Acute bacterial cystitis affects 8-10 million Americans each year. Occurring in otherwise healthy individuals with no neurological or structural abnormalities, acute, symptomatic, uncomplicated urinary tract infection (UTI) may be the most common infection after the common cold and flu.
An acute UTI will be experienced by 25 to 40% of females in their lives, and up to 6% of women will have one or more UTIs in a given year. When promptly treated, the period of discomfort can be shortened and the potential for more serious damage and recurrence is reduced. The risk of acquiring an acute infection is more than 3-fold among women with a previous infection compared to women with no history of UTI.
The largest risk factor for acquiring and developing an acute UTI is being female. This is because the short female urethra provides greater access to the bladder, and the nearby vagina provides a favorable environment for bacterial colonization and growth.
E. coli is responsible for more than 80% of all acute female bladder infections. However, S. saprophyticus is more often isolated from women using spermicide-coated condoms (74%) and diaphragms than is E. coli. Other bacteria such as Proteus, Klebsiella or Enterobacter are occasionally isolated from uncomplicated UTIs. Vaginitis and urethritis caused by sexually transmitted pathogens such as herpes simplex, chlamydia or gonorrhea may mimic cystitis.
Cystitis in Men
Cystitis is a common occurrence in women, but it is less common and a potentially more serious condition for men. For men the cause can be an underlying bladder or prostate infection, an obstruction or tumor, or an enlarged prostate. It's not serious if treated promptly, but the discomfort can be chronic and disabling. Untreated bladder infections can cause kidney or prostate infections and damage.
Natural Defense Mechanisms
The greatest defense mechanism against bacterial inflammation and adherence to the bladder or urethral lining is urine: invading bacteria stimulate urination. Voiding washes out bacteria from the bladder and urethra and dilutes bacterial concentrations, preventing adherence. The surface cells of the bladder are coated with a special urinary mucus. This thin negatively-charged surface layer attracts water molecules and forms a barrier between the bladder and urine, preventing bacterial adherence. White blood cells will also move into the bladder and urine to kill the invading bacteria. The kidneys produce a protein which contains mannose residues that block the attachment points of some types of E. coli. This prevents their attachment to the bladder and encourages their excretion.
Sex and Cystitis
Once referred to as "honeymoon-cystitis", many women acquire their first infection after their first sexual experience. A study has shown that, compared to women who have not been sexually active during the previous week, the relative risk of a UTI among unmarried women increases 2.6 times for women who have engaged in sexual intercourse 3 times per week, and 9.0 times for women who have had intercourse seven times during the previous week. New sex partners and intercourse methods introduce bacteria into the vagina and urethral area. If bacteria are not removed by voiding or cleaning, they will colonize in this area, posing a risk of infection.
Barrier methods of birth control can also increase the risk of acquiring a UTI. Condoms increase the risk of vaginal tears, allowing bacteria to invade and adhere. Contraceptive sponges, foams, creams, gels and condoms use nonoxynol-9 (N-9) as a spermicide. Lactobacilli, the normal flora of the vagina, provide protection from external bacteria overgrowth, but are eradicated by N-9. The removal of lactobacilli by N-9 or other antibiotics alters the vaginal pH and natural flora, allowing Escherichia coli (E. coli) and Staphylococcus saprophyticus to proliferate, colonize and adhere to the vaginal mucosa. The odds that a woman exposed to condoms coated with N-9 would get a UTI were found to be 3 times higher than for sexually active women who did not use coated condoms. Diaphragms that are worn for more than 24 hours or improperly fitted can harbor bacteria or irritate tissue. A cervical cap, however, may not be associated with an increased UTI risk; less spermicide is used inside the enclosed cap, causing less alteration of the vaginal flora. Using extra lubricant during sex to decrease friction and irritation can help prevent the development of an infection.
Treatment is usually recommended because if the infection progresses and spreads to the kidneys it is then classified as a complicated infection. Signs and symptoms of a complicated infection include nausea, vomiting, flank pain, fever and chills. Treatment may require hospitalization and longer, more expensive antibiotic treatment.
In the past, the treatment of acute female cystitis with an antibiotic for 7-14 days was the standard procedure. Although very effective, the associated adverse events, poor compliance and unnecessary costs necessitated a re-evaluation. Single-dose therapy is generally less effective than the same antimicrobial used for 7-14 days, but most antimicrobials given for three days are as effective as the same antimicrobial given for 7-14 days.
As a man, if you experience the symptoms of cystitis, you should see your doctor immediately. An analysis and culture/sensitivity of your urine will be performed which should identify the kind of bacteria causing the infection and the antibiotic most likely to help.