UTIs: Myths vs Facts

Urinary tract infections (UTIs) are more common in women than men. In fact, more than 50% of  women will experience a UTI with symptoms in their lifetimes, and about 25% will experience a recurrent UTI (RUTI), according to the American Urological Association. Why? One reason is that the urethra, the tube that carries urine out of the bladder, is shorter in women than in men, so bacteria can reach the bladder more easily.

Menopause changes the bacteria of the urogenital tract, which puts women at risk for UTIs. Intercourse may also make a woman more likely to get a UTI. Other causes may be anatomical, kidney stones, or foreign bodies, such as the mesh which is sometimes used to treat stress urinary leakage or a weakened pelvic floor.

We now know there is bacteria throughout the urogenital tract, says Laura Martin, D.O., a female pelvic medicine specialist at the University of Miami Health System. “The bladder isn’t sterile; everyone has bacteria in the bladder known as the microbiome.” Dr. Martin is enrolling participants in a study that will compare bacteria found in the bladder among normal and RUTI patients. “We’re identifying if the types of bacteria seen in certain individuals predispose them to RUTI. We’re sampling RUTI patients when they are asymptomatic to get baseline data,” says Dr. Martin. Study participants must meet certain eligibility criteria.

“Bacteria communicate with each other through molecules. This cross talk can change the environment in the bladder which may predispose patients to infection.” With this study, Dr. Martin hopes to determine if a person’s microbiome influences their risk of infection.

If you want to prevent or manage your UTI risk, you need to understand the difference between information you may find on the internet and accurate medical information, says Dr. Martin.

Myth: UTIs are transmitted between sexual partners.

Truth: Sexual partners do not transmit UTIs. In men, infections are generally caused by an obstruction or abnormality in the urinary tract, such as a kidney stone or enlarged prostate, having recently had a catheter to drain urine, or having a neurological condition like Parkinson’s that might make draining the bladder difficult. Studies have also shown that uncircumcised men are more likely to get a UTI than circumcised men.

Myth: Poor hygiene causes UTIs.

Truth: E.coli, Enterococcus, Staphylococcus, Pseudomonas, or Klebsiella bacteria are the most common bacterial causes of UTIs and bladder infections.  Though general hygiene is important, since urine is not sterile, an imbalance in the bladder bacteria or urobiome (the colony of bacteria living in the bladder) is the more likely culprit. When an imbalance occurs, you may experience a UTI.

Myth: My UTI symptoms should go away entirely after treatment.

Truth: After treatment, mild symptoms may linger for a few weeks. During a bladder infection, you may experience pain with urination. Burning during urination is just one UTI symptom. You should also watch for frequent or intense urges to urinate, with very little urine, lower abdominal pain; cloudy or bloody urine; foul-smelling urine or fatigue. Elderly patients can experience mental status changes. However, if moderate to severe symptoms persist, it is important to notify your doctor.

Myth: UTIs are the only condition that causes pain with urination, frequency and urgency to urinate.

Truth: Other conditions such as interstitial cystitis, sexually transmitted diseases, and dietary changes can mimic the symptoms of a UTI. You need a urine culture test to ensure a proper diagnosis when you suspect you have a UTI. Home urine tests are insufficient.

Myth: I know when I have a UTI and I do not need to be evaluated by my doctor.

Truth: If you think you have a UTI, it’s important to talk to a healthcare provider who can determine which antibiotic is appropriate for you. While UTIs can be self-limiting, a prescription antibiotic can cure a UTI. Without treatment, the infection could  progress to a kidney or blood infection with more serious consequences such as hospitalization. “Complete the entire antibiotic course you are given to help prevent future antibiotic resistance,” says Dr. Martin.

Myth: Cranberry juice can prevent a UTI.

Truth: There are varying results in research studies regarding the effectiveness of cranberry juice in preventing UTIs. Most studies do not support drinking it for UTI prevention because it does not contain a high enough concentration of proanthocyanidins (PAC), the substance found in cranberry juice linked to urinary tract health. Juice is also high in sugar. Instead, take cranberry tablets, which have higher amounts of PAC, practice good hygiene, and see your doctor.

Myth: If my urinary infection returns, it means my antibiotic didn’t work.

Truth: If your UTI returns after antibiotic treatment, you likely have a recurrence. That does not mean your antibiotic did not work if you completed the entire antibiotic course. However, your doctor will need another urine culture to determine if you are on the correct medicine. Dr. Martin says, “If you experience two UTIs in six months or three in one year, we consider this recurrence, and you should ask your doctor to refer you to a specialist to reduce the risk of future infections.”

Myth: Wiping front to back, avoiding tight clothes, and urinating after intercourse will prevent UTIs.

Truth: There is no evidence that any of these general hygiene methods help prevent UTIs. However, experts still recommend them as they cost nothing and are easy to do. If it works for you, there is no reason to stop these practices.

Myth: There is not much I can do to prevent UTIs.

Truth: There are several things you can do to prevent UTIs, after consulting with your doctor. These include:

• Initial therapies: probiotics, vitamin C, cranberry tablets with proanthocyanidins
• Intermediate treatments: D-Mannose, vaginal estrogen cream
• Advanced therapies: Methenamine hippurate tablets, oral antibiotics, antibiotic bladder washes

A simple thing you can do is to drink more water! A study led by the University of Miami Miller School of Medicine has shown that drinking more water every day significantly reduced the recurrence of urinary tract infections in women.

“If you feel you have a UTI, ask your doctor for a urine culture prior to starting antibiotics,” says Dr. Martin. “Remember, for women, if you experience two UTIs in six months or three in one year, we consider this recurrence, and you should ask your doctor to see a specialist to reduce the risk of future infections.”

If you are interested in advancing the future of UTI treatment by enrolling in the study, call 305-243-6090, press option 4, and refer to Dr. Martin’s microbiome study. 

Written by Mary Jo Blackwood, RN, MPH, July 2019, and updated by Nancy Moreland, February 2023. Both are contributing writers for UHealth Collective.

Originally published on: July 22, 2019

Tags: Antibiotic Bladder Washes, antibiotics, cranberry juice, Dr. Laura Martin, Methenamine hippurate, PAC, proanthocyanidins, urinary tract infection, UTI