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Urinary tract infections are very common, and most people will encounter one at some point during their lifetimes. What do you need to know about the different kinds of UTI?

UTIs are very common among women, but also among some men and people with compromised health.

Most UTIs are uncomplicated and can be dealt with with a course of antibiotics but some, such as non-gonococcal urethritis or pyelonephritis/kidney infection, require more intensive care.

The symptoms of each of the three different types of UTIs (cystitis, non-gonococcal urethritis, and pyelonephritis/kidney infection) are similar, but do have key differences. Equally, women with vaginitis/bacterial vaginosis may mistake it for a UTI, though it has a different cause and symptoms.

What is a UTI?

A urinary tract infection (UTI) is an umbrella term that covers bacterial infections along the urinary tract — which includes the urethra, bladder, and/or kidneys. The term UTI is usually used to refer to cystitis, a very common infection of the bladder. It mainly affects young women who are sexually active, but children and men can also be affected. The higher risk in women is due to the shorter urethra and the mechanics of penetrative intercourse that can push bacteria into the urethra.

When a person has a UTI the urethra, bladder, and/or kidneys become infected, usually by bacteria that live on the skin or in the colon. These bacteria travel up the urethra into the bladder where they do not belong. This causes an infection that leads to pain and difficulty urinating. If left untreated, compilations can arise, such as the bacteria traveling further up the urinary tract and causing kidney infections.

Classification of UTIs

UTIs are classified as either complicated or uncomplicated depending on how severe patient symptoms are and whether the symptoms are likely to respond quickly to medication.

Complicated cases of urinary tract infection include:

  • Men
  • Pregnancy
  • Recent or recurrent urinary tract infections
  • Abnormal urinary bladder
  • Diabetes
  • Immunosuppressed state

Uncomplicated cases of urinary tract infection are any in which the above factors are not at play. However, uncomplicated UTIs are different from asymptomatic baceuriuria. In asymptomatic baceuriuria (ABU) there are no painful symptoms of a UTI, only the presence of bacterial growth in the urine. ABU is considered to be a normal bacterial colonization, and not a health problem.

General symptoms of a UTI

The general symptoms of a UTI are limited and include:

  • Painful urination
  • Frequent need to urinate
  • An urgent need to urinate

Different types of UTIs

While UTIs can be classified into only two categories – complicated and uncomplicated – there are in fact a number of different types of infections that can be in the urinary tract.

  • Cystitis – an infection of the bladder
  • Nongonoccocal Urethritis – an infection of the urethra
  • Pyelonephritis – an infection of the kidneys

Women with vaginitis may also confuse this infection for a UTI, however it is not related to the urinary tract and has a different set of symptoms and causes

  • Vaginitis – a bacterial infection of the vagina

Cystitis

Cystitis is the, usually uncomplicated, infection of the bladder by bacteria that normally live in the colon or the skin: these include the bacteria E. coli and Streptococcus. These bacteria and others can get into the urinary tract in a number of ways.

Having sexual intercourse can bruise the bladder and urethra in women as well as push foreign bacteria into the urethra and bladder. Women with poor hygiene and children just learning to clean themselves after toileting can contract infections easily when bacteria from the anus are wiped towards the urethra. Also, women and children have shorter urethras so the bacteria has a quicker route to the bladder. Finally, harsh bubble baths and scented feminine hygiene products can irritate the urethra and bladder, causing inflammation and giving bacteria an easier place to colonize.

In more complicated instances the contributing factors include:

  • Pregnancy
  • Diabetes
  • Catheters
  • Kidney/bladder stones

Pregnant women are susceptible to infection as pressure from the growing fetus on the bladder prevents complete emptying of urine and can lead to bacterial growth.

People with diabetes can have urine which contains a great deal of sugar – an excellent place for bacteria to grow.

Further, the disease itself can damage the muscles of the bladder so that it can't contract properly. This means that, as with pregnancy, the bladder does not empty fully. Should a person have kidney or bladder stones, this can cause urine to stagnate in the bladder (as with pregnancy and diabetes), which creates a place for bacterial overgrowth.

Lastly, the use of catheters inserted into the bladder lends itself to the colonization of the urinary tract by bacteria. If they are in place for a longer length of time, the bladder has no defense against bacteria entering and colonizing.

Symptoms of cystitis include:

  • Painful urination
  • Urinating only small amounts
  • Urinating frequently
  • Dark, cloudy, and strong smelling urine

Less commonly, people with cystitis may experience

  • Blood in their urine
  • Painful intercourse
  • Feeling unwell, lethargy

Non-gonococcal urethritis

Non-gonococcal urethritis (NGU) is the term for the inflammation of the urethra which is not caused by gonorrhea. It is a condition mainly diagnosed among men, in contrast to cystitis which is diagnosed mainly among women. Further, when there is no specific cause then NGU may also be called non-specific urethritis (NSU).

Symptoms of non-gonococcal are not usually present in women. In men they include:

  • Discharge from the penis which is white or cloudy
  • Painful, burning sensation when urinating
  • Irritation or soreness at the tip of penis

Pyelonephritis or kidney infection

Pyelonephritis, also known as a kidney infection, is often the result of cystitis that has worsened and traveled up the urinary tract. This is particularly concerning during pregnancy when kidney infection can lead to miscarriage or preterm labor.

Symptoms of kidney infection include: 

  • Pain in the lower back and sides
  • Lethargy
  • Fever and/or chills
  • Nausea and vomiting

Vaginitis and bacterial vaginosis

Vaginitis is not a urinary tract infection, but rather an infection of the vagina. However, given its location next to the urethra, many women may mistake vaginitis for a UTI. Specifically, vaginitis is an inflammation that is not caused by a UTI nor a sexually transmitted infection. It can cause discomfort, discharge, or itching and it can lead to bacterial vaginosis (a bacterial infection of the inflamed vagina).

Symptoms of vaginitis and bacterial vaginosis include:

  • White, yellow, or green vaginal discharge
  • Vaginal discharge that has the consistency of cottage cheese
  • Vaginal itching or irritation
  • Pain when urinating or during sex
  • Light bleeding/spotting

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