphylococcus aureus typically occur secondary to blood-borne infections. Chlamydia trachomatis and Mycoplasma genitalium can infect the urethra but not the bladder.{{cite web |url=http://kidney.niddk.nih.gov/kudiseases/pubs/utiadult/ |title=Urinary Tract Infections in Adults |access-date=1 January 2015 |url-status=live |archive-url=https://web.archive.org/web/20150109084836/http://kidney.niddk.nih.gov/KUDiseases/pubs/utiadult/ |archive-date=9 January 2015 }} These infections are usually classified as a urethritis rather than urinary tract infection.{{cite journal | vauthors = Brill JR | title = Diagnosis and treatment of urethritis in men | journal = American Family Physician | volume = 81 | issue = 7 | pages = 873–878 | date = April 2010 | pmid = 20353145 }}

In young sexually active women, sexual activity is the cause of 75–90% of bladder infections, with the risk of infection related to the frequency of sex. The term "honeymoon cystitis" has been applied to this phenomenon of frequent UTIs during early marriage. In post-menopausal women, sexual activity does not affect the risk of developing a UTI. Spermicide use, independent of sexual frequency, increases the risk of UTIs. Diaphragm use is also associated.{{cite journal | vauthors = Franco AV | title = Recurrent urinary tract infections | journal = Best Practice & Research. Clinical Obstetrics & Gynaecology | volume = 19 | issue = 6 | pages = 861–873 | date = December 2005 | pmid = 16298166 | doi = 10.1016/j.bpobgyn.2005.08.003 }} Condom use without spermicide or use of birth control pills does not increase the risk of uncomplicated urinary tract infection.{{cite book | vauthors = Engleberg NC, DiRita V, Dermody TS |title=Schaechter's Mechanism of Microbial Disease |year=2007 |publisher=Lippincott Williams & Wilkins |location= Baltimore|isbn=978-0-7817-5342-5}}

Women are more prone to UTIs than men because, in females, the urethra is much shorter and closer to the anus.{{cite journal | vauthors = Dielubanza EJ, Schaeffer AJ | title = Urinary tract infections in women | journal = The Medical Clinics of North America | volume = 95 | issue = 1 | pages = 27–41 | date = January 2011 | pmid = 21095409 | doi = 10.1016/j.mcna.2010.08.023 | doi-access = free }} As a woman's estrogen levels decrease with menopause, her risk of urinary tract infections increases due to the loss of protective vaginal flora. Additionally, vaginal atrophy that can sometimes occur after menopause is associated with recurrent urinary tract infections.{{cite journal | vauthors = Goldstein I, Dicks B, Kim NN, Hartzell R | title = Multidisciplinary overview of vaginal atrophy and associated genitourinary symptoms in postmenopausal women | journal = Sexual Medicine | volume = 1 | issue = 2 | pages = 44–53 | date = December 2013 | pmid = 25356287 | pmc = 4184497 | doi = 10.1002/sm2.17 }}

Chronic prostatitis in the forms of chronic prostatitis/chronic pelvic pain syndrome and chronic bacterial prostatitis (not acute bacterial prostatitis or asymptomatic inflammatory prostatitis) may cause recurrent urinary tract infections in males. Risk of infections increases as males age. While bacteria is commonly present in the urine of older males this does not appear to affect the risk of urinary tract infections.{{cite journal | vauthors = Holt JD, Garrett WA, McCurry TK, Teichman JM | title = Common Questions About Chronic Prostatitis | journal = American Family Physician | volume = 93 | issue = 4 | pages = 290–296 | date = February 2016 | pmid = 26926816 }}

Urinary catheterization increases the risk for urinary tract infections. The risk of bacteriuria (bacteria in the urine) is between three and six percent per day and prophylactic antibiotics are not effective in decreasing symptomatic infections. The risk of an associated infection occurs linearly for enteric bacteria,{{Cite journal |last1=Karlsson |first1=Philip A. |last2=Bolin |first2=Christian |last3=Spång |first3=Labolina |last4=Frithiof |first4=Robert |last5=Hultström |first5=Michael |last6=Lipcsey |first6=Miklos |last7=Wang |first7=Helen |last8=Järhult |first8=Josef D. |date=7 November 2024 |title=Bacteriuria and antibiotic use during the third wave of COVID-19 intensive care in Sweden |journal=Infectious Diseases |pages=1–10 |doi=10.1080/23744235.2024.2423884 |pmid=39509144 |issn=2374-4235|doi-access=free }} and can be decreased by catheterizing only when necessary, using aseptic technique for insertion, and maintaining unobstructed closed drainage of the catheter.{{cite journal | vauthors = Phipps S, Lim YN, McClinton S, Barry C, Rane A, N'Dow J | title = Short term urinary catheter policies following urogenital surgery in adults | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD004374 | date = April 2006 | pmid = 16625600 | doi = 10.1002/14651858.CD004374.pub2 | veditors = Phipps S }}

Male scuba divers using condom catheters and female divers using external catching devices for their dry suits are also susceptible to urinary tract infections.{{cite journal | vauthors = Harris R | title = Genitourinary infection and barotrauma as complications of 'P-valve' use in drysuit divers | journal = Diving and Hyperbaric Medicine | volume = 39 | issue = 4 | pages = 210–212 | date = December 2009 | pmid = 22752741 | url = http://archive.rubicon-foundation.org/9482 | access-date = 4 April 2013 | url-status = usurped | archive-url = https://web.archive.org/web/20130526025635/http://archive.rubicon-foundation.org/xmlui/handle/123456789/9482 | archive-date = 26 May 2013 }}

A predisposition for bladder infections may run in families. This is believed to be related to genetics. Other risk factors include diabetes, being uncircumcised,{{cite journal | vauthors = Jagannath VA, Fedorowicz Z, Sud V, Verma AK, Hajebrahimi S | title = Routine neonatal circumcision for the prevention of urinary tract infections in infancy | journal = The Cochrane Database of Systematic Reviews | volume = 11 | pages = CD009129 | date = November 2012 | pmid = 23152269 | doi = 10.1002/14651858.CD009129.pub2 | quote = The incidence of urinary tract infection (UTI) is greater in uncircumcised babies }}{{cite journal | vauthors = Morris BJ, Wiswell TE | title = Circumcision and lifetime risk of urinary tract infection: a systematic review and meta-analysis | journal = The Journal of Urology | volume = 189 | issue = 6 | pages = 2118–2124 | date = June 2013 | pmid = 23201382 | doi = 10.1016/j.juro.2012.11.114 }} and having a large prostate. In children UTIs are associated with vesicoureteral reflux (an abnormal movement of urine from the bladder into ureters or kidneys) and constipation.

