European Journal of Obstetrics & Gynecology and Reproductive Biology
ReviewUrinary tract infections in women
Introduction
In routine gynecological practice it is very common to be consulted for symptoms suggestive of urinary tract infection (UTI). Indeed UTI is the first and the second infection recorded in the hospital setting and in the social community, respectively. It has been estimated that over one third of the female population experiences at least one episode of UTI during their lifetime. Therefore we decided to review the available international literature in order to provide a practical clinical guideline for the management of UTI. For this purpose we decided to track the contents of this document through a schematic academic division.
Section snippets
Review criteria
A comprehensive literature review of published experimental and clinical studies on UTI was carried out at the University of Insubria with cross-search of seven different medical databases (Allied and Complementary Medicine Database (AMED), BIOSIS Previews on Web of Knowledge, Cochrane Library, Embase and Medline on Web of Knowledge, OvidSP and PubMed). Search temporal limits included papers published between January 1999 and October 2010 with the purpose of providing the most recent evidence
Definition
UTI are among the most common bacterial infections in women: it is estimated that the lifetime possibility of each woman developing a UTI is above 40–60%. UTI can involve the lower and/or the upper urinary tract [1]. UTI can be schematically divided into different groups according to their characteristics, as follows:
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Asymptomatic bacteriuria: the presence of 100,000 colony-forming units (CFU)/mL in a woman without symptoms; if the patient is symptomatic, the presence of 100 CFU/mL is enough to
Prevalence, epidemiology and costs
The prevalence of UTI is higher in women than in men: about 81% of UTI occurs in women, with a peak between 16 and 35 years. Approximately 27% of women with a first episode of UTI record a recurrence within 6 months, and 48% within the first year. Such infection causes about 6 days of disability per episode, with an increasing morbidity in the USA. UTI is responsible for about 15% of all antibiotic prescriptions in the community with more than 1.6 billion dollars spent every year. UTI results
Pathophysiology and microbiology
UTI usually arises from ascending infection from the urethra to the bladder, but occasionally it develops with haematogenous or lymphatic spread. Evidence suggests a sort of genetic predisposition to develop UTI; non-secretors of ABH blood-group antigens, especially in premenopausal women, are genetically determined factors which may predispose to the development of UTI [4], [5]. Similarly, a study conducted on mice evidenced the role of innate immunity which is modulated by variable expression
Risk factors
Anatomic congenital abnormalities, urinary tract calculi, neurological disorders, diabetes, medical conditions determining indwelling or recurrent bladder catheterizations are the most frequent risk factors. Traumas to the pelvic floor also contribute to the development of UTI, as do multiparity and pelvic organ prolapse. In addition, in young women a number of other important risk factors for recurrent acute cystitis have been recognized, including recent history of UTI, young age at first
Diagnosis
Lower UTI generally presents with dysuria, frequent and urgent micturition, sometimes associated with suprapubical pain or pressure and rarely with haematuria. Fever is uncommon and it is usually associated with complicated forms of UTI, as previously mentioned. The likelihood that the underlying condition of a woman presenting with these symptoms is a UTI is about 50% in primary care settings. This possibility rises to 84–92% when women complaining these symptoms have a history of RUTI.
Upper
Treatment
The gold standard for symptomatic treatment of uncomplicated acute cystitis is a three-day treatment [15] with trimethoprim–sulfamethoxazole, with a percentage of eradication rate of 90%. Ciprofloxacin, levofloxacin, norfloxacin and gatifloxacin give comparable eradication rates after 3 days of administration [16]. This short-term treatment option achieves similar results to those obtained by prolonged therapies, and it reduces the number of adverse events and costs. Fosfomycin tromethamine can
Sexual intercourse
For women who describe a clear relationship between sexual intercourse and subsequent cystitis, the use of post-coital prophylaxis can be worthwhile. Postcoital voiding does not prevent cystitis. In sexually active women who use vaginal spermicide or diaphragms with history of RUTI, alternative methods of contraception should be suggested.
Low-dose antibiotic treatment
In women complaining of ≥2 UTI during a 6-month period or ≥3 infections over a 12-month period, prophylaxis with low-dose antibiotics once a day can be used,
Conflicts of interest
None.
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