Urinary tract infections (UTIs) in pregnancy - symptoms, causes
Urinary tract infections (UTIs) in pregnancy - symptoms, causes | Pregnancy Birth and Baby beginning of content
What is a urinary tract infection?
A urinary tract infection (UTI) is an infection of the urinary system. UTIs are the most common bacterial infection that women develop during pregnancy. They can occur in different parts of the urinary tract, including the bladder (cystitis), urethra (urethritis) or kidneys (pyelonephritis). Sometimes when a UTI develops and bacteria are detected in the urinary tract, you may not have any symptoms of an infection. This is known as asymptomatic bacteriuria.
While anyone can get a UTI, they are much more common in women than men and they are also more likely to occur in the very young and the elderly.
What are the symptoms of UTIs during pregnancy?
Common symptoms of a UTI during pregnancy are similar to those that you might experience at any other time, and include:
a burning sensation when you pass urine
feeling the urge to urinate more often than usual
urinating before you reach the toilet (‘leaking’ or incontinence)
feeling like your bladder is full, even after you have urinated
urine that looks cloudy, bloody or is very smelly
pain above the pubic bone
Sometimes the first sign of an infection is a faint prickly sensation when you pass urine. If the infection is more advanced and has moved up to the kidneys, you may also experience fever with a particularly high temperature, back pain and vomiting.
What are the common causes of UTIs?
Your urinary tract is normally free of bacteria. If bacteria enter the tract and multiply, they can cause a UTI. There are several factors that increase the risk of developing an infection:
Infection with common bacteria in your gut, usually from faeces (poo) can contaminate your urinary tract
Being sexually active increases the risk of bacteria moving around the genital area and entering the urinary tract
If you have weak pelvic floor muscles your bladder might not empty completely, which can lead to an infection
Women with diabetes are at increased risk of developing a UTI since the sugar in their urine may cause bacteria to multiply
Are UTIs a risk during pregnancy?
During pregnancy, many changes occur in your body that increase your risk of developing a UTI, including changes to the make-up of your urine and immune system. As your baby grows, there is also an increase in the pressure on your bladder, which can reduce the flow of your urine and lead to an infection.
UTIs can affect women whether they are pregnant or not. However, pregnant women are more likely to develop repeated or more severe infections. Up to 1 in 10 pregnant women will have a UTI but not have any symptoms at all.
Is there a risk to my baby?
Having a UTI during pregnancy can increase your risk of developing high blood pressure, and your baby may be born early and smaller than usual. For this reason, even if you don’t have any symptoms, it is important to treat a UTI as soon as possible.
How are UTIs diagnosed?
UTIs are diagnosed by taking a urine sample which is checked in a laboratory for bacteria. Your doctor may also perform a physical examination if they think you have an infection.
All pregnant women are offered a urine test, usually at their first antenatal visit or soon after. You may need to repeat the urine test if you have a history of UTIs; have symptoms of a UTI; have a contaminated sample or if your doctor thinks you are at high risk of developing a UTI. If you have frequent UTIs, you may also need additional tests such as an ultrasound of your kidneys.
How are UTIs treated during pregnancy?
When you have a UTI, it is important to drink plenty of water to flush out the urinary tract. UTIs are treated with antibiotics that are safe in pregnancy. Your doctor will select the right antibiotic, based on your infection and the type of bacteria found in your urine sample.
Can I prevent UTIs?
You can lower your risk of developing a UTI during pregnancy by:
drinking plenty of fluids, especially water
quickly treating any vaginal infection that may occur, including thrush or a sexually transmitted infection
avoiding becoming constipated
Some women have also found the following tips helpful:
urinate immediately after sex
don’t delay going to the toilet — go as soon as you feel the need
wipe from the front to the back after going to the toilet
wear cotton underwear
When should I see my doctor?
See your midwife or doctor if you have any symptoms of a UTI. It’s important not to delay treatment since infections develop quickly, and can affect both you and your baby.
UTIs are very common during pregnancy, and are best treated early. If you notice the symptoms of an infection, seek medical advice from your doctor, midwife or pharmacist.
For more information on UTIs, visit the Kidney Health Australia page on UTIs.
