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Is it a UTI?

How urine infections are diagnosed and treated

One in five women will have a urinary tract infection during her lifetime. These are more common in women than in men for two reasons: First, there’s a long distance between the bladder and the outside world for men, while the woman’s urethra is very short. In addition, that area in a woman is usually wet and often irritated, so it’s easier for bacteria to work their way into the bladder. 

The symptoms of a urinary tract infection relate to the bladder irritation. The bladder tries to rid itself of infection by emptying often, called “frequency,” resulting in small voids and a sense of urgency. The irritated bladder sends nerve signals that are interpreted as low back pain. 

The body fights infection by sending white blood cells to the site. Normal urine has no white blood cells, but infected urine will have many, noted as leukocytes or pus cells. Except in a hospital lab, most urine tests involve dipping in a little strip of plastic that has tiny patches of chemical-imbedded gauze along its length. Infection is diagnosed when certain readings are positive. 

Urine infections often go away without the need for antibiotics. Some people treat theirs with cranberry juice, which seems to work by making the bladder slippery to the bacteria. A numbing medicine, phenazopyridine, sold over the counter as Azo or just “urinary pain relief,” numbs the bladder and can make the condition tolerable for a day or two. Because medicines often are concentrated in the bladder, these infections usually respond promptly to low-dose antibiotics. 

The danger in ignoring bladder infections comes when the bacteria work their way up the urinary tract tubes into the kidneys. Infected kidneys cause fever and can lead to severe issues, such as sepsis. This is particularly dangerous if the kidneys can’t empty, say from an enlarged prostate or a kidney stone. 

Most of the time, making the diagnosis and prescribing treatment is easy. The patient has urinary tract infection symptoms, and the doctor confirms the infection with a dipstick and prescribes antibiotics; the patient ultimately improves. If the infection becomes severe, such as with fever or vomiting, the patient may need to be admitted to a hospital for IV antibiotics. Some patients are afflicted with recurrent infections, in which case a physician may recommend and prescribe a low-dose antibiotic to be taken every day as prevention. 

Older people may exhibit only vague, atypical symptoms with their urine infections. With their health already fragile, a mild bladder infection can cause an elderly person to have low blood pressure and faint or perhaps become delirious. Even very young children can have urinary tract infections, so a crying baby with a fever should have her urine checked. 

If infection settles into the man’s prostate, known as prostatitis, the symptoms mirror those of a urinary tract infection. Unlike the smooth surface of the bladder that easily clears infection, the prostate has multiple small channels and places for bacteria to hide. With prostatitis, a much longer course of antibiotics is necessary. 

Sometimes the bladder wall becomes irritated, a condition called interstitial cystitis. The symptoms mimic infection with frequency, painful urination and urgency. However, the condition is not caused by infection, and no matter how many antibiotics are given, the patient won’t improve. 

IC can be caused by various issues. Drinking too many colas is a common factor. Sometimes the patient has an autoimmune reaction, that is, the body thinks something on the bladder wall is foreign and ends up overreacting. Most of the time the cause can’t be found. The medical literature suggests treatments of anti-inflammatory medications (such as ibuprofen), antihistamines or tricyclic antidepressants, the latter relaxing the bladder spasms. I’ve found great success with low doses of oral steroids. 

The symptoms of venereal disease also mimic urine infection. Chlamydia in women and gonorrhea in either gender causes burning during urination. Certain vaginal infections, particularly trichomonas, may be responsible as well. These infections all need antibiotic treatment, but with a different choice of medication. 

Antibiotics have changed physicians’ abilities to cure disease, and urinary tract infections serve as a perfect example. A few pills not only provide comfort, but by preventing an infection from worsening, they can save lives. Several effective antibiotics are available, making properly treated bladder infections more of a temporary nuisance than a danger.

Dr. Philip L. Levin is a retired emergency medicine specialist in Gulfport. Learn more or contact him at

Written by Dr. Philip Levin

Dr. Philip L. Levin is a retired emergency medicine specialist in Gulfport. Learn more or contact him at

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