Urinary tract infections (UTI) are common bacterial infections that affect different parts of the urinary system. It is important to understand the differences between the types of infections, their risk factors, and available treatments to help manage your health effectively.

What is the difference between a UTI, cystitis, and pyelonephritis?

The term "urinary tract infection" is a general term for an infection that occurs anywhere in the urinary system (cystitis) or kidneys (pyelonephritis).

Cystitis

This refers specifically to an infection in the bladder. Symptoms may include burning with urination, frequent urination, urgency, and pelvic discomfort. Fever, nausea or vomiting, and generalized malaise are uncommon with simple cystitis.

Pyelonephritis

A more serious infection that involves the kidneys. Symptoms may include fever, chills, back pain, nausea, and vomiting in addition to urinary symptoms.

How is a UTI diagnosed?

While symptoms such as burning during urination, urgency, and frequency may suggest a UTI, urine cultures are essential for confirming the diagnosis. A urine culture helps identify the specific bacteria causing the infection, which guides appropriate antibiotic treatment. Diagnosing a UTI based solely on symptoms can lead to overuse of antibiotics or missed alternative diagnoses.

Who is at risk for a UTI?

Certain groups of people are at higher risk of contracting a UTI. Those groups include:

  • Post-menopausal women—due to decreased estrogen levels, the vaginal and urethral tissues become thinner and more vulnerable to infection.
  • Sexually active women—UTI are more common after sexual activity, particularly with frequent intercourse or the use of diaphragms and spermicides.
  • Older adults—older women are prone to asymptomatic bacteriuria (bacteria in the urine without symptoms), which typically does not require treatment. In older men, an enlarged prostate can prevent the bladder from emptying fully, increasing the risk of infection.
  • Pregnant persons—hormonal and anatomical changes during pregnancy increase UTI risk.
  • Those with chronic conditions—diabetes and urinary tract stones can also raise the likelihood of developing a UTI.

Some people believe that poor hygiene is the main cause of a UTI. However, this is not true. In fact, aggressive vaginal washing or the use of strong soaps can disrupt the natural balance and increase infection risk.

UTI in men

Although less common, UTI in men may be linked to an enlarged prostate, bladder stones, or other conditions that impair bladder emptying. Men with recurrent UTIs often require evaluation by a urologist to identify underlying causes.

Recurrent UTI and when to see a urologist

Recurrent UTI is a diagnosis made when a patient experiences more than three culture-proven UTIs in one year or two in six months. Patients diagnosed with recurrent UTI may require further investigation if all risk-factors have been controlled. Your doctor may recommend:

  • Imaging tests such as ultrasound or CT scan to check for structural issues in the urinary tract.
  • Cystoscopy to examine the bladder lining for abnormalities.

The role of vaginal estrogen

For postmenopausal women with recurrent UTI, vaginal estrogen therapy (in the form of creams, rings or tablets) can help restore the vaginal tissue's natural defenses, reducing infection risk by up to 50 percent. Oral estrogen therapy is not effective for this purpose.

Over-the-counter supplements for UTI prevention

Some over-the-counter supplements may help reduce the risk of recurrent UTI. Cranberry supplements have been shown to lower UTI risk by preventing bacteria from adhering to the bladder wall. D-mannose may also help in certain cases. Other commonly marketed products, such as probiotics and vitamin C, have not consistently been proven effective for UTI prevention. Always consult your primary care provider or urologist before starting any supplement regimen.

When to seek medical care

If you develop symptoms of a UTI, such as burning during urination, frequent urges to urinate, or pelvic discomfort, consult your primary care provider or urgent care provider. Prompt treatment can prevent complications such as kidney infections. If you develop recurrent UTI, you may need a referral to a urologist for further workup.

By understanding UTI and taking proactive steps, you can reduce your risk and improve your urinary tract health. If you have ongoing concerns or recurrent infections, don't hesitate to seek expert care.

Meredith Wasserman, MD

Meredith C. Wasserman, MD

Dr. Meredith Wasserman is a urologist at the Minimally Invasive Urology Institute at The Miriam Hospital. She holds joint appointments as assistant professor of surgery (urology) and assistant professor of obstetrics and gynecology at Brown University.