Minor problem or chronic problem? Your understanding of urinary tract infection may be wrong...

Recently, Aunt Wang's old problem - urinary tract infection - recurred. Aunt Wang didn't care much about it, thinking that urinary tract infection was a minor problem and could be cured by taking some antibiotics. But this time, Aunt Wang took the medicine for several days but it didn't get better.

Aunt Wang: I come to see you again as an expert. I seem to have a urinary tract infection again. Could you please prescribe the same medicine you gave me last time?

Doctor: Aunt Wang, I can’t be so sure whether it is a urinary tract infection this time. It has been two months. I’d better do a urine routine test before prescribing medicine.

(Auntie Wang had done a routine urine test and happened to walk to the hospital pharmacist consultation window)

Aunt Wang: Pharmacist, could you please help me look at the urine routine report? It seems that there is an extra + sign than before. What's going on? I took so many medicines, why is it not getting better?

Pharmacist: You may have a refractory urinary tract infection. Improper selection of antibiotics, insufficient course of treatment, irregular medication, and lack of attention to personal hygiene and living habits can all lead to refractory or recurrent infection.

Aunt Wang: Then all the medicines I took in the past were in vain? And you all say that medicines are three-part poisons. My infection has not been cured. Does it also damage my kidneys?

Pharmacist: Auntie, please listen to my explanation. You originally had a lower urinary tract infection, which should not be very serious. However, if it continues for a long time and is not controlled well, the bacteria will go back up and damage the kidneys. Some people have poor immune function and may even develop pyelonephritis, and in severe cases, kidney abscesses may occur. Therefore, you still need to see a doctor and take regular medication.

Aunt Wang saw a specialist, who determined that it was still a lower urinary tract infection and believed that it was related to her irregular medication, long periods of sitting playing mahjong, and drinking less water. After taking the medicine, the aunt went to the pharmacist's window to thank him.

According to statistics from 2017, more than 150 million people worldwide suffer from urinary tract infections. Most people suffer from recurrent attacks, and many of them abuse antibiotics. Long-term improper treatment not only fails to eliminate the infection, but also causes kidney infection due to low local immune function in the urinary system, and even develops into renal failure in severe cases.

So, how is urinary tract infection caused? And how to use medication correctly?

Frequent urination, urgent urination, and painful urination

Beware of "bladder irritation syndrome"

Urinary tract infection refers to the inflammation caused by pathogens (such as bacteria, fungi, chlamydia, mycoplasma, spirochetes and protozoa) growing and multiplying in the urinary tract and invading the urinary tract mucosa or tissue. Bacterial infection is the most common.

The clinical manifestations of urinary tract infection usually include the so-called "bladder irritation signs" (the bladder is stimulated by inflammation, resulting in corresponding symptoms), such as frequent urination, urgency, and pain when urinating. If the infection is more serious, there will also be fever. Different types of infection have different symptoms. For example, pyelonephritis generally causes fever and back pain, while asymptomatic urinary tract infection may not cause any discomfort, especially in the elderly.

It is not difficult to diagnose a general urinary tract infection. A routine urine test reveals a large number of white blood cells and a small number of red blood cells in the urine, which is enough to suspect a urinary tract infection. Coupled with the aforementioned symptoms, it is easy to confirm the diagnosis. However, some patients may need to undergo midstream urine culture due to a long course of illness and poor treatment results.

Once a urinary tract infection is suspected, you should first go to the nephrology or urology department for consultation. Some people need to see a gynecologist, and some need to see a sexually transmitted disease department (actually it is a urinary and reproductive system infection).

Infection is not a minor problem

Misunderstandings to avoid

Myth 1: Urinary tract infection will not damage the kidneys.

Urinary tract infection is divided into lower urinary tract infection (cystitis, urethritis) and upper urinary tract infection (pyelonephritis, ureteritis). If the antibiotics are not used in sufficient quantity after lower urinary tract infection, it is easy to cause "reverse infection", that is, chronic pyelonephritis. A few people with low immune function may even develop kidney abscess. Therefore, urinary tract infection will damage the kidneys.

Myth 2: Urinary tract infection is a minor problem that can be cured by taking medicine for a few days.

Urinary tract infections caused by bacteria are relatively easy to treat, mainly with oral antibiotics, usually drugs against Gram-negative bacteria. Although lower urinary tract bacterial infections are not serious, medication must be taken for at least 7 days, while upper urinary tract infections require continuous medication for 7 to 14 days. If the pathogen causing the urinary tract infection is fungus or chlamydia, the medication is more complicated and must be followed according to the doctor's instructions. Do not choose or stop medication at will.

Misconception 3: Urinary tract infections are “equal for men and women”.

This is both true and false. If the infection involves not only the urinary system but also the reproductive system, then the incidence rate in men is indeed higher than that in women, but women can be infected by men, especially between couples.

However, bacterial infections of the lower urinary tract are not "equal" and are more common in women. There are several reasons for this: (1) The female urethra is wider and shorter than the male urethra, and the urination opening is closer to the anus, so bacteria can more easily invade the urethra; (2) Women have menstruation. During the menstrual cycle, the resistance of the female urinary and reproductive tracts is reduced. In addition, improper cleaning, insufficient cleaning, insufficient replacement of sanitary napkins, etc. make it easier to get infected; (3) The female urethra is very close to the reproductive tract, and infections of the female reproductive system (such as vaginitis) may also "affect" the urinary tract; (4) The increase in progesterone during pregnancy relaxes the ureteral smooth muscle, slowing the flow of urine and facilitating bacterial reproduction; (5) Due to the difference in anatomical structure, when women go to the toilet, the urinary system must contact the toilet seat, which is a very obvious disadvantage compared to men.

How to treat urinary tract infection?

These are the key points to remember:

1. If you experience symptoms such as frequent urination, urgency, and pain when urinating, seek medical attention promptly and do not force yourself to urinate.

2. Avoid purchasing drugs based on experience. Antimicrobial drugs are prescription drugs, and my country strictly stipulates that a doctor's prescription is required to purchase antimicrobial drugs.

3. Antibacterial drugs should not be kept in the family medicine box all the time. Used antibacterial drugs should not be reused at will. Because the bacteria may be different in different infection sites and at different stages of infection, if you are infected again, you must consult a doctor and get the medicine.

4. Pay attention to scientific prevention measures for the causes of the disease and factors that are susceptible to infection, such as not sitting for long periods of time; develop the habit of drinking water frequently; women should pay special attention to personal hygiene during menstruation or pregnancy, and wash and change underwear frequently; underwear must be made of cotton and breathable, and changed and washed every day. Underwear should be washed separately from other clothes, especially socks, and it is best to dry it in the sun.

5. Once a urinary tract infection is confirmed, take medication according to the doctor's orders. After dispensing the medicine, you can go to the hospital's medication service window to consult the pharmacist.

Author: Chen Lumei, Chief Pharmacist of the Pharmacy Department of Shanghai Naval Medical University

Review expert: Miao Xiaohui, chief physician of the Department of Infectious Diseases, Changzheng Hospital affiliated to the Second Military Medical University

Wang Baoxin, deputy director and pharmacist of the Pharmacy Department of Peking University First Hospital