Persons with spinal cord injury are at increased risk for urinary tract infection in part because of chronic use of catheter, and in part because of voiding dysfunction.{{cite journal | vauthors = Eves FJ, Rivera N | title = Prevention of urinary tract infections in persons with spinal cord injury in home health care | journal = Home Healthcare Nurse | volume = 28 | issue = 4 | pages = 230–241 | date = April 2010 | pmid = 20520263 | doi = 10.1097/NHH.0b013e3181dc1bcb | s2cid = 35850310 | doi-access = free }} It is the most common cause of infection in this population, as well as the most common cause of hospitalization.

File:Bladder Infection.png

The bacteria that cause urinary tract infections typically enter the bladder via the urethra. However, infection may also occur via the blood or lymph. It is believed that the bacteria are usually transmitted to the urethra from the bowel, with females at greater risk due to their anatomy. After gaining entry to the bladder, E. Coli are able to attach to the bladder wall and form a biofilm that resists the body's immune response.

Escherichia coli is the single most common microorganism, followed by Klebsiella and Proteus spp., to cause urinary tract infection. Klebsiella and Proteus spp., are frequently associated with stone disease. The presence of Gram positive bacteria such as Enterococcus and Staphylococcus is increased.{{cite book | vauthors = Gutierrez-Aceves J | chapter = Preoperative Antibiotics and Prevention of Sepsis in Genitourinary Surgery | veditors = Smith AD, Badlani GH, Preminger GM, Kavoussi LR |title=Smith's Textbook of Endourology |date=2011 |publisher=John Wiley & Sons |location=Hoboken, NJ |isbn=978-1-4443-4514-8 |edition=3rd | page = 39 }}

The increased resistance of urinary pathogens to quinolone antibiotics has been reported worldwide and might be the consequence of overuse and misuse of quinolones.

Image:Bacteriuria pyuria 4.jpg (rod-shaped bacteria, here shown as black and bean-shaped) shown between white blood cells in urinary microscopy. These changes are indicative of a urinary tract infection.]]

In straightforward cases, a diagnosis may be made and treatment given based on symptoms alone without further laboratory confirmation. In complicated or questionable cases, it may be useful to confirm the diagnosis via urinalysis, looking for the presence of urinary nitrites, white blood cells (leukocytes), or leukocyte esterase.{{cite journal | vauthors = Detweiler K, Mayers D, Fletcher SG | title = Bacteruria and Urinary Tract Infections in the Elderly | journal = The Urologic Clinics of North America | volume = 42 | issue = 4 | pages = 561–568 | date = November 2015 | pmid = 26475952 | doi = 10.1016/j.ucl.2015.07.002 | type = Review }} Another test, urine microscopy, looks for the presence of red blood cells, white blood cells, or bacteria. Urine culture is deemed positive if it shows a bacterial colony count of greater than or equal to 10³ colony-forming units per mL of a typical urinary tract organism. Antibiotic sensitivity can also be tested with these cultures, making them useful in the selection of antibiotic treatment. However, women with negative cultures may still improve with antibiotic treatment. As symptoms can be vague and without reliable tests for urinary tract infections, diagnosis can be difficult in the elderly.

Normal urine pH is slightly acidic, with usual values of 6.0 to 7.5, but the normal range is 4.5 to 8.0. A urine pH of 8.5 or 9.0 is indicative of a urea-splitting organism, such as Proteus, Klebsiella, or Ureaplasma urealyticum; therefore, an asymptomatic patient with a high pH means UTI regardless of the other urine test results. Alkaline pH also can signify struvite kidney stones, which are also known as "infection stones".{{cite journal | title = Urinary Tract Infection | journal = Statpearls | date = 2020 | pmid = 29261874 | vauthors = Bono MJ, Leslie SW, Reygaert WC }} 50px Text was copied from this source, which is available under a [https://creativecommons.org/licenses/by/4.0/ Creative Commons Attribution 4.0 International License] {{Webarchive|url=https://web.archive.org/web/20171016050101/https://creativecommons.org/licenses/by/4.0/ |date=16 October 2017 }}.

A urinary tract infection may involve only the lower urinary tract, in which case it is known as a bladder infection. Alternatively, it may involve the upper urinary tract, in which case it is known as pyelonephritis. If the urine contains significant bacteria but there are no symptoms, the condition is known as asymptomatic bacteriuria. If a urinary tract infection involves the upper tract, and the person has diabetes mellitus, is pregnant, is male, or immunocompromised, it is considered complicated. Otherwise if a woman is healthy and premenopausal it is considered uncomplicated. In children when a urinary tract infection is associated with a fever, it is deemed to be an upper urinary tract infection.{{cite journal | vauthors = Bhat RG, Katy TA, Place FC | title = Pediatric urinary tract infections | journal = Emergency Medicine Clinics of North America | volume = 29 | issue = 3 | pages = 637–653 | date = August 2011 | pmid = 21782079 | doi = 10.1016/j.emc.2011.04.004 }}

To make the diagnosis of a urinary tract infection in children, a positive urinary culture is required. Contamination poses a frequent challenge depending on the method of collection used, thus a cutoff of 10⁵{{nbsp}}CFU/mL is used for a "clean-catch" mid stream sample, 10⁴{{nbsp}}CFU/mL is used for catheter-obtained specimens, and 10²{{nbsp}}CFU/mL is used for suprapubic aspirations (a sample drawn directly from the bladder with a needle). The use of "urine bags" to collect samples is discouraged by the World Health Organization due to the high rate of contamination when cultured, and catheterization is preferred in those not toilet trained. Some, such as the American Academy of Pediatrics recommends renal ultrasound and voiding cystourethrogram (watching a person's urethra and urinary bladder with real time x-rays while they urinate) in all children less than two years old who have had a urinary tract infection. However, because there is a lack of effective treatment if problems are found, others such as the National Institute for Health and Care Excellence only recommends routine imaging in those less than six 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 gonorrhoeae infection may be the cause.{{cite journal | vauthors = Raynor MC, Carson CC | title = Urinary infections in men | journal = The Medical Clinics of North America | volume = 95 | issue = 1 | pages = 43–54 | date = January 2011 | pmid = 21095410 | doi = 10.1016/j.mcna.2010.08.015 }} These infections are typically classified as a urethritis rather than a urinary tract infection. Vaginitis may also be due to a yeast infection.{{cite book| vauthors = Hui D | veditors = Leung A, Padwal R |title=Approach to internal medicine : a resource book for clinical practice|publisher=Springer|location=New York|isbn=978-1-4419-6504-2|page=244 |url=https://books.google.com/books?id=lnXNpj5ZzKMC&pg=PA244 |edition=3rd |url-status=live|archive-url=https://web.archive.org/web/20160520142217/https://books.google.com/books?id=lnXNpj5ZzKMC&pg=PA244|archive-date=20 May 2016|date=15 January 2011}} Interstitial cystitis (chronic pain in the bladder) may be considered for people who experience multiple episodes of UTI symptoms but urine cultures remain negative and not improved with antibiotics.{{cite book| veditors = Kursh ED, Ulchaker JC |title=Office urology|year=2000|publisher=Humana Press|location=Totowa, N.J.|isbn=978-0-89603-789-2|page=131|url=https://books.google.com/books?id=AdYs-QwU8KQC&pg=PA131|url-status=live|archive-url=https://web.archive.org/web/20160504192213/https://books.google.com/books?id=AdYs-QwU8KQC&pg=PA131|archive-date=4 May 2016}} Prostatitis (inflammation of the prostate) may also be considered in the differential diagnosis.{{cite book | veditors = Mick NW, Peters JR, Egan D, Nadel ES, Walls R, Silvers S |title=Blueprints emergency medicine|year=2006|publisher=Lippincott Williams & Wilkins|location=Baltimore, Md.|isbn=978-1-4051-0461-6|page=152|url=https://books.google.com/books?id=NvqaWHi1OTsC&pg=RA1-PA152|edition=2nd|url-status=live|archive-url=https://web.archive.org/web/20160527135605/https://books.google.com/books?id=NvqaWHi1OTsC&pg=RA1-PA152|archive-date=27 May 2016}}

