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Urinary Tract Infection (UTI) Guide

The burning, urgency, and pain of UTI — causes, treatment, and prevention

Urinary tract infections (UTIs) are one of the most common bacterial infections, affecting up to 50% of women at least once in their lifetime. They are 50 times more common in women than men due to the shorter female urethra. In Nigeria, UTIs are often poorly treated — either under-treated (dismissed as 'normal discomfort') or over-treated with antibiotics without urine culture. This guide covers the right approach.

Signs and Symptoms

✓ Burning or stinging sensation when urinating (dysuria) — the hallmark symptom
✓ Urgent and frequent need to urinate, often passing only small amounts
✓ Cloudy, foul-smelling, or blood-tinged urine
✓ Pelvic pressure or lower abdominal pain
✓ Fever and back/flank pain suggests kidney infection (pyelonephritis) — more serious
✓ In the elderly: confusion or sudden behavioural change may be the only sign of UTI
✓ In children: bedwetting, fever, or foul-smelling urine

Risk Factors

When to Seek Help

Fever or back pain with UTI symptomsSuggests kidney infection (pyelonephritis) — requires antibiotics for 7–14 days and may need IV treatment. See a doctor promptly.
UTI in pregnancyUTI in pregnancy must be treated to prevent premature labour and kidney infection. Urine culture is essential before starting antibiotics.
UTI in menUTI in a man is uncommon and suggests an underlying cause (prostate enlargement, kidney stones) — requires investigation.
Recurrent UTIs (more than 3 per year)Needs urine culture, imaging, and a prevention strategy — not just repeated courses of antibiotics.

Tests & Diagnosis

🧪 Urine dipstick
Quick screening for nitrites and leucocyte esterase — supports UTI diagnosis. A negative dipstick in a symptomatic patient is still suggestive.
🧪 Midstream urine culture and sensitivity
The definitive test — grows the bacterium and tests antibiotic sensitivity. Essential before treatment in complicated UTI, pregnancy, recurrence, or treatment failure.
🧪 Renal ultrasound
If pyelonephritis, recurrent UTI, or obstruction is suspected.
🧪 Urine glucose
Diabetes must be excluded in recurrent UTIs.

Treatment Options

1
Uncomplicated cystitis (non-pregnant adult woman)
Nitrofurantoin 100 mg twice daily for 5 days, OR trimethoprim 200 mg twice daily for 7 days (check local resistance patterns). Start empirically while awaiting culture. Amoxicillin is now ineffective for E. coli UTI due to widespread resistance in Nigeria.
2
Pyelonephritis (kidney infection)
Ciprofloxacin 500 mg twice daily for 7–14 days, or co-amoxiclav based on culture. Hospitalisation and IV antibiotics if vomiting, severe illness, or pregnancy.
3
UTI in pregnancy
Nitrofurantoin (avoid in third trimester) or cefalexin 500 mg three times daily for 7 days, based on culture. Avoid trimethoprim in first trimester.
4
Increase fluid intake
Drink 2–3 litres of water daily to flush bacteria. Symptoms often improve within 24–48 hours of antibiotics plus adequate hydration.
5
Urinary alkalinising agents
Potassium citrate sachets (Effercitrate) alkalinise urine and relieve dysuria within hours — available OTC. Use alongside antibiotics.
6
Prevention for recurrent UTI
Void after sexual intercourse. Wipe front to back. Stay hydrated. D-mannose powder may reduce recurrence. Post-menopausal women benefit from vaginal oestrogen cream (reduces recurrence significantly). Prophylactic low-dose antibiotics for very frequent recurrence.

Frequently Asked Questions

Can I treat UTI without antibiotics?
Mild UTI symptoms may resolve spontaneously in healthy non-pregnant young women — about 25–50% clear without antibiotics. Ibuprofen and urinary alkalinisers reduce symptoms while the immune system fights infection. However, antibiotics are significantly faster and prevent the risk of progression to kidney infection. In pregnancy, diabetes, or severe symptoms, antibiotics are essential.
Why does UTI keep coming back?
Recurrent UTI (3 or more per year) is common in women and has specific causes: sexual activity pattern, post-menopausal atrophy, bladder not emptying completely, underlying urinary tract abnormality, or resistant organisms. It needs proper investigation and a tailored prevention plan.
Can cranberry juice prevent UTI?
Cranberry contains proanthocyanidins that prevent E. coli from adhering to the bladder wall. Clinical evidence is modest — cranberry supplements (not juice, which contains too much sugar) may reduce recurrence by 25–30% in women with recurrent UTI. Cranberry juice is not a treatment for active UTI.
Is UTI sexually transmitted?
UTI is not classified as an STI — it is caused by bowel bacteria (usually E. coli) entering the urethra. Sexual intercourse increases UTI risk by introducing bacteria mechanically, which is why voiding immediately after sex is preventive.
Should I take antibiotics every time I get UTI symptoms?
No — self-treating without urine culture leads to antibiotic resistance. In uncomplicated recurrent UTI, self-diagnosis by dipstick and self-treatment with a prescribed standby antibiotic is appropriate. But regular UTI without culture is poor medicine — you may be treating resistant organisms or a different condition.

Related Pages

Dialysis Explained for Nigerian PatientsGlomerulonephritis in NigeriaProtein in Urine: What It MeansAcute Kidney Injury in Nigeria

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