Because the decrease in estrogen associated with menopause makes the vagina more alkaline, Smith prescribes vaginal estrogen to restore the formerly-acidic environment that's inhospitable to disease-causing bacteria.
Most UTI patients have experimented with self-help remedies, downing pitchers of cranberry juice or cranberry extract pills, although the largest and best-designed studies to date show cranberry doesn't help much.
Tired of spending months on continuous low-dose antibiotics as a preventive, chronic UTI sufferers increasingly try complementary and alternative approaches, such as acupuncture and probiotics, which have been shown in doctors' practices and some clinical trials to make them feel better.
Ultimately, vaccines may be the best way to reduce the incidence of UTIs, but in the meantime, researchers are studying UTIs from many angles. The biggest strides in UTI research have come in understanding the microbiology and genetics of the disease-causing bacteria; the biology and responses of the tissues they infect; and the response of the immune system to the bacterial invasion.
Scientists are trying to use that information to defeat those marauding microbes before they get the upper hand. They're devising ways of boosting the immune system so that if nasty bacteria reach the urinary tract, the immune system can defeat them. They're also designing vaccines to interfere with bacteria's ability to attach to urinary tract cells.
To appreciate the enormity of UTI infections, which have drawn attention and research funding from the National Institute of Digestive and Diabetes and Kidney Diseases, and the Office of Women's Health Research, it helps to understand the basic anatomy that makes women particularly vulnerable.
UTIs comprise infections of the urethra, the opening where urine leaves the body; the bladder, which holds urine; and the kidneys, which filter liquid wastes from the body.
Women's urethras are closer to the rectum than men's urethras, so they're more readily exposed to bacteria. Their urethras also are shorter than men's, so bacteria don't have to travel as far to enter the urinary tract. Other factors that contribute to women's susceptibility include use of contraceptives like diaphragms and spermicides containing nonoxynol-9, which eliminate normal protective vaginal bacteria.
The basic tools for diagnosing UTIs remain tests for blood, pus or bacteria in the urine, and urine cultures, which typically take 48 hours, to identify which bacteria are present and determine the medications to which they remain susceptible. Infections of the bladder and kidneys can be diagnosed with ultrasound, CT images or pyelograms that use dye to make certain features more readily visible.
Most laboratory-confirmed UTIs are treated with antibiotics and antimicrobials. Before urine culture results become available, symptomatic patients receive initial treatment based upon their doctors' best guesses about which bacteria are making them ill.
Doctors typically follow treatment guidelines that quickly become obsolete as bacterial resistance evolves, contends Dr. Anthony J. Schaeffer, chairman of urology at Northwestern University Feinberg School of Medicine in Chicago. He's using a tool called data-mining to improve the way doctors select the drugs for patients with UTIs.