Hemorrhagic cystitis, characterized by blood in the urine, can occur secondary to a number of causes including: infections, radiation therapy, underlying cancer, medications and toxins. Medications that commonly cause this problem include the chemotherapeutic agent cyclophosphamide with rates of 2–40%.{{cite book | veditors = Graham SD, Keane, James TE, Glenn F |title=Glenn's urologic surgery|year=2009|publisher=Lippincott Williams & Wilkins|location=Philadelphia, Pa.|isbn=9780781791410|page=148|url=https://books.google.com/books?id=GahMzaKgMKAC&pg=PA148|edition=7th|url-status=live|archive-url=https://web.archive.org/web/20160424192313/https://books.google.com/books?id=GahMzaKgMKAC&pg=PA148|archive-date=24 April 2016}} Eosinophilic cystitis is a rare condition where eosinophiles are present in the bladder wall. Signs and symptoms are similar to a bladder infection.{{cite book| veditors = Belman AB, King LR, Kramer SA |title=Clinical pediatric urology |year=2002 |publisher=Dunitz |location=London |isbn=9781901865639 |page=338 |url= https://books.google.com/books?id=IKexq6xCRmIC&pg=PA338|edition=4.|url-status=live|archive-url=https://web.archive.org/web/20160515140354/https://books.google.com/books?id=IKexq6xCRmIC&pg=PA338|archive-date=15 May 2016}} Its cause is not entirely clear; however, it may be linked to food allergies, infections, and medications among others.{{cite journal | vauthors = Popescu OE, Landas SK, Haas GP | title = The spectrum of eosinophilic cystitis in males: case series and literature review | journal = Archives of Pathology & Laboratory Medicine | volume = 133 | issue = 2 | pages = 289–294 | date = February 2009 | pmid = 19195972 | doi = 10.5858/133.2.289 }}

A number of measures have not been confirmed to affect UTI frequency including: urinating immediately after intercourse, the type of underwear used, personal hygiene methods used after urinating or defecating, or whether a person typically bathes or showers. There is similarly a lack of evidence surrounding the effect of holding one's urine, tampon use, and douching. In those with frequent urinary tract infections who use spermicide or a diaphragm as a method of contraception, they are advised to use alternative methods. In those with benign prostatic hyperplasia urinating in a sitting position appears to improve bladder emptying{{cite journal | vauthors = de Jong Y, Pinckaers JH, ten Brinck RM, Lycklama à Nijeholt AA, Dekkers OM | title = Urinating standing versus sitting: position is of influence in men with prostate enlargement. A systematic review and meta-analysis | journal = PLOS ONE | volume = 9 | issue = 7 | pages = e101320 | date = 2014 | pmid = 25051345 | pmc = 4106761 | doi = 10.1371/journal.pone.0101320 | doi-access = free | bibcode = 2014PLoSO...9j1320D }} which might decrease urinary tract infections in this group.{{Citation needed|date=January 2022}}

Using urinary catheters as little and as short of time as possible and appropriate care of the catheter when used prevents catheter-associated urinary tract infections.{{cite journal | vauthors = Nicolle LE | title = The chronic indwelling catheter and urinary infection in long-term-care facility residents | journal = Infection Control and Hospital Epidemiology | volume = 22 | issue = 5 | pages = 316–321 | date = May 2001 | pmid = 11428445 | doi = 10.1086/501908 | s2cid = 40832193 }} They should be inserted using sterile technique in hospital however non-sterile technique may be appropriate in those who self catheterize.{{cite journal | vauthors = Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA | title = Guideline for prevention of catheter-associated urinary tract infections 2009 | journal = Infection Control and Hospital Epidemiology | volume = 31 | issue = 4 | pages = 319–326 | date = April 2010 | pmid = 20156062 | doi = 10.1086/651091 | s2cid = 31266013 | url = https://zenodo.org/record/1235702 | access-date = 2 July 2019 | archive-date = 16 March 2020 | archive-url = https://web.archive.org/web/20200316015723/https://zenodo.org/record/1235702 | url-status = live }} The urinary catheter set up should also be kept sealed. Evidence does not support a significant decrease in risk when silver-alloy catheters are used.{{cite journal | vauthors = Lam TB, Omar MI, Fisher E, Gillies K, MacLennan S | title = Types of indwelling urethral catheters for short-term catheterisation in hospitalised adults | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 9 | pages = CD004013 | date = September 2014 | pmid = 25248140 | doi = 10.1002/14651858.CD004013.pub4 | pmc = 11197149 }}

