Lower Urinary Tract Infection (UTI)

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Pharmacist (Females / Cisgender women and some transgender men)

•  A Pharmacy First Pharmacist can provide females / Cisgender women and some transgender men (16-64 years old) with antibiotic treatment over the counter, as long as there are no complications in your symptoms. You do not need an appointment for this service and do not need to see your GP first.

• You cannot use this service for UTIs if you have been treated with any antibiotic for a UTI in the previous 3 months; you're male / transwoman; you're pregnant or suspect you are; you're severely immunosuppressed; if you're allergic to Nitrofurantoin; you had the initial 3 days of treatment via this service but that has failed and a few other conditions

Additionally, Pharmacists can also

• Offer advice on things that can help you get better
• Suggest the best painkiller to take 
• Tell you if you need to see a GP about your symptoms

Sexual Health

• If you think your symptoms may be related to sexual contact, Central & North West London NHS Foundation Trust provide sexual health services in Surrey - you can refer yourself by booking an appointment online

• If you do not have any symptoms, you can order a home testing kit (for HIV, Syphilis, Hepatitis, Gonorrhoea and Chlamydia) 

• For more information on Sexual Health Surrey, please see the dedicated page - here

GP / 111

Routinely contact your GP or call 111 if 

• You have symptoms of a urinary tract infection (UTI) for the first time
• You're a man with symptoms of a UTI
• You're pregnant and have symptoms of a UTI
• You're caring for an older, frail person who may have symptoms of a UTI
• You have symptoms of a UTI after surgery
• Your symptoms get worse or do not improve within 2 days
• Your symptoms come back after treatment

Urgently contact your GP or call 111 if 

• Have a very high temperature / feel hot and shivery
• Have a low temperature below 36.0c
• You are confused or drowsy
• You have pain in the lower tummy or in the back, just under the ribs
• You can see blood in your pee

UTI symptoms (as per "Routine" above) AND ANY ONE:

• Pain in the mid/lower back or one/both sides (often tender to touch)
• Muscle aches (myalgia)
• Flu-like symptoms
• Nausea and/or vomiting

These symptoms could mean you have a kidney infection, which can be serious if it's not treated as it could cause sepsis. 

• Symptoms of Sepsis (click here for more information)

• Symptoms get worse rapidly or significantly

• Feeling very breathless and unable to speak in full sentences (dyspnoea)

• Coughing up more than small dots or streaks of blood, or coughing up blood frequently (haemoptysis)

• Lips and/or tongue turning blue (cyanosis)

• New or worsening confusion and/or agitation

• Abnormal use of neck or other accessory muscles (e.g., shoulders, chest) to aid breathing

• Feeling of exhaustion while suffering with shortness of breath or difficulty in breathing.

• Experiencing a persistent or spiking fever (above 38°C in most, 37.5°C in those with cancer or immunosuppression) that isn’t controlled with Paracetamol

• Experiencing chest pain, especially if it is sharp, worsens with breathing, or radiates to other areas

• Severe drowsiness, difficulty waking, or unresponsiveness

• Significant reduction in urine output, which could indicate dehydration or worsening systemic illness

If you experience any of these symptoms, go to the nearest Emergency Department as quickly and safely as possible. You may need to call 999 for an ambulance or consider alternative transport options, such as asking a friend or relative, or using a taxi or ride-sharing service.

Please note: Arriving by ambulance does not guarantee you will be seen sooner. All patients are assessed on arrival, and treatment is prioritized based on the urgency of their symptoms.

Symptoms of a Lower Urinary Tract Infection (UTI) may include:

• Pain or a burning sensation when peeing (dysuria)
• Needing to pee more often than usual (polyuria)
• Needing to pee more often than usual during the night (nocturia)
• Needing to pee suddenly or more urgently than usual
• Pee that looks cloudy (turbid)
• Blood in your urine (haematuria)
• Abdominal (tummy) pain
• A high temperature, or feeling hot and shivery

Your pee may also be dark or smell. If this is your only symptom, it might be because you've not been drinking enough water.