Government of South Australia (Urinary Tract Infection in Pregnancy), Jean Hailes (Urinary Tract Infections), Kidney Health Australia (Factsheet: Urinary Tract Infections), Government of Western Australia North Metropolitan Health Service (Urinary Tract Infection in Pregnant Women)
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Last reviewed: August 2021
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Incontinence during pregnancy
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UTIs During Pregnancy: Symptoms, Treatment, Common Questions
Urinary tract infections (UTIs), also known as bladder infections, are the most common type of bacterial infection diagnosed today, according to research published in the American Journal of Medicine. Roughly 31 percent of pregnant women will have either a symptomatic or an asymptomatic (without symptoms) UTI during pregnancy, research suggests. UTIs occur when bacteria enters into the usually sterile urinary tract and multiplies, causing painful urination and other symptoms. Certain factors during pregnancy make this occurrence more likely to happen. Here’s what you need to know to keep you and your baby healthy.
RELATED: 8 Home Remedies for Urinary Tract Infection (UTI) Symptoms
Why Are UTIs Common in Pregnant Women?
When you’re pregnant, the anatomy of your urinary tract actually changes. For instance, your kidneys become larger and your growing uterus can compress your ureters and bladder. Because of this compression, fully emptying your bladder during pregnancy becomes more difficult. In addition, your progesterone and estrogen levels increase during pregnancy, which can weaken your bladder and ureters. Pregnancy also alters the makeup of your urine, reducing the acidity and increasing the amount of protein, hormones, and sugar in your urine. That excess sugar, for one, can encourage bacterial growth. All of the above contribute to a heightened chance of developing a UTI in pregnancy. And that is why it’s recommended that all pregnant women receive a urinalysis and urine culture at 12 to 16 weeks or during the first prenatal visit.
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UTIs by Pregnancy Trimester
Your risk of UTI goes up beginning at week 6 of your pregnancy; the chances you’ll have a UTI vary by trimester.
About 41 percent of UTIs are diagnosed during the first trimester. Because getting a UTI during the first trimester is so common, the U.S. Preventive Services Task Force recommends that your healthcare provider obtain a urinalysis and urine culture at your first prenatal visit. That recommendation holds whether you present with UTI symptoms or not.
According to the Centers for Disease Control and Prevention, about half as many pregnant women are diagnosed with a UTI during their second trimester compared with the first trimester.
Compared with the second trimester, the number of women who experience a UTI during the third trimester is almost halved. However, 80 to 90 percent of acute kidney infections in pregnancy (many caused by the progression of an untreated UTI) occur in the second and third trimesters, according to research published in the Archives of Medical Science. Thus, it’s recommended to do a repeat urine culture during the third trimester, too.
Common UTI Symptoms in Pregnant Women
“While mildly painful urination during pregnancy can often mean a yeast infection, not a UTI, it’s always best to see your healthcare provider if you experience any symptoms,” says Heather Bartos, MD, an ob-gyn in Cross Roads, Texas. After all, research suggests that about 18 percent of UTIs that occur during pregnancy are symptomatic UTIs, meaning the telltale UTI signs and symptoms are present:
Strong and frequent urge to use the bathroom
Burning while urinating
Regularly passing only small amounts of urine
Cloudy, red, pink or cola-colored urine
Pelvic pain, usually in the center of the pelvis
In pregnancy, women are also more susceptible to asymptomatic UTIs, meaning you have significant bacteria in your urine but your urinary tract is free of signs and symptoms. Experiencing no symptoms, however, does not mean that asymptomatic UTIs are benign. “An asymptomatic UTI can lead to a symptomatic UTI or even a kidney infection,” says Dr. Bartos. In fact, research shows that if asymptomatic UTIs are left untreated, 30 percent of pregnant women will go on to develop a symptomatic UTI, and half of those women will eventually be diagnosed with acute pyelonephritis (a kidney infection). Up to 23 percent will have a kidney infection recurrence during the same pregnancy. It’s important to note that classic UTI signs, like frequent and painful urination, may or may not occur with a kidney infection. Here, some signs to look out for:
Typical Signs of a Symptomatic UTI
Chills and rigors (sudden feeling of cold with shivering)
Nausea or vomiting
Lower back pain
Flank pain (often right side)
Possible reduced urine output
Are UTIs Dangerous During Pregnancy?
“UTIs can rapidly progress to a kidney infection in pregnancy, which can be much more dangerous than a kidney infection in nonpregnant women,” says Bartos. “Severe infections can lead to respiratory problems and sepsis, which can then lead to preterm labor or even the need to urgently deliver the baby.” Beyond a kidney infection, simply having a UTI during pregnancy appears to possibly be a contributing factor to low birth weight. Women who have a UTI in pregnancy also have a 1.31-fold higher risk of developing preeclampsia, a pregnancy complication characterized by high blood pressure, according to a meta-analysis published in September 2018 in the journal Medicine. It’s thought that a UTI may alter a pregnant woman’s inflammatory response, which can spur preeclampsia.