File:Co-trimoxazole.JPG

For those with recurrent infections, taking a short course of antibiotics when each infection occurs is associated with the lowest antibiotic use. A prolonged course of daily antibiotics is also effective. Medications frequently used include nitrofurantoin and trimethoprim/sulfamethoxazole. Some recommend against prolonged use due to concerns of antibiotic resistance. Methenamine is another agent used for this purpose as in the bladder where the acidity is low it produces formaldehyde to which resistance does not develop.{{cite book| vauthors = Finkel R, Clark MA, Cubeddu LX |title=Pharmacology |year=2009 |publisher= Lippincott Williams & Wilkins |location= Philadelphia |isbn=9780781771559 |pages=397 |url=https://books.google.com/books?id=Q4hG2gRhy7oC&pg=PA397 |edition=4th |url-status=live |archive-url= https://web.archive.org/web/20160609210228/https://books.google.com/books?id=Q4hG2gRhy7oC&pg=PA397&lpg=PA397 |archive-date=9 June 2016}} A UK study showed that methenamine is as effective daily low-dose antibiotics at preventing UTIs among women who experience recurrent UTIs. As methenamine is an antiseptic, it may avoid the issue of antibiotic resistance.{{cite journal |date=20 December 2022 |title=Methenamine is as good as antibiotics at preventing urinary tract infections |url=https://evidence.nihr.ac.uk/alert/methenamine-as-good-as-antibiotics-preventing-urinary-tract-infections/ |journal=NIHR Evidence |doi=10.3310/nihrevidence_55378 |s2cid=254965605 |access-date=20 January 2023 |archive-date=20 January 2023 |archive-url=https://web.archive.org/web/20230120170002/https://evidence.nihr.ac.uk/alert/methenamine-as-good-as-antibiotics-preventing-urinary-tract-infections/ |url-status=live |url-access=subscription }}{{cite journal | vauthors = Harding C, Mossop H, Homer T, Chadwick T, King W, Carnell S, Lecouturier J, Abouhajar A, Vale L, Watson G, Forbes R, Currer S, Pickard R, Eardley I, Pearce I, Thiruchelvam N, Guerrero K, Walton K, Hussain Z, Lazarowicz H, Ali A | title = Alternative to prophylactic antibiotics for the treatment of recurrent urinary tract infections in women: multicentre, open label, randomised, non-inferiority trial | journal = BMJ | volume = 376 | pages = e068229 | date = March 2022 | pmid = 35264408 | pmc = 8905684 | doi = 10.1136/bmj-2021-0068229 }}

In cases where infections are related to intercourse, taking antibiotics afterwards may be useful. In post-menopausal women, topical vaginal estrogen has been found to reduce recurrence.{{cite journal | vauthors = Beerepoot M, Geerlings S | title = Non-Antibiotic Prophylaxis for Urinary Tract Infections | journal = Pathogens | volume = 5 | issue = 2 | pages = 36 | date = April 2016 | pmid = 27092529 | pmc = 4931387 | doi = 10.3390/pathogens5020036 | type = Review | doi-access = free }} As opposed to topical creams, the use of vaginal estrogen from pessaries has not been as useful as low dose antibiotics.{{cite journal | vauthors = Perrotta C, Aznar M, Mejia R, Albert X, Ng CW | title = Oestrogens for preventing recurrent urinary tract infection in postmenopausal women | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD005131 | date = April 2008 | pmid = 18425910 | doi = 10.1002/14651858.CD005131.pub2 }} Antibiotics following short term urinary catheterization decreases the subsequent risk of a bladder infection.{{cite journal | vauthors = Marschall J, Carpenter CR, Fowler S, Trautner BW | title = Antibiotic prophylaxis for urinary tract infections after removal of urinary catheter: meta-analysis | journal = BMJ | volume = 346 | pages = f3147 | date = June 2013 | pmid = 23757735 | pmc = 3678514 | doi = 10.1136/bmj.f3147 }} A number of UTI vaccines are in development as of 2018.{{cite journal | vauthors = Magistro G, Stief CG | title = Vaccine Development for Urinary Tract Infections: Where Do We Stand? | journal = European Urology Focus | volume = 5 | issue = 1 | pages = 39–41 | date = January 2019 | pmid = 30093359 | doi = 10.1016/j.euf.2018.07.034 | doi-access = free }}{{cite journal | vauthors = Huttner A, Gambillara V | title = The development and early clinical testing of the ExPEC4V conjugate vaccine against uropathogenic Escherichia coli | journal = Clinical Microbiology and Infection | volume = 24 | issue = 10 | pages = 1046–1050 | date = October 2018 | pmid = 29803843 | doi = 10.1016/j.cmi.2018.05.009 | doi-access = free }}

The evidence that preventive antibiotics decrease urinary tract infections in children is poor.{{cite journal | vauthors = Dai B, Liu Y, Jia J, Mei C | title = Long-term antibiotics for the prevention of recurrent urinary tract infection in children: a systematic review and meta-analysis | journal = Archives of Disease in Childhood | volume = 95 | issue = 7 | pages = 499–508 | date = July 2010 | pmid = 20457696 | doi = 10.1136/adc.2009.173112 | s2cid = 6714180 }} However recurrent UTIs are a rare cause of further kidney problems if there are no underlying abnormalities of the kidneys, resulting in less than a third of a percent (0.33%) of chronic kidney disease in adults.{{cite journal | vauthors = Salo J, Ikäheimo R, Tapiainen T, Uhari M | title = Childhood urinary tract infections as a cause of chronic kidney disease | journal = Pediatrics | volume = 128 | issue = 5 | pages = 840–847 | date = November 2011 | pmid = 21987701 | doi = 10.1542/peds.2010-3520 | s2cid = 41304559 }}

Circumcision of boys has been observed to exhibit a strong protective effect against UTIs, with some research suggesting as much as a 90% reduction in symptomatic UTI incidence among male infants, if they are circumcised.{{Cite journal |last1=Shaikh |first1=Nader |last2=Morone |first2=Natalia E. |last3=Bost |first3=James E. |last4=Farrell |first4=Max H. |date=Apr 2008 |title=Prevalence of Urinary Tract Infection in Childhood: A Meta-Analysis |url=https://journals.lww.com/00006454-200804000-00004 |journal=Pediatric Infectious Disease Journal |volume=27 |issue=4 |pages=302–308 |doi=10.1097/INF.0b013e31815e4122 |pmid=18316994 |issn=0891-3668|url-access=subscription }}{{Cite journal |last1=Dave |first1=Sumit |last2=Afshar |first2=Kourosh |last3=Braga |first3=Luis H. |last4=Anderson |first4=Peter |date=Feb 2018 |title=Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (full version) |journal=Canadian Urological Association Journal |volume=12 |issue=2 |pages=E76–E99 |doi=10.5489/cuaj.5033 |issn=1911-6470 |pmc=5937400 |pmid=29381458}} The protective effect is even stronger in boys born with urogenital abnormalities.