Older, frail people or people with a urinary catheter in place:

In older, frail people who have problems with memory, learning and concentration (such as dementia), and people with a urinary catheter, symptoms of a UTI may also include:

• Changes in behaviour, such as acting agitated or confused (delirium)
• New shivering or shaking (rigors)

Antibiotics

 When antibiotics are necessary to treat a UTI, the length of the treatment course can vary based on individual circumstances, including anatomy and pregnancy status:

For individuals with a shorter urethra (e.g., most cisgender women and some transgender men): A 3-day course of antibiotics is typically prescribed initially

For pregnant individuals: A 7-day course of antibiotics is usually recommended to ensure comprehensive treatment

For individuals with a longer urethra (e.g., most cisgender men and some transgender women): A 7-day course of antibiotics is usually required.

Cisgender Men / Males / Transgender Women

UTI in men is less common than in women, but incidence rates are higher in older men and those with risk factors  such as BPH; Urine outflow obstruction; Catheterised; Previous Urinary tract surgery; Immunosuppression.

You may be referred by your GP to the Urology team at your preferred NHS or Private hospital if your UTI symptoms do not resolve with initial treatment or where they have more than one UTI in a 6 month period; or your GP may advise a prostate examination and some blood tests.

Causes of UTIs

UTIs are usually caused by bacteria from poo entering the urinary tract.

The bacteria enter through the tube that carries pee out of the body (urethra).

Women have a shorter urethra than men. This means bacteria are more likely to reach the bladder or kidneys and cause an infection.

Things that increase the risk of bacteria getting into the bladder include:

• Having sex
• Pregnancy
• Conditions that block the urinary tract – such as kidney stones
• Conditions that make it difficult to fully empty the bladder – such as an enlarged prostate in men
• Urinary catheters (a tube in your bladder used to drain urine)
• Having a weakened immune system – for example, people with diabetes or people having chemotherapy
• Not drinking enough fluids
• Not keeping the genital area clean and dry

 DO's

• Wipe from front to back when you go to the toilet
• Keep the genital area clean and dry
• Drink plenty of fluids, particularly water – so that you regularly pee during the day and do not feel thirsty
• Wash the skin around the vagina with water before and after sex
• Pee as soon as possible after sex
• Promptly change nappies / incontinence pads if they're soiled

DON'Ts

• Do not use scented soap
• Do not hold your pee in if you feel the urge to go
• Do not rush when going for a pee – try to fully empty your bladder
• Do not wear tight synthetic underwear, such as nylon
• Do not drink lots of alcoholic drinks, as they may irritate your bladder
• Do not have lots of sugary food or drinks, as they may encourage bacteria to grow
• Do not use condoms or a diaphragm or cap with spermicidal lube on them (try non-spermicidal lube or a different type of contraception)

 Other ways to prevent some UTIs coming back

If you keep getting a bladder infection (cystitis), there's some evidence it may be helpful to take:

• D-mannose – a sugar you can buy as a powder or tablets to take every day
• Cranberry products – available as juice, tablets or capsules to take every day

Speak to your doctor before taking any of these during pregnancy.

Be aware that D-mannose and cranberry products can contain a lot of sugar.

If you're taking warfarin, you should avoid cranberry products.

• Take paracetamol up to 4 times a day to reduce pain and a high temperature

• Rest and drink enough fluids so you pass pale urine regularly during the day

• Avoid having sex

Some people take cystitis sachets or cranberry drinks and products every day to prevent UTIs from happening, which may help. But there's no evidence they help ease symptoms or treat a UTI if the infection has already started.

If you're taking warfarin, you should avoid cranberry products.

NHS UK - Urinary Tract Infections (UTIs)

https://www.nhs.uk/conditions/urinary-tract-infections-utis/

NHS UK - Urinary Catheters

https://www.nhs.uk/conditions/urinary-catheters/

NICE - Clinical Knowledge Summaries: Lower UTI in Women

https://cks.nice.org.uk/topics/urinary-tract-infection-lower-women/

NICE - Clinical Knowledge Summaries: Lower UTI in Men

https://cks.nice.org.uk/topics/urinary-tract-infection-lower-men/

Central and North West London - Surrey Sexual Health

https://www.sexualhealth.cnwl.nhs.uk/surrey-sexual-health-and-contraception/

NHS Medicines Guide: Paracetamol

https://www.nhs.uk/medicines/paracetamol-for-adults/