Urinary tract infections occur when certain bacteria invade the urethra.

Welcome to the latest installment of “Over 90 Percent of What Planned Parenthood Does,” a series on Planned Parenthood Advocates of Arizona’s blog that highlights Planned Parenthood’s diverse array of services — the ones Jon Kyl doesn’t know about.

A urinary tract infection (UTI) affects the urinary system, most notably the urethra. Symptoms might include an increased urge to urinate, accompanied by a burning sensation; urine might be cloudy or bloody. Among adults, UTIs are 50 times more common in people with vaginas than in people with penises, probably due to the shorter distance bacteria travel from the bowel. If you have a vagina, there is more than a 50 percent chance that you’ll have at least one UTI in your lifetime. And, if you’re unlucky enough to be in this group, there’s a 20 percent chance that you’ll develop recurrent UTIs (three or more infections yearly). Annually, UTIs prompt an estimated 8 million visits to health-care providers, costing at least $1 billion.

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How can urinary tract infections be prevented?

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Although symptoms often recede without medical intervention, it’s important to seek treatment for persistent UTIs because the infection could spread. If you are or have been sexually active, it is also important to ensure you don’t actually have a sexually transmitted disease.

Causes of UTIs

When certain species of fecal bacteria wend their way from the bowel into your urethra, they might initiate an infection. Up to 90 percent of UTIs are caused by certain strains of Escherichia coli; the rest are caused by Staphylococcus saprophyticus, Proteus mirabilis, Klebsiella pneumoniae, and a few other species.

Risk factors for UTIs include:

• holding in urine, rather than urinating when you feel the urge
• nerve damage that inhibits complete urination
• being above the age of 65
• kidney stones
• catheters
• diabetes
• compromised immunity

If you have a vagina:

• vaginal intercourse, which might push germs into the urethra
• spermicides, such as those used in spermicide-coated condoms, which might promote bacterial growth — especially when used in tandem with diaphragms

If you have a penis:

• enlarged prostate
• performing anal sex
• being uncircumcised

If you’ve had sex-reassignment surgery:

Concerns that urinary disorders might be a long-term risk of sex-reassignment surgery prompted a couple of small studies of transgender men and women who had undergone such procedures. While one study found no correlation between the surgery and UTIs, the other found higher-than-average rates among some transgender people. However, due to small sample sizes and methodological weaknesses, large, well-designed studies need to be undertaken.

Preventing UTIs

Along with avoiding some of the above-mentioned risk factors, you can also avoid bringing fecal matter into contact with the urethra by:

• using condoms during anal intercourse (if you have a penis)
• using lubricated condoms without spermicide during vaginal intercourse (if you have a vagina)
• avoiding receiving anal penetration followed by vaginal penetration without changing condoms between acts

If you have recurrent UTIs, you might consider antibiotics — either a daily dose or one taken after sexual intercourse. Antibiotics have drawbacks, including side effects and the possibility of antibiotic resistance evolving among the bacteria that infect you. A health care provider can help evaluate risk versus benefit.

There is a lot of contradictory information about preventing UTIs. For instance, ubiquitous gynecological advice holds that urinating immediately after vaginal intercourse can flush out bacteria that might cause UTIs; another common bit of advice holds that people with vaginas should wipe from front to back at the toilet, especially after a bowel movement. Health authorities such as the National Institute of Diabetes and Digestive and Kidney Diseases advise against tight-fitting jeans or nylon underwear, reasoning that such clothing can trap bacteria-friendly moisture. However, the idea that post-coital urination prevents UTIs has not been demonstrated in scientific studies. Considering that the urethra and vagina are two separate openings, this isn’t too surprising (though some posit that friction from intercourse pushes germs into the urethra). One study, for example, found no relationship between recurrent UTIs and post-coital urination, the frequency of urination, wiping patterns, or wearing pantyhose or tights.

There is emerging, but inconclusive, evidence that cranberry juice (not capsules) might be effective in preventing (but not curing) UTIs, especially recurrent UTIs (although this latest study has been criticized on statistical grounds). While it’s possible that cranberry juice contains therapeutic chemicals, it might merely be an excellent placebo, or perhaps increased hydration leads to increased urination, which flushes bacteria out of the body.

Treating UTIs

Some people believe cranberry products cure UTIs, but the current body of evidence doesn’t support this idea. There is tentative evidence that cranberry juice might work as a preventative (see above).

There are over-the-counter medications that mask symptoms, but UTIs are only cured by prescription antibiotics from a health care provider, such as Planned Parenthood. Treatment might last from one day to two weeks. If symptoms don’t abate, schedule a followup. Untreated UTIs can spread to the bladder, kidneys, and beyond, where they can do serious damage.

Unfortunately, antibiotic resistance is growing among uropathogenic E. coli, so it’s important to take the full course of prescribed antibiotics — even if you feel better before treatment is finished! Additionally, even without specific genes for antibiotic resistance, E. coli can spontaneously enter a slow-growing “persister” state, which helps it evade antibiotics as the drugs only work on growing cells. Just as suddenly as they enter this state, they can return to normal. So, if antibiotics kill 99.99 percent of the billions of bacteria infecting you, even a few lingerers can reestablish an infection once they are roused from their persister state. And, because E. coli can double their population as rapidly as every 20 minutes, an infection can come raging back in no time. Unfortunately, if persisters can outlast your course of antibiotics, your infection might recur.

No matter what kind of reproductive organs you have, if your urinary tract is infected, Planned Parenthood Arizona can diagnose and treat you. After describing your symptoms and giving a history, you might be prescribed antibiotics immediately, or you might need to provide a urine sample. Schedule an appointment today!