When used as an adjuvant to antibiotics and other standard treatments, cranberry supplements decrease the number of UTIs in people who get them frequently.{{cite journal | vauthors = Wang CH, Fang CC, Chen NC, Liu SS, Yu PH, Wu TY, Chen WT, Lee CC, Chen SC | title = Cranberry-containing products for prevention of urinary tract infections in susceptible populations: a systematic review and meta-analysis of randomized controlled trials | journal = Archives of Internal Medicine | volume = 172 | issue = 13 | pages = 988–996 | date = July 2012 | pmid = 22777630 | doi = 10.1001/archinternmed.2012.3004 }}{{Cite journal |last1=Xia |first1=Jia-yue |last2=Yang |first2=Chao |last3=Xu |first3=Deng-feng |last4=Xia |first4=Hui |last5=Yang |first5=Li-gang |last6=Sun |first6=Gui-ju |date=2 September 2021 |title=Consumption of cranberry as adjuvant therapy for urinary tract infections in susceptible populations: A systematic review and meta-analysis with trial sequential analysis |journal=PLOS ONE |volume=16 |issue=9 |pages=e0256992 |doi=10.1371/journal.pone.0256992 |doi-access=free |issn=1932-6203 |pmc=8412316 |pmid=34473789|bibcode=2021PLoSO..1656992X }} A 2023 review concluded that cranberry products can reduce the risk of UTIs in certain groups (women with reoccurring UTIs, children, and people having had clinical interventions), but not in pregnant women, the elderly or people with urination disorders.{{cite journal | vauthors = Williams G, Stothart CI, Hahn D, Stephens JH, Craig JC, Hodson EM | title = Cranberries for preventing urinary tract infections | journal = The Cochrane Database of Systematic Reviews | volume = 2023 | issue = 11 | pages = CD001321 | date = November 2023 | pmid = 37947276 | pmc = 10636779 | doi = 10.1002/14651858.CD001321.pub7 }} Some evidence suggests that cranberry juice is more effective at UTI control than dehydrated tablets or capsules. Cranberry has not been effective in attempts to replace antibiotics for the treatment of active infections.{{Cite journal |last1=Kwok |first1=Michael |last2=McGeorge |first2=Stephen |last3=Mayer Coverdale |first3=Johanna |last4=Graves |first4=Bianca |last5=Paterson |first5=David L. |last6=Harris |first6=Patrick N.A. |last7=Esler |first7=Rachel |last8=Dowling |first8=Caroline |last9=Britton |first9=Sumudu |last10=Roberts |first10=Matthew J. |date=Nov 2022 |title=Guideline of guidelines: management of recurrent urinary tract infections in women |journal=BJU International |volume=130 |issue=Suppl 3 |pages=11–22 |doi=10.1111/bju.15756 |issn=1464-4096 |pmc=9790742 |pmid=35579121}} Cranberry supplements are also high in sugar content, which may worsen the risks associated with UTIs in patients with diabetes mellitus.{{Cite journal |last1=Jepson |first1=Ruth G |last2=Williams |first2=Gabrielle |last3=Craig |first3=Jonathan C |date=17 October 2012 |title=Cranberries for preventing urinary tract infections |journal=The Cochrane Database of Systematic Reviews |volume=2012 |issue=10 |pages=CD001321 |doi=10.1002/14651858.CD001321.pub5 |issn=1469-493X |pmc=7027998 |pmid=23076891}}

D-mannose is often marketed as a dietary supplement that prevents UTIs; however, there is little evidence supporting its use. A randomised controlled trial compared daily d-mannose with a placebo (fructose) among women with recurrent urinary tract infections over 6 months. D-mannose offered no benefit over placebo in reducing UTIs.{{Cite journal |last=Hayward |first=Gail |last2=Mort |first2=Sam |last3=Hay |first3=Alastair D. |last4=Moore |first4=Michael |last5=Thomas |first5=Nicholas P. B. |last6=Cook |first6=Johanna |last7=Robinson |first7=Jared |last8=Williams |first8=Nicola |last9=Maeder |first9=Nicola |last10=Edeson |first10=Rebecca |last11=Franssen |first11=Marloes |last12=Grabey |first12=Jenna |last13=Glogowska |first13=Margaret |last14=Yang |first14=Yaling |last15=Allen |first15=Julie |date=1 June 2024 |title=d-Mannose for Prevention of Recurrent Urinary Tract Infection Among Women: A Randomized Clinical Trial |url=https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2817488 |journal=JAMA Internal Medicine |volume=184 |issue=6 |pages=619–628 |doi=10.1001/jamainternmed.2024.0264 |issn=2168-6106|doi-access=free |pmc=11002776 }}{{Cite journal |date=6 February 2025 |title=D-mannose does not prevent urinary tract infections |url=https://evidence.nihr.ac.uk/alert/d-mannose-does-not-prevent-urinary-tract-infections-utis/ |journal=NIHR Evidence}}

As of 2015, probiotics require further study to determine if they are beneficial for UTI.{{cite journal | vauthors = Schwenger EM, Tejani AM, Loewen PS | title = Probiotics for preventing urinary tract infections in adults and children | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 12 | pages = CD008772 | date = December 2015 | pmid = 26695595 | pmc = 8720415 | doi = 10.1002/14651858.CD008772.pub2 }}

The mainstay of treatment is antibiotics. Phenazopyridine is occasionally prescribed during the first few days in addition to antibiotics to help with the burning and urgency sometimes felt during a bladder infection.{{cite journal | vauthors = Gaines KK | title = Phenazopyridine hydrochloride: the use and abuse of an old standby for UTI | journal = Urologic Nursing | volume = 24 | issue = 3 | pages = 207–209 | date = June 2004 | pmid = 15311491 }} However, it is not routinely recommended due to safety concerns with its use, specifically an elevated risk of methemoglobinemia (higher than normal level of methemoglobin in the blood).{{cite book| veditors = Aronson JK |title=Meyler's side effects of analgesics and anti-inflammatory drugs|year=2008|publisher=Elsevier Science|location=Amsterdam|isbn=978-0-444-53273-2|page=219|url=https://books.google.com/books?id=2WxotnWiiWkC&pg=PA219|url-status=live|archive-url=https://web.archive.org/web/20160507143221/https://books.google.com/books?id=2WxotnWiiWkC&pg=PA219|archive-date=7 May 2016}} Paracetamol may be used for fevers.{{cite book| vauthors = Cash JC, Glass CA |title=Family practice guidelines|year=2010|publisher=Springer|location=New York|isbn=978-0-8261-1812-7|page=271|url=https://books.google.com/books?id=4uKsZZ4BoRUC&pg=PA271|edition=2nd|url-status=live|archive-url=https://web.archive.org/web/20160611013523/https://books.google.com/books?id=4uKsZZ4BoRUC&pg=PA271|archive-date=11 June 2016}} There is no good evidence for the use of cranberry products for treating current infections.{{cite journal | vauthors = Santillo VM, Lowe FC | title = Cranberry juice for the prevention and treatment of urinary tract infections | journal = Drugs of Today | volume = 43 | issue = 1 | pages = 47–54 | date = January 2007 | pmid = 17315052 | doi = 10.1358/dot.2007.43.1.1032055 }}{{cite journal | vauthors = Guay DR | title = Cranberry and urinary tract infections | journal = Drugs | volume = 69 | issue = 7 | pages = 775–807 | year = 2009 | pmid = 19441868 | doi = 10.2165/00003495-200969070-00002 | s2cid = 26916844 }}

