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Overall key points.
- Half of adult women will have at least one urinary tract infection in their lives.
- A urinary tract infection may be detected on midstream urine as an asymptomatic bacteriuria.
- Antimicrobial therapy should be initiated when symptoms of infection are present.
- The ideal drug should have a high urinary excretion rate and broad spectrum activity.
- Simple measures, such as high fluid intake and complete bladder emptying, can help prevent infection.
Part 1: Epidemiology and aetiology
Urinary tract infection (UTI) in women is often poorly recognised and treated, because many infections are asymptomatic.
UTIs may become recurrent and lead to serious complications but because they occur so frequently, many women turn to alternative medicines that may not provide effective treatment.
Other bladder and pelvic conditions, notably endometriosis and pelvic inflammatory disease (PID), can mimic UTI.
A UTI can be assumed if there is a significant bacteriuria: >105 colony-forming units per ml urine. Recurrent infections are defined as those occurring after the resolution of a previous UTI.
Most UTIs are caused by faecal bacteria such as Escherichia coli, Klebsiella, Proteus or enterococci. Occasionally, yeasts or certain mycoplasma-like organisms may be involved.
Faecal bacteria from the perineum ascend into the vulva, urethra and bladder, often at the time of coitus. Risk factors include sexual intercourse, spermicide use, frequent courses of antibiotics, low …