Urinary Tract Infection

First of all, there’s the seemingly constant feeling of having to go to the bathroom—and then there’s the burning feeling when you do urinate. Those who have had one—or more—recognize these as classic symptoms of a urinary tract infection (UTI), the most common infection in the United States. Though the symptoms are unpleasant and sometimes embarrassing, UTIs are usually quickly resolved with a course of antibiotics. Still, they lead to millions of medical office visits and billions of dollars spent in diagnosis and treatment. And for some people, UTIs keep coming back with frustrating frequency.

A UTI occurs in part of the urinary system, which includes the urethra, bladder, ureters, and kidneys. Nearly all UTIs are bacterial, most frequently caused by Escherichia coli, which normally plays a vital role in keeping the digestive system healthy, but can cause infection if it enters the urinary tract. Smaller numbers of UTIs may be caused by yeast, a type of fungus.

Bladder infections (lower UTIs), which lead to more than 8 million medical office visits each year, are also known as acute cystitis. Bladder infections are more common than kidney infections (upper UTIs), but kidney infections tend to be more severe and more likely to lead to hospitalization. Each year, about 250,000 people are diagnosed with kidney infection, also called pyelonephritis.

Most women will have at least one UTI in their lifetime, and many have more than one. Young women (ages 14 to 24) and older women (after menopause) are at the greatest risk for UTI.

If you’ve experienced a UTI, then you know that this burning, painful, uncomfortable condition is nothing to mess around with. That’s why the health experts at Harvard Medical School have created a guide to help you protect your health. This guide explains how a UTI begins and ways to help prevent infection. It covers the factors that increase risk at all ages, how UTIs are diagnosed, and how they’re treated. The guide also discusses the growing problem of antibiotic resistance and how this affects treatment for UTI.

Prepared by the editors of Harvard Health Publishing in consultation with Lisa M. Bebell, MD Assistant Professor of Medicine, Harvard Medical School Assistant in Medicine, Infectious Diseases Division, Massachusetts General Hospital. (2022)

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Harvard Medical School Guides delivers compact, practical information on important health concerns. These publications are smaller in scope than our Special Health Reports, but they are written in the same clear, easy-to-understand language, and they provide the authoritative health advice you expect from Harvard Health Publishing.

Older women

Menopause lowers estrogen levels, which changes the bacterial populations in the reproductive and urinary tracts and thins the lining of the urethra. These changes may increase risk for UTI. Older women also are more likely to have chronic medical conditions that could increase risk, such as diabetes, dementia, limited mobility, or urinary incontinence.

Several studies have shown that the use of vaginal estrogen cream reduces risk, and some physicians recommend it. These creams may help because estrogen strengthens the lining of the urethra and bladder and also makes the genitourinary area more acidic, which discourages the growth of E. coli and other bacteria.

Older women are more likely than younger ones to be admitted to a hospital or long-term-care facility, where they may face urinary catheterization, a risk factor for UTI. 

Antibiotic treatment for older women depends on whether the infection is uncomplicated or complicated. Women with complicated UTIs often have other risk factors, such as poorly controlled diabetes or urinary tract abnormalities, which decrease the odds of successful treatment. Therefore, complicated UTIs frequently require longer courses of antibiotics than uncomplicated cases do.

Older men

Although the risk of a UTI is much lower for men than for women, men’s risk gradually increases after about age 60. Rates in men 80 and older are similar to rates in women of the same age. UTI is the most common bacterial infection in older men, and hospitalizations are more common in older men as well, though complications and death are rare.
There are many risk factors for UTIs among older men, including
• diabetes
• incontinence
• dementia
• limited mobility
• benign prostatic hyperplasia (BPH), a swelling of the prostate gland (which is below the bladder) that can obstruct normal urine flow.

Other structural and functional issues also can affect men’s urinary tracts, though BPH is the most common.

When an older man with no history of urinary catheter use or previous UTI develops a UTI, experts sometimes recommend an evaluation of the entire urinary tract to rule out any structural or functional problems. This usually involves ultrasound, a CT scan, or both. Other than BPH, men can have kidney stones or a condition called urethral stricture, in which the urethra has been scarred and narrowed (usually with no identifiable cause). Antibiotic treatment for older men with a UTI usually lasts seven to 14 days, though newer studies suggest that less severe UTIs may be cured with shorter treatment. In those with a kidney infection, hospitalization may be necessary if the infection has spread to the blood, a dangerous condition known as sepsis.

Sometimes a UTI that is not cured by antibiotics can invade the prostate, leading to prostatitis, an infection that also may have other causes. Even with antibiotic treatment, bacteria can continue to survive in the prostate, so it is important to identify a prostate infection and get appropriate antibiotic treatment, which is usually given for four to six weeks.

• What are urinary tract infections?

• Anatomy of the urinary tract

• Signs and symptoms

• Causes and risk factors

• UTIs across the lifespan

• Diagnosis

• Treatment

• Recurrent UTIs

• Antibiotic resistance and UTIs

• Prevention of UTIs

• Resources

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