Fosfomycin can be used as an effective treatment for both UTIs and complicated UTIs including acute pyelonephritis. The standard regimen for complicated UTIs is an oral 3g dose administered once every 48 or 72 hours for a total of 3 doses or a 6 grams every 8 hours for 7 days to 14 days when fosfomycin is given in IV form.{{cite journal | vauthors = Zhanel GG, Zhanel MA, Karlowsky JA | title = Oral and Intravenous Fosfomycin for the Treatment of Complicated Urinary Tract Infections | journal = The Canadian Journal of Infectious Diseases & Medical Microbiology | volume = 2020 | pages = 8513405 | date = 28 March 2020 | pmid = 32300381 | pmc = 7142339 | doi = 10.1155/2020/8513405 | publisher = Hindawi Limited | doi-access = free }}

Gepotidacin was approved for medical use in the United States in March 2025.{{cite press release | title=Blujepa (gepotidacin) approved by US FDA for treatment of uncomplicated urinary tract infections (uUTIs) in female adults and pediatric patients 12 years of age and older | website=GSK | date=25 March 2025 | url=https://us.gsk.com/en-us/media/press-releases/blujepa-gepotidacin-approved-by-us-fda-for-treatment-of-uncomplicated-urinary-tract-infections-uutis-in-female-adults-and-pediatric-patients-12-years-of-age-and-older/ | access-date=28 March 2025}} It is the first new antibiotic approved in the US for UTIs in nearly 30 years.{{Cite web |date=25 March 2025 |title=FDA approves first new antibiotic for UTIs in nearly 30 years |url=https://www.nbcnews.com/health/health-news/fda-approves-first-new-antibiotic-utis-nearly-30-years-rcna197953 |access-date=26 March 2025 |website=NBC News }}{{Cite web |last=Goodman |first=Brenda |date=25 March 2025 |title=Millions of women get painful UTIs that keep coming back. A new kind of antibiotic may help break the cycle |url=https://www.cnn.com/2025/03/25/health/uti-antibiotic-fda-gepotidacin-blujepa/index.html |access-date=26 March 2025 |website=CNN }}

Uncomplicated infections can be diagnosed and treated based on symptoms alone. Antibiotics taken by mouth such as trimethoprim/sulfamethoxazole, nitrofurantoin, or fosfomycin are typically first line.{{cite journal | vauthors = Grigoryan L, Trautner BW, Gupta K | title = Diagnosis and management of urinary tract infections in the outpatient setting: a review | journal = JAMA | volume = 312 | issue = 16 | pages = 1677–1684 | date = 22 October 2014 | pmid = 25335150 | doi = 10.1001/jama.2014.12842 }} Cephalosporins, amoxicillin/clavulanic acid, or a fluoroquinolone may also be used. However, antibiotic resistance to fluoroquinolones among the bacteria that cause urinary infections has been increasing. The Food and Drug Administration (FDA) recommends against the use of fluoroquinolones, including a Boxed Warning, when other options are available due to higher risks of serious side effects, such as tendinitis, tendon rupture and worsening of myasthenia gravis.{{cite web | title = FDA Drug Safety Communication: FDA updates warnings for oral and injectable fluoroquinolone antibiotics due to disabling side effects | url = https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-updates-warnings-oral-and-injectable-fluoroquinolone-antibiotics | website = Food and Drug Administration (FDA) | access-date = 17 July 2019 | date = 8 March 2018 | url-status = live | archive-url = https://web.archive.org/web/20190718015612/https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-updates-warnings-oral-and-injectable-fluoroquinolone-antibiotics | archive-date = 18 July 2019 }} These medications substantially shorten the time to recovery with all being equally effective.{{cite journal | vauthors = Zalmanovici Trestioreanu A, Green H, Paul M, Yaphe J, Leibovici L | title = Antimicrobial agents for treating uncomplicated urinary tract infection in women | journal = The Cochrane Database of Systematic Reviews | volume = 10 | issue = 10 | pages = CD007182 | date = October 2010 | pmid = 20927755 | doi = 10.1002/14651858.CD007182.pub2 | veditors = Zalmanovici Trestioreanu A }}{{cite journal| vauthors = Jarvis TR, Chan L, Gottlieb T |title=Assessment and management of lower urinary tract infection in adults|journal=Australian Prescriber|date=February 2014|volume=37|issue=1|pages=7–9|doi=10.18773/austprescr.2014.002|doi-access=free}} A three-day treatment with trimethoprim/sulfamethoxazole, or a fluoroquinolone is usually sufficient, whereas nitrofurantoin requires 5–7{{nbsp}}days. Fosfomycin may be used as a single dose but is not as effective.

Fluoroquinolones are not recommended as a first treatment.{{Citation |author1 = American Urogynecologic Society |author1-link = American Urogynecologic Society |date = 5 May 2015 |title = Five Things Physicians and Patients Should Question |publisher = American Urogynecologic Society |work = Choosing Wisely: an initiative of the ABIM Foundation |url = http://www.choosingwisely.org/societies/american-urogynecologic-society/ |access-date = 1 June 2015 |url-status = live |archive-url = https://web.archive.org/web/20150602021428/http://www.choosingwisely.org/societies/american-urogynecologic-society/ |archive-date = 2 June 2015 }} The Infectious Diseases Society of America states this due to the concern of generating resistance to this class of medication.{{cite journal | vauthors = Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, Moran GJ, Nicolle LE, Raz R, Schaeffer AJ, Soper DE | title = International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases | journal = Clinical Infectious Diseases | volume = 52 | issue = 5 | pages = e103–e120 | date = March 2011 | pmid = 21292654 | doi = 10.1093/cid/ciq257 | doi-access = free }} Amoxicillin-clavulanate appears less effective than other options.{{cite journal | vauthors = Knottnerus BJ, Grigoryan L, Geerlings SE, Moll van Charante EP, Verheij TJ, Kessels AG, ter Riet G | title = Comparative effectiveness of antibiotics for uncomplicated urinary tract infections: network meta-analysis of randomized trials | journal = Family Practice | volume = 29 | issue = 6 | pages = 659–670 | date = December 2012 | pmid = 22516128 | doi = 10.1093/fampra/cms029 | doi-access = free }} Despite this precaution, some resistance has developed to all of these medications related to their widespread use. Trimethoprim alone is deemed to be equivalent to trimethoprim/sulfamethoxazole in some countries. For simple UTIs, children often respond to a three-day course of antibiotics.{{cite web|url=http://www.bestbets.org/bets/bet.php?id=939| vauthors = Afzalnia S |date=15 December 2006|title=BestBets: Is a short course of antibiotics better than a long course in the treatment of UTI in children|website=www.bestbets.org|url-status=live|archive-url=https://web.archive.org/web/20090814225657/http://www.bestbets.org/bets/bet.php?id=939|archive-date=14 August 2009}} Women with recurrent simple UTIs are over 90% accurate in identifying new infections. They may benefit from self-treatment upon occurrence of symptoms with medical follow-up only if the initial treatment fails.