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Can Having a UTI While Pregnant Hurt the Baby?
Possibly. “A UTI itself doesn’t hurt the baby directly,” says Bartos. “It’s the failure to treat a UTI that can cause things like preterm birth or, rarely, infection of the amniotic sac. ” For example, research published in American Family Physician shows that treating pregnant women who have asymptomatic UTIs decreases the incidence of preterm birth and low-birth-weight infants. That’s why screening and prompt treatment are important.
Can a UTI Cause Contractions During Pregnancy?
Urinary tract infections are not associated with preterm labor, according to research published in the Journal of the Chinese Medical Association. However, if a urinary tract infection is left untreated, it can progress to a kidney infection. And a kidney infection (pyelonephritis) during pregnancy can modestly increase your chances of early contractions and delivery. Research published in the American Journal of Obstetrics & Gynecology notes that women diagnosed with acute pyelonephritis in pregnancy have a 10.3 percent chance of preterm delivery compared with the 7.9 percent chance among women without a kidney infection during pregnancy.
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Do UTIs Differ by Trimester?
At week 6, UTI risk starts to go up, with two-fifths of UTIs occurring during the first trimester. Because of the likelihood of getting a UTI during the first trimester, the U.S. Preventive Services Task Force recommends that pregnant women have a urinalysis and urine culture at their first prenatal visit — whether they have UTI symptoms or not. In the second trimester, about half as many pregnant women are diagnosed with a UTI as in the first trimester, according to the Centers for Disease Control and Prevention, and that number is almost halved again for the third trimester. However, 80 to 90 percent of acute kidney infections in pregnancy (many caused by the progression of an untreated UTI) occur in the second and third trimesters, according to data published in the Archives of Medical Science, so pregnant women should have a repeat urine culture during the third trimester.
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What Are Pregnancy-Safe UTI Treatment Options?
How do you treat a UTI when pregnant? It’s similar to how you treat a UTI when not pregnant — with a few key differences. A short-course of antibiotics is the standard treatment for asymptomatic and symptomatic urinary tract infections that occur during pregnancy. There are, however, two important contrasts in treating UTIs in pregnant women versus nonpregnant women. First, asymptomatic UTIs diagnosed during the first trimester are treated with antibiotics, whereas nonpregnant women’s infections are often not treated in this manner. (Outside of pregnancy, asymptomatic bacteriuria is usually not treated with antibiotics.) Also, the preferred antibiotic drugs used to treat UTI in pregnancy often differ than what would be used while not pregnant. For instance, the following antibiotics have not been associated with any birth defects, thus are likely safe to use at any point during pregnancy:
Penicillins Amoxicillin, ampicillin, and augmentin are in this group.
Erythromycin Some of the brand names include Ery-Tab, Akne-Mycin, E.E.S. Eryc, and Pediamycin.
Cephalosporins Keflex (cephalexin) is a cephalosporin.
UTI history and resistance patterns must be considered before prescribing any of these drugs.
Because certain antibiotics pose a potential risk for birth defects (anencephaly, heart defects, and cleft palate) when taken during the first trimester, they are only considered a first-line treatment for UTIs occurring during the second and third trimesters, according to the American College of Obstetricians and Gynecologists. Prescribing the antibiotics listed below during the first trimester is considered appropriate only when no other suitable alternative treatments are available:
Nitrofurantoin Macrobid, Furadantin, and Macrodantin are in this category.
SulfonamidesBactrim (trimethoprim-sulfamethoxazole) is part of this class.
Be sure to double-check what your healthcare provider is prescribing, since despite the warnings, nitrofurantoin remains the most frequently prescribed antibiotic during the first trimester.
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Urinary tract infection
Urinary tract infection - an infection of the urinary system, which includes the kidneys, ureters, bladder, urethra. The kidneys form urine by removing excess fluid from the blood and waste materials that are unnecessary for the body. Urine from the kidneys through special tubes (ureters) enters the bladder, where it accumulates and is periodically excreted through the urethra (urethra).
