UTI/Urethritis/IC in teens/adults of both sexes
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In this article, we will cover the causes of cystitis, how it is diagnosed and treated, including home remedies, and how it can be prevented. Interstitial cystitis is a more serious, chronic type of cystitis. Find out more about it here. Cystitis usually occurs when the urethra and bladder, which are normally sterile , or microbe-free, become infected with bacteria.
Bacteria fasten to the lining of the bladder and cause the area to become irritated and inflamed. Cystitis affects people of both sexes and all ages. It is more common among females than males because women have shorter urethras. Around 80 percent of all urinary tract infections UTIs are caused by bacteria from the bowel that reach the urinary tract. Most of these bacteria form part of the healthy intestinal flora, but once they enter the sterile space in the urethra and bladder, they can cause a UTI.
Elderly individuals may feel weak and feverish but have none of the other symptoms mentioned above. They may also present with altered mental status. When children have cystitis, they may have any of the symptoms listed above, plus vomiting and general weakness.
Urinary tract infection
There are many possible causes of cystitis. Most are infectious, and the majority of these cases stem from an ascending infection. The bacteria enter from the external genitourinary structures. Risk factors include :. Women on hormone replacement therapy HRT have a lower risk of developing cystitis compared with menopausal women not on HRT.
However, HRT has its own set of risks, so it is not routinely used for the treatment of infectious cystitis in post-menopausal women. A doctor will ask the patient some questions, carry out an examination, and do a urine test. The urine test will either be sent to a laboratory, or the doctor may use a dipstick. Urine dipstick results come back quickly while the patient is still in the office. A urine culture or catheterized urine specimen may be performed to determine the type of bacteria in the urine.
After finding out which specific bacterium is causing the infection, the doctor will prescribe an oral antibiotic. Most doctors will also offer to test for a sexually transmitted infection STI. STIs often have similar symptoms to cystitis. This could include an ultrasound scan , an X-ray, or a cystoscopy of the bladder, using a fiber-optic camera. Most cases of mild cystitis will resolve itself within a few days. Any cystitis that lasts more than 4 days should be discussed with a doctor.
Doctors may prescribe a 3 day or 7 to 10 day course of antibiotics, depending on the patient. This should start to ease symptoms within a day. If symptoms do not improve after taking the antibiotics, the patient should return to the doctor. Antibiotics commonly used for bacterial cystitis are nitrofurantoin, trimethoprim-sulfamethoxazole, amoxicillin, cephalosporins, ciprofloxacin, and levofloxacin. In older people and those with weakened immune systems, due, for example, to diabetes , have a higher risk of the infection spreading to the kidney and other complications.
Most women are expected to have at least one incident of cystitis during their lives, and many will have more than one. Male cystitis is more likely to result from another underlying condition, such as a prostate infection, cancer , an obstruction, or an enlarged prostate.
Men who have sex with men are more likely to have cystitis than other men. In most cases of male cystitis, early treatment solves the problem effectively, but untreated male bladder infections can lead to kidney or prostate infections or damage. Article last updated by Adam Felman on Thu 30 November Visit our Urinary Tract Infection category page for the latest news on this subject, or sign up to our newsletter to receive the latest updates on Urinary Tract Infection.
All references are available in the References tab. Cystitis bladder infection. Cystitis: overview.
Cystitis - symptoms. Mayo Clinic Staff. Cystitis risk factors. Saint, S. Krein, S. Preventing hospital-acquired urinary tract infection in the United States: A national study. Clinical Infectious Diseases 46 2, Clustering was performed as previously described [ 23 ] and resulted in operational taxonomic units OTUs and a total of 4,, reads. Preparation of 16S rRNA gene amplicon libraries and sequencing of vaginal fluid samples was performed independent of urine samples, but both were processed simultaneously in the same bioinformatics pipeline. OTU data were rarefied to reads, and all subsequent analyses were performed on this dataset.