The combination sulopenem etzadroxil/probenecid (Orlynvah) was approved for medical use in the United States in October 2024.{{cite web | title=FDA approves new treatment for women with uncomplicated UTIs | website=U.S. Food and Drug Administration (FDA) | date=1 October 2024 | url=https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-new-treatment-uncomplicated-urinary-tract-infections-adult-women-who-have-limited-or-no | archive-url=https://web.archive.org/web/20241026232334/https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-new-treatment-uncomplicated-urinary-tract-infections-adult-women-who-have-limited-or-no | url-status=dead | archive-date=26 October 2024 | access-date=25 October 2024}}{{cite press release | title=Iterum Therapeutics Receives U.S. FDA Approval of Orlynvah (Oral Sulopenem) for the Treatment of Uncomplicated Urinary Tract Infections | website=Iterum Therapeutics | date=25 October 2024 | url=https://ir.iterumtx.com/press-releases/detail/136/iterum-therapeutics-receives-u-s-fda-approval-of | access-date=25 October 2024}}

Complicated UTIs are more difficult to treat and usually requires more aggressive evaluation, treatment, and follow-up.{{cite book | vauthors = Bryan CS |title=Infectious diseases in primary care |publisher=W.B. Saunders |location=Philadelphia |year=2002 |pages=319 |isbn=978-0-7216-9056-8 |url=http://pathmicro.med.sc.edu/infectious%20disease/Urinary%20Tract%20Infections.htm |url-status=live |archive-url=https://web.archive.org/web/20120213052452/http://pathmicro.med.sc.edu/Infectious%20Disease/Urinary%20Tract%20Infections.htm |archive-date=13 February 2012 }} It may require identifying and addressing the underlying complication.{{cite journal | vauthors = Wagenlehner FM, Vahlensieck W, Bauer HW, Weidner W, Piechota HJ, Naber KG | title = Prevention of recurrent urinary tract infections | journal = Minerva Urologica e Nefrologica | volume = 65 | issue = 1 | pages = 9–20 | date = March 2013 | pmid = 23538307 }} Increasing antibiotic resistance is causing concern about the future of treating those with complicated and recurrent UTI.{{cite journal | vauthors = Pallett A, Hand K | title = Complicated urinary tract infections: practical solutions for the treatment of multiresistant Gram-negative bacteria | journal = The Journal of Antimicrobial Chemotherapy | volume = 65 | issue = Suppl 3 | pages = iii25–iii33 | date = November 2010 | pmid = 20876625 | doi = 10.1093/jac/dkq298 | doi-access = free }}{{cite journal | vauthors = Shepherd AK, Pottinger PS | title = Management of urinary tract infections in the era of increasing antimicrobial resistance | journal = The Medical Clinics of North America | volume = 97 | issue = 4 | pages = 737–57, xii | date = July 2013 | pmid = 23809723 | doi = 10.1016/j.mcna.2013.03.006 }}{{cite journal | vauthors = Karlović K, Nikolić J, Arapović J | title = Ceftriaxone treatment of complicated urinary tract infections as a risk factor for enterococcal re-infection and prolonged hospitalization: A 6-year retrospective study | journal = Bosnian Journal of Basic Medical Sciences | volume = 18 | issue = 4 | pages = 361–366 | date = November 2018 | pmid = 29750894 | pmc = 6252101 | doi = 10.17305/bjbms.2018.3544 }}

Those who have bacteria in the urine but no symptoms should not generally be treated with antibiotics.{{cite journal | vauthors = Ariathianto Y | title = Asymptomatic bacteriuria - prevalence in the elderly population | journal = Australian Family Physician | volume = 40 | issue = 10 | pages = 805–809 | date = October 2011 | pmid = 22003486 }} This includes those who are old, those with spinal cord injuries, and those who have urinary catheters.{{cite journal | vauthors = Colgan R, Nicolle LE, McGlone A, Hooton TM | title = Asymptomatic bacteriuria in adults | journal = American Family Physician | volume = 74 | issue = 6 | pages = 985–990 | date = September 2006 | pmid = 17002033 }}{{Citation |author1=American Geriatrics Society |title=Five Things Physicians and Patients Should Question |url=http://www.choosingwisely.org/doctor-patient-lists/american-geriatrics-society/ |work=Choosing Wisely: an initiative of the ABIM Foundation |archive-url=https://web.archive.org/web/20130901100140/http://www.choosingwisely.org/doctor-patient-lists/american-geriatrics-society/ |publisher=American Geriatrics Society |access-date=1 August 2013 |archive-date=1 September 2013 |author1-link=American Geriatrics Society |url-status=live}} Pregnancy is an exception and it is recommended that women take seven{{nbsp}}days of antibiotics.{{cite journal | vauthors = Widmer M, Lopez I, Gülmezoglu AM, Mignini L, Roganti A | title = Duration of treatment for asymptomatic bacteriuria during pregnancy | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 11 | pages = CD000491 | date = November 2015 | pmid = 26560337 | pmc = 7043273 | doi = 10.1002/14651858.CD000491.pub3 }}{{cite journal | vauthors = Guinto VT, De Guia B, Festin MR, Dowswell T | title = Different antibiotic regimens for treating asymptomatic bacteriuria in pregnancy | journal = The Cochrane Database of Systematic Reviews | issue = 9 | pages = CD007855 | date = September 2010 | pmid = 20824868 | pmc = 4033758 | doi = 10.1002/14651858.CD007855.pub2 }} If not treated it causes up to 30% of mothers to develop pyelonephritis and increases risk of low birth weight and preterm birth. Some also support treatment of those with diabetes mellitus{{cite journal | vauthors = Julka S | title = Genitourinary infection in diabetes | journal = Indian Journal of Endocrinology and Metabolism | volume = 17 | issue = Suppl 1 | pages = S83–S87 | date = October 2013 | pmid = 24251228 | pmc = 3830375 | doi = 10.4103/2230-8210.119512 | doi-access = free }} and treatment before urinary tract procedures which will likely cause bleeding.

Urinary tract infections, even asymptomatic presence of bacteria in the urine, are more concerning in pregnancy due to the increased risk of kidney infections. During pregnancy, high progesterone levels elevate the risk of decreased muscle tone of the ureters and bladder, which leads to a greater likelihood of reflux, where urine flows back up the ureters and towards the kidneys. While pregnant women do not have an increased risk of asymptomatic bacteriuria, if bacteriuria is present they do have a 25–40% risk of a kidney infection. Thus if urine testing shows signs of an infection—even in the absence of symptoms—treatment is recommended. Cephalexin or nitrofurantoin are typically used because they are generally considered safe in pregnancy. A kidney infection during pregnancy may result in preterm birth or pre-eclampsia (a state of high blood pressure and kidney dysfunction during pregnancy that can lead to seizures). Some women have UTIs that keep coming back in pregnancy.{{cite journal |vauthors=Schneeberger C, Geerlings SE, Middleton P, Crowther CA |date=July 2015 |title=Interventions for preventing recurrent urinary tract infection during pregnancy |journal=The Cochrane Database of Systematic Reviews |volume=2015 |issue=7 |pages=CD009279 |doi=10.1002/14651858.CD009279.pub3 |pmc=6457953 |pmid=26221993}} There is insufficient research on how to best treat these recurrent infections.

