Urinary tract infections (UTIs) are among the most common infections affecting adult women. One-half of all women will experience at least one UTI in their lifetime. Recurrence of UTIs is common, with a reported rate of 25% within 6 months of the first occurrence.

UTIs are the collective term used to describe infections involving any part of the urinary tract, which includes the kidneys, ureters, bladder and urethra. Infections of the bladder (cystitis) and urethra (urethritis) are known as lower UTIs and infections of the kidneys (pyelonephritis) or ureters are classed as upper UTIs.

Diagnosis of UTI is based primarily on signs and symptoms.

The incidence of UTIs in adult males under age 50 years is low.

Up to 40% of women develop a UTI at some point in their life, compared to 12% in men. In men, cystitis is often associated with infection and inflammation of the prostate gland (prostatitis). Anatomically, the female urethra is shorter and located closer to the anus than in males, which makes it easier for bacteria to reach the female urethra and bladder.

Adult women are 30 times more likely than men to develop a UTI, with almost half of them experiencing at least one episode during their lifetime and one-in-three women experiencing their first episode by the age of 24 years. UTIs are most commonly seen in sexually-active young women.

UTIs can be classified as ‘uncomplicated’ (sometimes referred to as a ‘simple’ UTI) or ‘complicated.’ Uncomplicated infections present most frequently in women without any structural or functional abnormality of the urinary tract, any history of renal disease, or other comorbidity (e.g. immunocompromised patients or those with diabetes), which may contribute to more serious outcomes. Complicated UTIs are associated with a condition or underlying disease that interferes with the patient’s immune mechanisms and increases the risk of acquiring infection.

Recurrent UTIs, defined as at least two UTIs in 6 months or three UTIs in 1 year, are a significant burden for the patient and result in high costs to the health system. The most commonly prescribed regimens are trimethoprimsulfamethoxazole (or trimethoprim alone), nitrofurantoin, cephalexin and the fluoroquinolones at a quarter of the usual daily dose for 6 months.

Symptoms may include:

• Pain or a burning sensation when passing urine

• Needing to urinate more often during the night

• Urine that looks cloudy

• Needing to urinate more urgently than usual

• Blood in the urine

Children with UTIs may also:

• Have a high temperature

• Appear generally unwell

• Wet the bed or themselves

• Be sick

When to Refer:

• Someone who has symptoms of a UTI for the first time

• A child has symptoms of a UTI

• A man with symptoms of a UTI

• Pregnant women with symptoms of a UTI

• Symptoms of a UTI after surgery

• Symptoms get worse or do not improve within 2 days

Those suffering with UTIs can be advised to take paracetamol up to four times a day to help reduce pain and a temperature. Children can take liquid paracetamol. They should also be advised to rest and drink fluids so that they can pass urine more regularly during the day.

It may also help for sufferers to avoid sexual intercourse until symptoms have passed.

Cranberry juice and capsules

Drinking cranberry juice may help to prevent UTIs. For those with recurring UTIs, higher strength cranberry capsules are recommended.

However, advise customers that they should not consume cranberry juice or cranberry capsules if they are taking warfarin.

Treat constipation promptly

Constipation (where it is difficult to pass stools) can increase the chances of developing a UTI.

Recommended treatments for constipation include:

• increasing the amount of fibre in the diet (20g to 30g of fibre a day)

• using a mild laxative on a short-term basis

• drinking plenty of fluids

Vaginal Dryness

Normally, the walls of the vagina stay lubricated with a thin layer of clear fluid. The hormone estrogen helps maintain that fluid and keeps the lining of your vagina healthy, thick, and elastic. A drop in estrogen levels reduces the amount of moisture available and can lead to vaginal dryness.

It is a common but treatable problem that many women experience at some point in their lives. It can be a problem at any age, but is a particular issue for women who are going through or have experienced the menopause. Sufferers will often feel embarrassed about seeking help but can be advised that there are a number of treatments that can help.

Symptoms

Some women only have symptoms of vaginal dryness at certain times, such as during sex, while others have them all the time.

Problems associated with having a dry vagina include:

• vaginal irritation, discomfort, itchiness or a burning sensation

• discomfort during sex

• a reduced sex drive

• difficulty getting aroused and reaching orgasm

• the surface of the vagina looks pale and thin

• narrowing or shortening of the vagina

• needing to pass urine more often than usual

• repeated urinary tract infections (UTIs)

Causes

Causes of a dry vagina include:

• the menopause – decreased levels of the hormone oestrogen during the menopause can cause persistent vaginal dryness (also known as vaginal atrophy or atrophic vaginitis)

• breastfeeding or childbirth oestrogen levels can temporarily decrease after giving birth and make the vagina feel drier than usual

• not being aroused before sex – if a woman doesn’t feel aroused before having sex, her vagina may not produce natural lubricant and sex may be uncomfortable

• some types of contraception the combined contraceptive pill and contraceptive injection can occasionally cause vaginal dryness, although this is uncommon

• cancer treatment radiotherapy to the pelvic area, hormonal cancer treatments, and sometimes chemotherapy can cause vaginal dryness

Vaginal dryness is also sometimes caused by an underlying condition such as diabetes or Sjögren’s syndrome, where the immune attacks the glands in the body that produce fluid.

Self-help

Sufferers of vaginal dryness can be advised that it’s worth trying self-help options first. It can help to:

• try using a lubricant or vaginal moisturiser – these can be bought without a prescription

• give yourself enough time to become aroused before having sex – read more about female arousal and get good sex tips

Treatments

The most common treatment for vaginal dryness due to low oestrogen levels is topical oestrogen therapy. These replace some of the hormone the body is no longer making. That helps relieve vaginal symptoms, but it doesn’t put as much oestrogen in the bloodstream as the hormone therapy in pills.

Lubricants – liquids or gels that are applied to the vulva, vagina or the partner’s penis just before having sex to keep the vagina moist. They offer immediate but short-term relief from vaginal dryness. Several different brands of lubricant are available to buy from pharmacies without a prescription.

Vaginal moisturisers – creams that are applied inside the vagina to keep it moist. They may be better than lubricants if the dryness isn’t just causing problems during sex, as they tend to have a longerlasting effect. They usually need to be applied every few days.

Vaginal oestrogen – a GP may prescribe vaginal oestrogen if the dryness is caused by the menopause. This works by increasing the level of oestrogen that declines during and after the menopause.

Vaginal oestrogen is available as pills that are placed in the vagina (pessaries), vaginal creams and vaginal rings. Oestrogen treatment can be more effective than lubricants and moisturisers for menopausal women, and it generally causes few side effects. However, it can take a few weeks to start working, so the patient may want to use a lubricant or moisturiser as well to begin with. Treatment usually needs to be continued indefinitely, as the dryness tends to return if treatment stops.

Hormone replacement therapy – HRT is a treatment that involves taking medication to replace the hormones that start to decline during the menopause.

It’s available on prescription from a GP either as tablets, a skin patch, an implant under the skin, or a gel that’s applied to the skin.

HRT has a wider effect on the body than vaginal oestrogen, so may be best if the person has other menopause symptoms, such as hot flushes. However, it also has more side effects.