Some microbes, like Chlamydia and Mycoplasma, require special bacterial cultures in order to be detected. A doctor should suspect one of these infections if the patient has symptoms of a UTI and has pus in the urine, but a laboratory culture fails to grow any bacteria. When a patient has a persistent infection-one that does not clear up with appropriate treatment and is traced to the same strain of bacteria--the doctor orders an intravenous pyelogram (IVP). This examination gives x-ray images of the bladder, kidneys, and ureters. An opaque dye visible on x-ray film is injected into a vein, and a series of x-rays are taken. The film shows an outline of the urinary tract, revealing even small changes in the contours of these organs that might contribute to infection.

Some doctors may also recommend an IVP for women patients who have five or more infections in a year. (As stated before, most recurring infections are caused by a different strain or type of bacteria.) Another test that may be useful for patients with recurring infections is a cystoscopy. A cystoscope is an instrument made of a hollow tube with several lenses and a light source, which allows the doctor to see the inside of the bladder.

Treatment

Urinary tract infections are treated with antibacterial drugs. The choice of drug and length of treatment depends on the patient's history and the urine tests that identify the offending bacteria. The sensitivity test is especially useful in helping the doctor select the most effective drug.

An uncomplicated infection in women can often be cured with 1 or 2 days of treatment.

Several clinical trials have shown that an uncomplicated infection in women can be cured with 1 or 2 days of treatment. However, many physicians prefer to have their patients take antibiotics for a longer period (e.g., 7 to 14 days) to assure that the infection has been cured. Single-dose treatment is not recommended for certain groups of patients, for example, those who have delayed treatment or have signs of bacterial invasion of tissue, patients with diabetes or structural abnormalities, or men who have infections in the prostate gland. Lengthier treatment is also needed by patients with infections caused by Mycoplasma or Chlamydia, who are usually treated with tetracycline, trimethoprim/ sulfamethoxazole (TMP/SMZ), or doxycycline. A follow-up urinalysis helps to confirm that the urinary tract is infection free. It is important to take the full course of treatment, even after symptoms disappear.

Severely ill patients with kidney infections may be hospitalized until they are able to take fluids and needed drugs on their own. The consensus among physicians is that kidney infections require several weeks of antibiotic therapy. A recent clinical trial at the University of Washington found that 2-week therapy with TMP/SMZ was as effective as 6 weeks of treatment with the same drug in women with "uncomplicated" kidney infections. (Uncomplicated infections are those in which there is no underlying obstruction or nervous system disorder. In such cases, kidney infections rarely lead to kidney damage or kidney failure unless they go untreated.) Moreover, the research showed that 2-week TMP/SMZ treatment was more effective and better tolerated than either 2- or 6-week treatment with ampicillin.

Various drugs are available to relieve the pain of a UTI. A heating pad or a warm bath may help. Physicians have different opinions on the importance of drinking extra fluids, but most suggest that drinking plenty of water helps cleanse the urinary tract of harmful bacteria. Others feel that increasing fluid intake is unnecessary because the infection is so quickly cured by antibiotics. For the time being, it is best to avoid irritants like coffee, alcohol, and spicy foods. (And one of the kindest favors a smoker can do for his or her bladder is to quit smoking. Smoking is the most important known risk factor for bladder cancer.)

Women who have frequent recurrences may benefit from preventive therapy. Recurrent Infections in Women

About four out of five women who have a UTI get another one within 18 months. Many women have them even more frequently. Women who have frequent recurrences (e.g., three or more a year) may benefit from preventive therapy. Doctors use several approaches to manage these patients after the most recent infection has been eradicated. One of the most common is for the patient to take low doses of an antibiotic daily for 6 months or longer. (If taken at bedtime, the drug remains in the bladder longer and may be more effective.) Another is to take a single dose of an antibiotic after sexual intercourse. Even after long-term treatment, however, some women continue to have recurrent infections.

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