Rarefaction curves were obtained with the vegan package in the R environment. The mean relative abundance was calculated by adding all reads for each OTU and dividing them by the number of samples. For statistical tests, the Wilcoxon rank sum test was used for unpaired data and the paired Wilcoxon rank-sum test for paired data in R. Clustering of samples was performed based on the Euclidean distance using the Ward clustering method in R.
Spearman correlations between urine and vaginal fluid samples, corresponding p value calculations and Bonferroni correction were also performed in R. In the BV study group, A rarefaction analysis was performed and showed that most of the samples had or had almost reached saturation Additional file 3 : Figure S2. Because the sequencing depth was then between and 69, reads, the dataset was resampled to determine the error introduced by resampling.
Four samples with different sequencing depths reads; 17, reads; 43, reads and 69, reads were resampled 20 times Additional file 4 : Figure S3.
Because this study does not focus on rare OTUs, resampling this dataset once was sufficient. Comparing the urine microbiota of healthy women with that of women with acute BV showed a separation into two different clusters and an overlapping region where a subgroup of samples from healthy as well as symptomatic women were located Fig. Oral metronidazole treatment apparently did not shift the urine bacterial community. While the vaginal microbiota was massively changed by the antibiotic [ 23 ], the FUM could not be shifted to the healthy cluster by metronidazole treatment Additional file 5 : Figure S4.
Principle coordinate analyses of the urinary microbiota of healthy men and women a and women during acute BV, after metronidazole treatment, and in health b. The urine microbiota diversity was clearly different in the various treatment groups analysed here: Diversity was largest in healthy men, followed by healthy women, then by women with acute BV and was lowest in women after metronidazole treatment of BV Fig. Interestingly, the urine microbiota of healthy men, although nested in the healthy female microbiota cluster, had a higher Shannon diversity but lower alpha-diversity than that of women, indicating that less OTUs were present, but their abundance was more evenly distributed.
Diversity collapsed after metronidazole treatment, since only OTUs were identified and 6 OTUs were needed to cover half of the total abundance. These findings can be interpreted as the result of an increased relative abundance of BV-associated OTUs during BV which thereby diminished diversity.
After metronidazole treatment, growth of the metronidazole-resistant OTUs might have further reduced microbial diversity when BV-associated OTUs had already been eradicated Additional file 6 : Figure S5. Rank abundance and Shannon diversity of urinary microbiota. Mean and quartile range are shown. The urinary microbiota of healthy men and women and of women with BV clustered into eight different urotypes Table 2 Fig. Urotype UT 1 was comprised of four sub-clusters a through d and UT 3 of two sub-clusters a and b.
All clusters contained samples from men and women, in acute BV and after metronidazole treatment, with the exception of UT 2, which was only found in women both during BV and after metronidazole treatment , and UT 7 which was only found in healthy women. Individual urinary microbiota of healthy men and women and women during acute BV clustered according to urotypes.
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Urotypes UTs 1—8 with subtypes are indicated in the boxes above the relative abundance plot. UT 1a was characterized by high relative abundance of P. It showed two distinct sub-clusters, one that contained only samples of healthy men and women and one containing only samples of women with BV.
These two sub-clusters showed a marked difference in diversity, e. UT 1b was characterized by a high relative abundance of S. UT 1c was defined by a high relative abundance of G. UT 1d was defined by a high relative abundance of A. UT 1b, c and d were dominated in relative abundance by samples from women with BV, but a few samples from healthy men and women were also present.
UT 2 was mainly composed of L. UT 2 was only found in women, both with and without BV. This urotype could be sub-clustered into urotypes 3a and 3b according to the relative abundances of Sh. UTs 3a and 3b were further characterized by abundant Propionibacterium propionicus or Enterococcus faecalis.