Pyelonephritis 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 areas where the resistance rate is less than 10%. If the local antibiotic resistance rates are greater than 10%, a dose of intravenous ceftriaxone is often prescribed. Trimethoprim/sulfamethoxazole or amoxicillin/clavulanate orally for 14 days is another reasonable option.{{cite book |title=The Sanford Guide to Antimicrobial Therapy 2011 (Guide to Antimicrobial Therapy (Sanford)) |publisher=Antimicrobial Therapy |year=2011 |pages=[https://archive.org/details/sanfordguidetoan00davi_0/page/30 30] |isbn=978-1-930808-65-2 |url=https://archive.org/details/sanfordguidetoan00davi_0/page/30 }} In those who exhibit more severe symptoms, admission to a hospital for ongoing antibiotics may be needed. Complications such as ureteral obstruction from a kidney stone may be considered if symptoms do not improve following two or three days of treatment.

With treatment, symptoms generally improve within 36{{nbsp}}hours. Up to 42% of uncomplicated infections may resolve on their own within a few days or weeks.{{cite journal | vauthors = Long B, Koyfman A | title = The Emergency Department Diagnosis and Management of Urinary Tract Infection | journal = Emergency Medicine Clinics of North America | volume = 36 | issue = 4 | pages = 685–710 | date = November 2018 | pmid = 30296999 | doi = 10.1016/j.emc.2018.06.003 | s2cid = 52942247 }}

15–25% of adults and children have chronic symptomatic UTIs including recurrent infections, persistent infections (infection with the same pathogen), a re-infection (new pathogen), or a relapsed infection (the same pathogen causes a new infection after it was completely gone).{{cite journal |vauthors=Cooper TE, Teng C, Howell M, Teixeira-Pinto A, Jaure A, Wong G |date=August 2022 |title=D-mannose for preventing and treating urinary tract infections |journal=The Cochrane Database of Systematic Reviews |volume=2022 |issue=8 |pages=CD013608 |doi=10.1002/14651858.CD013608.pub2 |pmc=9427198 |pmid=36041061}} Recurrent urinary tract infections are defined as at least two infections (episodes) in a six-month time period or three infections in twelve months, can occur in adults and in children.

Cystitis refers to a urinary tract infection that involves the lower urinary tract (bladder). An upper urinary tract infection which involves the kidney is called pyelonephritis. About 10–20% of pyelonephritis will go on and develop scarring of the affected kidney. Then, 10–20% of those develop scarring will have increased risk of hypertension in later life.{{cite journal | vauthors = MacKenzie JR | title = A review of renal scarring in children | journal = Nuclear Medicine Communications | volume = 17 | issue = 3 | pages = 176–190 | date = March 1996 | pmid = 8692483 | doi = 10.1097/00006231-199603000-00002 | s2cid = 22331470 }}

Urinary tract infections are the most frequent bacterial infection in women. They occur most frequently between the ages of 16 and 35{{nbsp}}years, with 10% of women getting an infection yearly and more than 40–60% having an infection at some point in their lives. Recurrences are common, with nearly half of people getting a second infection within a year. Urinary tract infections occur four times more frequently in females than males. Pyelonephritis occurs between 20 and 30 times less frequently. They are the most common cause of hospital-acquired infections accounting for approximately 40%.{{cite book | vauthors = Smeltzer SC, Bare BG, Hinkle JL, Cheever KH | chapter = Management of Patients with Urinary Disorders |title=Brunner & Suddarth's textbook of medical-surgical nursing. |year=2010 | publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins|location=Philadelphia|isbn=978-0-7817-8589-1|page=1359|chapter-url=https://books.google.com/books?id=SmtjSD1x688C&pg=PA1359|edition=12th|url-status=live|archive-url=https://web.archive.org/web/20160428194226/https://books.google.com/books?id=SmtjSD1x688C&pg=PA1359|archive-date=28 April 2016}} Rates of asymptomatic bacteria in the urine increase with age from two to seven percent in women of child-bearing age to as high as 50% in elderly women in care homes. Rates of asymptomatic bacteria in the urine among men over 75 are between 7–10%. 2–10% of pregnant women have asymptomatic bacteria in the urine and higher rates are reported in women who live in some underdeveloped countries.{{cite journal | vauthors = Smaill FM, Vazquez JC | title = Antibiotics for asymptomatic bacteriuria in pregnancy | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 11 | pages = CD000490 | date = November 2019 | pmid = 31765489 | pmc = 6953361 | doi = 10.1002/14651858.CD000490.pub4 }}

Urinary tract infections may affect 10% of people during childhood. Among children, urinary tract infections are most common in uncircumcised males less than three months of age, followed by females less 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 two years, 2–20% were diagnosed with a UTI.

Domestic cats are less susceptible to bacterial urinary tract infections than domestic dogs.{{Cite journal |last1=Dorsch |first1=Roswitha |last2=Teichmann-Knorrn |first2=Svenja |last3=Sjetne Lund |first3=Heidi |date=1 November 2019 |title=Urinary tract infection and subclinical bacteriuria in cats: A clinical update |journal=Journal of Feline Medicine and Surgery |volume=21 |issue=11 |pages=1023–1038 |doi=10.1177/1098612X19880435 |issn=1098-612X |pmc=6826873 |pmid=31601143}}

Urinary tract infections have been described since ancient times with the first documented description in the Ebers Papyrus dated to c. 1550 BC. It was described by the Egyptians as "sending forth heat from the bladder".{{cite book | vauthors = Whiteman W, Topley C|title=Topley and Wilson's Principles of bacteriology, virology and immunity : in 4 volumes |year=1990 |publisher=Arnold |location=London |isbn=978-0-7131-4591-5 |page=198|edition=8th}} Effective treatment did not occur until the development and availability of antibiotics in the 1930s, before which time herbs, bloodletting and rest were recommended.

• Urinary anti-infective agent

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{{Medical condition classification and resources

| ICD11 = {{ICD11|GC00}}, {{ICD11|GC02}}, {{ICD11|GC08}}

| ICD10 = {{ICD10|N|39|0|n|30}}

| ICD9 = {{ICD9|599.0}}

| ICDO =

| OMIM =

| OMIM_mult =

| MedlinePlus = 000521

| eMedicineSubj = emerg

| eMedicineTopic = 625

| eMedicine_mult = {{eMedicine2|emerg|626}}

| DiseasesDB = 13657

| MeshID = D014552

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