The most commonly affected parts of the urinary system are the bladder and urethra. A urinary tract infection occurs when bacteria enter the urethra and multiply in the bladder. With the further development of the inflammatory process, a decrease in the body's defenses, the infection can spread through the ureters and affect the kidneys, causing serious complications.
Urinary tract infections are more common in women than in men. This is due to the structural features of the male and female urogenital system. For the treatment of these diseases, various antibacterial drugs are prescribed.
Urinary tract infection, urinary tract infection.
Urinary tract infection, urinary system infection.
Frequent, strong urge to urinate
Small urine output
Soreness, burning sensation when urinating
Discoloration of urine
Turbidity of urine, appearance of flocculent discharge in urine
Strong smell of urine
Pain in the lower abdomen
Pain in the lumbar region
Increased body temperature
General information about the disease
The organs of the urinary system include the kidneys, ureters, bladder, urethra. The kidneys are paired organs located in the lumbar region. Their function is to remove unnecessary and harmful substances that are formed in the process of human life. The kidneys extract these substances from the blood and excrete them along with excess fluid (urine). They also play an important role in maintaining blood pressure, the formation of red blood cells, and other vital functions. Through the ureters, urine from the kidneys enters the bladder, and then, with the contraction of its walls, into the urethra (urethra) and is excreted.
Urinary tract infections are more common in women. This is due to the structural features of the male and female urogenital system. In women, the urethra is shorter, which shortens the path for bacteria to reach the bladder, where infection can develop more intensely. With inflammation of the urethra, urethritis occurs, with inflammation of the bladder - cystitis, with the penetration of infection into the kidneys - pyelonephritis.
Urethritis - inflammation of the urethra. One of the reasons may be the penetration of infection from the anus into the urethra. This route of infection is especially common in women, since the anus and the opening of the urethra are located close to them. Urethritis is caused by sexually transmitted infections: chlamydia, gonorrhea, herpes and others.
Cystitis - inflammation of the bladder. Occurs when the infection spreads through the urethra to the bladder. A short urethra in women causes their frequent development of cystitis.
Pyelonephritis - inflammation of the renal pelvis (part of the kidney). One of the reasons for the development of pyelonephritis is the penetration of infection from the bladder through the ureters into the kidneys. At the same time, body temperature rises, intense pain in the lumbar region occurs. Pyelonephritis can be accompanied by damage to the kidneys, a violation of their functions.
Who is at risk?
Women, in particular:
using certain means of contraception - vaginal caps;
menopausal (hormonal changes make the urinary tract more susceptible to infections)
Persons with abnormalities in the development of the organs of the urinary system - this often interferes with the normal excretion of urine, which contributes to the penetration and reproduction of bacteria.
Persons with impaired normal urine flow. Diseases that can cause difficulty in the outflow of urine: prostate adenoma (accompanied by an increase in the size of this gland and squeezing of the urethra, which causes urinary retention in the bladder), kidney stones, etc. Urinary retention creates favorable conditions for the reproduction of bacteria.
Immunocompromised people - various diseases (eg diabetes) cause a decrease in the body's ability to fight infections, which increases the risk of diseases of the urinary system.
Patients with a urinary catheter.
Laboratory diagnostics plays a leading role in the detection of urinary tract infections.
Urinalysis. Allows you to determine the various properties of urine (color, density, transparency), to identify inflammatory changes in the organs of the urinary system. An increase in the number of leukocytes in the urine, the presence of bacteria, mucus is observed with infections of the urinary system.
Urinalysis according to Nechiporenko. It can be prescribed for changes in the general analysis of urine. This analysis shows the exact number of red blood cells, white blood cells, cylinders (protein particles that should not normally be) in the urine. The level of leukocytes indicates the severity of the inflammatory process.
Culture for antibiotic susceptibility (morning urine). This study is of great importance for the treatment of infectious diseases of the urinary system. It allows you to identify the bacteria that caused the inflammation, and antibiotics that act specifically on this type of bacteria.
Complete blood count (without leukocyte formula and ESR). Allows you to determine the number of erythrocytes, platelets, leukocytes, hemoglobin content in erythrocytes. The number of leukocytes increases with various inflammatory processes.
Erythrocyte sedimentation rate (ESR). One of the reasons for the increase in the erythrocyte sedimentation rate is the inflammatory process. Changes in ESR are not specific for urinary tract infection, but this indicator can be useful for assessing the severity of inflammation.
