Why Urinary Tract Infections in Females are Difficult to Treat

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Urinary tract infection is very common in females due to various reasons. Most of the women suffer from urinary infection at least once in their life time. It is also difficult to eradicate.
The urinary tract extends right from the kidneys to the end of urethra. The urethra in female is only 4 cms in length in comparison to male where it is 20 cms. It is also situated in close proximity to vaginal and anal opening. Vagina and anus are the potentially infected places; harboring different microbes, those can have easy access to urethra. This anatomical disadvantage in female may make them susceptible to frequent urinary tract infections.
Ladies get infection from their sexual partners during active sex life. Masturbation also contributes to the entry of infection by way of inflicting minor injuries. Those help bacteria to colonize and spread infection.
Sometimes catheterization of urethra may be necessary for different medical conditions. Pelvis surgeries in the female viz. hysterectomy and caesarian section may require catheterization of urinary bladder. An unclean catheterization may introduce bacteria to the urinary tract; and urinary bladder in particular gets infected in this way. That is termed as iatrogenic urinary tract infection.
Apart from these, in hormonal insufficiency state, particularly the estrogen in post-menopausal setting; may lead to colonization pathogenic bacteria, as natural acidity in vagina is lost or becomes low. This is one of the commonest causes of urinary tract infection in post-menopausal women, which run a protracted course. Apart from these ascending infections; urinary tract may get infected from blood borne infections from other adjacent infected structures e.g. a pelvic inflammatory disease.
Features of urinary tract infection include;
•    Burning urination,
•    Frequency of urination,
•    Pus discharge in urine making it opaque,
•    Blood in urine,
•    Pain in the lower abdomen,
•    Weakness, loss of appetite and vomiting and
•    Fever with chills and rigors.
Common tests include; routine and microscopic urine analysis, culture and sensitivity test of urine and ultrasonogram to exclude other facilitating causes of urinary infection viz. a calculus disease of urinary tract or anomalous urinary tract. Diabetic state of the patient has to be evaluated as they are prone for infection in any form.
Empirically, an antibiotic targeting E.Coli is usually started pending urine analysis and result of sensitivity test. Paracetamol for fever and a urinary soothing agent for burning sensation in urethra may be needed. Later on recommended antibiotic as available from the culture and sensitivity report may be substituted. In ladies, a little prolonged antibiotic therapy may be necessary, may be in full doses for 15 days and another 15 days in a relatively low dose. Plenty of water drinking is advised. Urinary alkalinisation may sometimes be required, of course depending on the type of antibiotics selected because some antibiotics work better in acidic environment and aklalinisation may hamper the effectiveness. Cleanliness, particularly in using tampons and catheterization will minimize contact of infection. Local application of low dose estrogen hormone gel in the vagina in menopausal ladies or low dose hormone replacement therapy (HRT) wherever needed may aid to prevent this resistant infection.
Untreated or under treated patients may land up in more problems including recurrent infections of urinary tract, stone formation and infection of kidneys.

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