All of those urotypes were mixed, i. UT 7 was dominated in relative abundance by L. Therefore, no consistent difference in urotypes was observed between healthy men and women and women with BV except for UT 7, which was comprised of samples from healthy women only as was previously observed. Strong shifts of microbiota composition were observed in almost every woman after metronidazole treatment Fig. However, in spite of these shifts in individual microbial profiles, women with acute BV could not be separated from those after metronidazole treatment in a PCO Fig.
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Clustering of microbiota composition revealed that certain urotypes persisted after metronidazole treatment, such as UTs 1, 2 and 3, and an additional urotype was identified Fig. It was nested within UT 8 before metronidazole treatment. Sequencing depth and DNA concentration after extraction of those samples with high Chitinophagaceae abundance were analysed due to the risk of it being a contaminant [ 29 ].
Read numbers were below average but not at the bottom median of reads compared to 17, reads after abundance filter and above average for the DNA yield median of 9. In UT 1, no significant difference was found regarding P. In UT 2, the urotype that is mainly composed of L. Here, too, the relative abundance of G. Thus, metronidazole treatment resulted in a decrease of G. Since the midstream urine samples analysed here can be expected to contain vaginal fluid microbiota to a certain extent, we compared urine samples before and after metronidazole treatment with vaginal fluid samples of the same patients and at the same time points.
The remaining samples were grouped according to source urine or vaginal fluid , but not according to BV status acute BV or after metronidazole treatment. The urinary microbiota during acute BV and after metronidazole treatment. Samples from the same women are connected by a black line. Urotypes are indicated. In all other urotypes, none or just a few vaginal fluid samples correlated with the respective urine sample. After treatment, two of the six patients in UT 1 and one in UT 2 showed a correlation between vaginal fluid and urine microbiota, but none of the urine samples from other urotypes correlated with vaginal fluid microbiota composition.
These data show that vaginal fluid and urine are most similar when the communities are dominated in relative abundance by bacteria like P. However, most urine microbiota were not correlated with their vaginal fluid counterpart, suggesting that different microbiota are located in bladder and urethra compared to the vagina.
We then analysed the mean relative abundance of OTUs in urine and vaginal fluid samples in BV before and after treatment with metronidazole and compared it to the healthy FUM. This finding is in accordance with the high correlation between urine and vaginal fluid microbiota in BV before antibiotic treatment for those patients whose urinary microbiota belongs to UT 1 Table 3.
All of those OTUs were strongly reduced by metronidazole treatment in both types of samples. OTUs that were abundant in vaginal fluid samples, but not in urine, were S. Interestingly, one of the most striking results following metronidazole treatment was an increase in the mean relative abundance of L. By contrast, L. Comparison between urine and vaginal fluid microbiota in acute BV and after metronidazole treatment. Met metronidazole. OTUs that were abundant in urine, but not in vaginal fluid, were Chitiniphagaceae , E.
With the exception of Chitinophagaceae , they were found both in BV and in health. Metronidazole treatment had little influence on their mean relative abundance. Thus, with the notable exception of BV-associated bacteria, most OTUs showed a complementary mean relative abundance pattern, i. Metronidazole treatment did not affect those OTUs that were abundant only in urine. The aim of our study was to characterize the urinary microbiota of healthy men and women and compare it to the urinary microbiota during acute BV and after antibiotic treatment in order to better understand the role of bacteria in urine for BV and its etiology.
Therefore, we additionally compared microbiota in urine samples to those in vaginal fluid samples of the same women before and after metronidazole treatment of BV. We identified nine urotypes. Interestingly, all but two were shared between men and women and were present in both BV and health. Two urotypes were found in women only. UT 7, dominated in relative abundance by L. Unexpectedly, no urotype characteristic of the male urinary microbiota was found.
A very strong correlation between the microbiota in the vagina and male urethra and penile skin has been demonstrated for sexual partners if the woman suffered from BV [ 20 ]. In our study, male and female participants were not related. Yet, the male urine microbiota were nested inside the female microbiota and dispersed among seven of the nine urotypes found here.
