Recurrent Urinary Tract Infections

Urinary tract infections are infections involving the bladder and the urethra. These infections often go unrecognized and the body can clear them without medications. In some situations, the immune system, genetics and the hormonal state of the patient do not allow for adequate clearing thus infections causing discomfort and foul smelling urine and new onset frequency (need to urinate often) will appear. If these infections are not treated, they could in some situations lead to infections involving the kidneys. This is called pyelonephritis (pie-LO-nef-rie-TIS). Treatment usually involves intravenous antibiotics but in some situations oral medications, depending on the condition of the patient. Physicians prefer to prevent infections from reaching the kidneys and treat infections before they have the potential for causing systemic spread. Patients with urinary tract infections that have been diagnosed and proven by urine culture (where the urine is tested and checked for growth of bacteria over a 3 day period). Urinalysis (where urine is dipped and checked for white blood cells or blood or nitrites which some bacteria produce) is often not accurate in diagnosing an infection. It is important to identify the bacteria when treating an infection because some antibiotics don't work for all types of bacteria, especially if resistance to the treatment exists (bacteria is not affected by the antibiotic because of recurrent need for antibiotics). When a patient has more than 3 infections in a one year period, she is diagnosed with what is known as recurrent urinary tract infections.

To ensure that you are adequately taken care of, our urogynecologists will often want to inspect your bladder and urethra and possibly your whole urinary tract system to ensure that only treatment with antibiotics is what will get your infections under control. There are times when your physician will work hand in hand with infectious specialists if your treatment is requiring specific antibiotic therapy.

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Treatment options

UTI are infections that involve the bladder, urethra and kidneys. Recurrent UTIs are infections that keep happening despite treatment (they are called recurrent if a patient has more than two infections in one year or more than one infection in 6 months). With time, some bacteria may stop responding to an antibiotic. This is called resistance and this makes treatment more difficult.

Common signs of UTIs include the following:

  • New or worsening frequent urination
  • Foul-smelling urine
  • Burning with urination
  • Fever
  • Chills
  • Nausea
  • Flank pain (pain near the middle and lower back)

Infections involving the kidneys can be serious and require strong antibiotics and sometimes necessitate a stay in the hospital. If admitted, the internal medicine team will administer intravenous antibiotics for a few days. Signs of kidney infections, called pyelonephritis (PIE-lo-NE-fry-TIS), include flank pain (pain below the ribs and to the sides of the body where the kidneys are located) as well as new or worsening confusion (which in older patients may occur with UTIs).

UTIs are diagnosed by urinalysis or urine culture. Sometimes, a urinalysis (where the urine is tested and results are immediately reported) may help identify an infection. However, for patients with recurrent UTIs, it is important to know the bacteria and the antibiotics that appropriately treat it. A urine culture may take up to three days after a sample is provided. Culture results include the identification of the specific bacteria causing the infection as well as the antibiotics that treat it.

For patients with recurrent UTIs, it is important to make sure that the antibiotic used has completely cleared the UTI. To check this, a urine culture is repeated. This is called a test of cure (TOC) because it ensures that the patient has been treated. A TOC is a urine culture that is performed within 7-14 days after completing the last pill of the treatment antibiotic.

Some patients may need to take a daily antibiotic for 6-9 months to help prevent recurrence of the infection after completing the treatment course. This is called a suppression or prophylaxis antibiotic. It is usually a low dose of an antibiotic that has minimal long-term side effects.

It is important to have a specialist such as a urogynecologist manage recurrent UTIs so as to help avoid kidney infections and permanent kidney damage.