As I perused the latest edition of Georgetown’s leading publication — the Stall Seat Journal — I was pleased to see a brief paragraph describing urinary tract infections (UTIs), part of a larger piece about sexually transmitted infections (STIs). Nearly 25% of college students have an STI, so I was glad my peers could use this article to learn about STIs from the comfort of the porcelain throne. Unfortunately, it is slightly misleading to describe UTIs in an article titled “STIs Questions Answered,” as UTIs are not transmitted through sex. Although I still believe the Stall Seat Journal to be a pillar of campus journalism, I hope that uncovering the science of UTIs will help my fellow Hoyas better understand this common health issue.
While STIs involve the transmission of a pathogen — often bacteria or viruses — from an infected person to an uninfected person through sexual activity, UTIs are not contagious. Anybody can get a UTI, whether or not they are sexually active: dehydration, diabetes and hormonal changes are also common risk factors. However, this distinction can be confusing, as sexual activity is one of several ways an individual can increase their risk of developing a UTI. That’s because penetrative sex can push bacteria from the vaginal or fecal microbiome into the urethra, the tube through which we expel urine.
Strikingly, UTIs are 30 times more common in women than men, since women’s urethral opening is physically closer to these vaginal and fecal reservoirs of opportunistic pathogens. Once bacteria enter the urethra, they can ascend the urinary tract toward the bladder using their flagella, a tail-like structure used to swim upstream. This process relies on pili and adhesins, specialized bacterial proteins that help them stick to cells lining the urethra.
Escherichia coli, or E. coli, is the most common UTI pathogen, but many other bacterial species can infect the urinary tract. Thus, when you seek treatment for UTI symptoms — the most common being urgent or frequent urination that may burn or produce cloudy urine — your doctor will likely analyze your urine sample to determine the identity of the responsible species. This identification step allows healthcare providers to prescribe an antibiotic specifically targeting that bacteria.
Typically, a short course of antibiotics will take care of a UTI, but bacteria can also adopt strategies to sneakily evade treatment. Sometimes, they shield themselves against antibiotics by forming biofilms, dense, surface-attached communities that excrete a protective extracellular matrix. They can also evolve genetic mutations that confer outright resistance to antibiotics, rendering key drugs dangerously ineffective.
UTIs are one of the most common infectious diseases on Earth, yet, like many health conditions that predominantly affect women, they remain relatively understudied in the scientific community. They’re especially prevalent among college-aged individuals, with at least a third of women under 26 experiencing a UTI. Additionally, it’s typical for women to experience these infections repeatedly, with women aged 18-24 experiencing between one and five infections per year, on average.
For women who struggle with recurrent UTIs, seeking medical help can be an incredibly frustrating experience. Frequently, healthcare professionals dismiss their symptoms and may flippantly instruct them to simply wipe front-to-back or pee after sex. This framing of UTIs as purely a personal hygiene issue is not only patronizing but unproven by scientific research. Indeed, the well-worn proverb about peeing after sex lacks clinical evidence, highlighting the need for more research about effective ways to prevent UTIs.
Another popular belief about UTIs is that drinking cranberry juice will stave off bacteria. However, controlled studies of cranberry juice and cranberry-based products have failed to produce consistent support for this claim. Nonetheless, these products have flooded the market, capitalizing on the desperation of individuals dealing with chronic UTIs.
The medical community is also eager for an alternative to antibiotics as the be-all end-all solution for UTIs. Though doctors may prescribe a long, prophylactic course of antibiotics in extreme cases of chronic infection, continuous use of antimicrobial agents can exacerbate the risk of developing an antibiotic-resistant infection. Promisingly, new studies about hormone therapies for UTIs among postmenopausal women and probiotics for individuals with recurrent UTIs have shown that antibiotics aren’t the only answer.
Filling the gaps in our knowledge of UTI prevention and treatment could be life-changing for some of the 400 million people who contract UTIs annually. In the meantime, addressing UTIs starts with reminding people, especially college students, that UTIs are neither a sign of uncleanliness nor a shameful consequence of sexual activity. I hope someday we can all talk more openly about UTIs, but in the meantime, I’m glad Hoyas can get a daily reminder about this common condition every time they glance up from their Stall Seat.