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The term urotype was first introduced in in a study by Pearce et al. However, our data had a higher taxonomic resolution and we were therefore able to identify the responsible species and find additional UTs, such as L. We could not identify an UT characterized by Staphylococcus, but found additional UTs that had not been detected previously. They were characterized by P. Our data showed that the female urinary microbiota differed in health and BV, but these changes were complex.
All UTs were present in health as well as in BV.
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Shannon diversity decreased in BV, in contrast to the vaginal microbiota where the diversity is strongly increased in BV [ 23 , 30 , 31 , 32 , 33 ]. Alpha-diversity was unchanged in urine of healthy women and those with BV, indicating that the shift in Shannon diversity was caused by a shift of abundance. This was found although the different UTs varied strongly in diversity and a high inter-individual variability was present, as found before [ 2 ].
The changes of the urinary microbiota of women with BV after metronidazole treatment were not unidirectional, i. The largest differences before and after metronidazole treatment on a cumulative level were observed for Lactobacillus species. In contrast, L. These findings are in accordance with those on the vaginal microbiota, where L. Interestingly, the importance of Lactobacillus sp. This inconsistency may have been caused by the lack of species-level resolution. In the vaginal microbiota, L. Oral metronidazole treatment affected the UTs present in BV in different ways. These genera have all been detected in the FUM of women who did not suffer from an infection; the urine samples had been obtained using a transurethral catheter, i.
These finding suggest that the urethra and bladder might act as a reservoir for BV-associated bacteria.
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These taxa have not been detected in the above mentioned studies and thus may have originated from the vagina, where they are commonly found during BV [ 33 ]. In UT 2 patients, G. This species was one of the first to be detected in transurethral catheter urine samples [ 6 ]. In UT 3, G. Lactobacillus species are a major part of the FUM [ 2 ] as well as of the vaginal microbiota [ 36 , 37 ], and it remains to be clarified if they reside in the urethra and bladder and contribute to recurrence.
Some of the OTUs found here are also known from other body sites, e. Even though they were present, they did not play a major role in this analysis due to their low abundance. The increase in mean relative abundance of L. However, L. Detailed analyses of samples obtained directly from the bladder and urethra of healthy men and women are required to clarify whether L.
Currently, it is hypothesized that pathogens residing in the vagina can colonize the urethra and thus cause urinary tract infections [ 38 ]; given the presence of BV-related bacteria in the urethra and bladder of healthy women and in the urethra of healthy men, the converse route could also be possible and should be investigated in the future. Moreover, certain urinary tract microbiota might have a protective role [ 8 ] thereby preventing bacterial vaginosis or its recurrence.
Oral application of metronidazole for treatment of BV results in systemic absorption, while localized vaginal application at high doses shows the same treatment success but only little systemic absorption [ 39 ]. Therefore, the impact of localized metronidazole application on the urinary microbiota should be minimal. Analysing the effect of oral vs. This study indicates that the male urine microbiota formed a subgroup of the female urinary microbiota rather than a separate cluster, suggesting that it was not strongly influenced by the distal regions of the urogenital tract.
Oral application of metronidazole in women with BV caused massive changes in urine microbiota composition, but it did not restore a healthy community. While some pathogens were eradicated, others even increased in relative abundance, suggesting strongly different susceptibility to the antibiotic. The data suggest that the urinary tract harbors distinct microbiota that may contribute to BV recurrence but might also serve a protective role.
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J Infect Dis. Bacterial vaginosis biofilms: challenges to current therapies and emerging solutions. Front Microbiol. Bacterial communities in penile skin, male urethra, and vaginas of heterosexual couples with and without bacterial vaginosis. Verstraelen H, Swidsinski A. The biofilm in bacterial vaginosis: implications for epidemiology, diagnosis and treatment. Curr Opin Infect Dis.