Urinary Tract Infection

A urinary tract infection (UTI) is an infection affecting any part of the urinary system — the kidneys, ureters, bladder, or urethra. The vast majority of UTIs involve the bladder (cystitis) and urethra (urethritis), causing uncomfortable but uncomplicated lower urinary tract symptoms. When infection spreads to the kidneys (pyelonephritis), it becomes a more serious upper UTI requiring prompt treatment. UTIs are among the most common bacterial infections worldwide and are particularly common in women — more than half of all women will experience at least one UTI in their lifetime. In Nigeria, UTIs are frequently encountered in outpatient and emergency settings.

Lower UTI (bladder infection — cystitis): • Burning or stinging pain or discomfort when urinating (dysuria) • Frequent, urgent need to urinate: often passing only small amounts of urine each time • A strong, persistent urge to urinate that is difficult to ignore • Cloudy, dark, bloody, or strong-smelling urine • Pelvic pain or pressure, especially in the central lower abdomen • In older adults: confusion or behaviour change may be the only symptom Upper UTI — kidney infection (pyelonephritis): • All of the above, plus: • High fever (38.5°C or above) with chills and shaking • Severe back or flank pain (pain in the side, below the ribs) • Nausea and vomiting • Feeling very unwell and weak • Tenderness when pressing on the back or flank In infants and young children, UTI symptoms may be non-specific: • Fever without obvious cause • Irritability and poor feeding • Vomiting • Foul-smelling urine or wet nappy more than usual

UTIs are caused by bacteria entering and multiplying in the urinary tract. The most common causes include: • Escherichia coli (E. coli): responsible for approximately 80% of uncomplicated UTIs; originates from the bowel flora • Klebsiella pneumoniae: increasingly common in Nigeria, including multidrug-resistant strains • Staphylococcus saprophyticus: common in sexually active young women • Proteus mirabilis: frequently associated with kidney stones • Pseudomonas aeruginosa and Enterococcus: more common in healthcare-associated and complicated UTIs Bacteria typically enter through the urethra (the tube that carries urine out of the body), which is shorter in women than in men — explaining the higher UTI prevalence in women.

• Female sex: the female urethra is shorter, making it easier for bacteria to reach the bladder • Sexual activity: particularly a new sexual partner or frequent intercourse • Certain contraceptive methods (diaphragm, spermicides) • Pregnancy: hormonal and anatomical changes increase risk • Menopause: reduced oestrogen makes the urinary tract more susceptible • History of previous UTIs • Urinary catheterisation (hospital-associated) • Urinary tract abnormalities (e.g., vesicoureteral reflux, kidney stones, enlarged prostate in men) • Diabetes: high blood glucose and impaired immunity increase risk • Weakened immune system • Poor hygiene practices

• Kidney infection (pyelonephritis): can lead to permanent kidney scarring • Recurrent UTIs: some women experience repeated infections • Sepsis: bacteria from the urinary tract enter the bloodstream and cause a life-threatening systemic response • Kidney damage and chronic kidney disease from recurrent or untreated upper UTIs • In pregnancy: preterm labour, low birth weight, maternal sepsis • In infants: untreated UTI can cause renal scarring that leads to hypertension and kidney failure in adulthood • Antibiotic resistance: overuse and misuse of antibiotics for UTI is a major contributor to resistance in Nigeria

• Drink adequate fluids (6–8 glasses of water per day): helps flush bacteria from the urinary tract • Urinate promptly when you feel the urge: do not hold urine for long periods • Wipe from front to back after using the toilet (for women): prevents bacteria from the rectum reaching the urethra • Urinate soon after sexual intercourse • Avoid using douches, feminine deodorant sprays, and harsh soaps around the genital area • Wear breathable, cotton underwear • For those with recurrent UTIs: ask your doctor about low-dose prophylactic antibiotics or post-coital prophylaxis • For postmenopausal women: vaginal oestrogen may help reduce recurrent UTIs • Manage diabetes well: good blood glucose control reduces infection risk