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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Features and Management of Prostate Infection

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Men suffer from prostate infection mostly as a part of urinary tact infection. Prostate; a sex gland in male, surrounds the initial part of urethra; where it commences from the urinary bladder and is chest-nut shaped; consisting of fibrous, muscular and glandular elements. It is communicated with the urethra and secretes a fluid rich in fructose and other ingredients during sex act; probably to nourish and facilitate the sperm migration. It may sometimes get infected by the bacteria from the infected urine of urinary tract infection (UTI).
Infection of the prostate is called prostatitis.
It may cause:
Pain in the anterior part of anus,
Fever with chill and rigors,
Sometimes blood in the seminal fluid
and
Passage of mucous threads per urethra especially in the morning during defecation.
It can be diagnosed by per rectal digital examination of prostate; which is painful to the palpating finger, may feel swollen and irregular. Pus may be seen coming out, if prostate is massaged a little during the digital examination.
An ultrasonogram is an invaluable tool in the diagnosis as well as the semen analysis. A culture and sensitivity test of urine is to be performed to find out the exact antibiotic requirement.
Little prolonged antibiotic treatment may be required along with daily prostatic massage to expel out the contents. It will invariably contain the infection and cure the patient.
Sometimes, it may become chronic; and sometimes, an abscess forms in the prostate. Prostatic abscess may need to be drained.
Prostatitis is invariably a very painful condition and sometimes simulates a perianal abscess. Careful history taking and rectal examination will clinch the diagnosis.

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Orchitis

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I do not remember if I have seen bilateral orchitis in the recent past that I saw to-day.The enlargement is quite remarkable.May be it is due to the delay in arrival to the hospital.Orchitis is inflammation of testis commonly by bacteria in an adult but in tropical countries usually filarial. .In children it is usually of viral in origin.Here the testis enlarges and becomes painful accompanied by fever.Epididymis is also involved most of the times.It follows an urinary tract infection through backward infection.
Support of testis,analgesics to relieve the pain and antibiotics to control infection are required.Investigations like urine examination along with culture and sensitivity test and ultrasonography of testis and abdomen are important to support treatment.

URINARY TRACT INFECTION AND HONEYMOON CYSTITIS.

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Dysuria,the painful micturition is very distressing and if added to it frequent urination with fever makes the patient's condition miserable.And these are hallmark of urinary tract infection.Urinary tract includes right from kidneys to to urethra.It is commonly due to bacterial infection and females predisposed to it due to proximity of urethra to the anus.E.Coli, the organism present in feces is isolated frequently now-a-days.Gonorrheal  and syphilitic infections are also seen but less than before because of rampant use of good antibiotics.Some thing called honeymoon cystitis occurs after first honeymoon in females infecting the urinary bladder. Another source of contacting infection is door handle of common toilets at community places.

Commonly urine is subjected to microscopic examination which may reveal number of pus cells and sometimes red blood cells.Culture and sensitivity of urine will give information about suitable antibiotic required.

 A little long term use of antibiotics in female is recommended  .Though it is cured without any sequel but in gonorrheal  infection complications like narrowing of urethra called stricture of urethra and other systemic complication do occur.Syphilis is more notorious for causing more dreaded complications even involve the central nervous system.