In infectious diseases of the urinary system, kidney function may be impaired. To assess its function, various tests are carried out, which include:
Serum creatinine. Creatinine is formed in the muscles during various energy processes and then released into the blood. It is excreted from the body by the kidneys, and if their function is impaired, its level may increase.
Serum urea. Urea is the end product of protein metabolism in the body. Excreted by the kidneys. With their diseases, its level rises.
Ultrasound examination of the kidneys, bladder (ultrasound). Allows you to get images of internal organs, identify developmental disorders of the urinary system, kidney stones and other changes.
Computed tomography of the urinary system. Obtaining accurate layer-by-layer images of internal organs is of great importance in determining the possible causes of infectious diseases of the urinary system.
Intravenous urography. X-ray method of examination of the urinary system. A special contrast agent is injected into the vein, then after a certain time a series of x-rays are taken, which show the passage of this substance through the urinary system. At the same time, kidney function is assessed, violations in the structure of the urinary tract, kidney stones and other diseases of the urinary system organs are detected.
Cystoscopy. The method allows you to see the inner wall of the bladder, to perform various manipulations (for example, removal of stones, some tumors). A tube of an apparatus with an optical lens system is inserted into the urethra, then into the bladder, thus obtaining images. It is also used for chronic, often occurring inflammatory diseases of the bladder.
The scope of the required examination is determined by the attending physician.
Various antibiotics are prescribed to treat urinary tract infections. The number of drugs, the duration of treatment, the route of administration of antibiotics (in tablets, intramuscularly, intravenously) depends on the severity of the disease and is prescribed by a doctor.
Drinking enough fluids helps flush out bacteria with urine.
Do not tolerate the urge to urinate for a long time - prolonged stagnation of urine in the bladder increases the risk of infection.
Women are advised to wash from front to back (from the pubis to the anus).
Complete Urinalysis with Sediment Flow Cytometry
Urinalysis according to Nechiporenko
Complete blood count
Erythrocyte sedimentation rate (ESR)
Urinary tract infections: symptoms and treatment
Urinary tract infections (UTIs) cause more than 8 million doctor visits each year and about five percent of all doctor visits. 40 percent of women and 12 percent of men will have at least one episode of a symptomatic urinary tract infection during their lifetime. A bladder infection is called cystitis, and a kidney infection is called pyelonephritis. Kidney infections are much less common but more dangerous.
A few words about the urinary system of a healthy person
The organs of the urinary system form and accumulate urine, which is one of the waste products of our body. Urine is formed in the kidneys and travels down the ureters to the bladder. The bladder serves as a reservoir for storing urine, which is then emptied through the urethra. The urethra ends at the penis in men and the area above the vagina in women.
The kidneys are a pair of fist-sized organs located in the lumbar region that serve as a filter for the body, removing waste products from the body in the form of urine. The kidneys also regulate the balance in the body of various chemicals (sodium, potassium, calcium, phosphorus, etc. ) and control the acidity of the blood. The kidneys produce certain hormones that are involved in regulating blood pressure, stimulating the production of red blood cells, and promoting the development of strong bones.
The ureters are two muscular tubes that transport urine to the bladder.
Normal urine is sterile and free from bacteria. However, bacteria can enter urine from the urethra and travel to the bladder.
Urinary tract infection symptoms
If you have a urinary tract infection (UTI), the lining of your bladder and urethra becomes inflamed and irritated, just like your throat during a cold. Possible pain in the lower abdomen and pelvic region, frequent urination with burning in the urethra. During urination, only a few drops of urine may be excreted, despite a distinct urge. You may also find that your urine has become foul-smelling and cloudy.
Kidney infections are often accompanied by fever and back pain. These infections must be treated promptly because a kidney infection can quickly spread through the bloodstream and lead to life-threatening conditions.
UTIs are often classified as simple (uncomplicated) or complicated. Complicated UTIs can be defined as urinary tract abnormalities or when the bacteria causing the infection are resistant to most antibiotics.
What are the causes of urinary tract infections?
A large number of bacteria live in the rectal area and also on our skin. Bacteria can enter the urine from the urethra, from there into the bladder, and even end up in the kidneys.
Just as some people are more prone to colds, many of us are prone to UTIs. In women who have gone through menopause, there are changes in the lining of the vagina and a decrease in estrogen, which increases the likelihood of UTIs. Postmenopausal women with UTIs may benefit from hormone therapy. Some women are genetically predisposed to urinary tract infections.
Sexual intercourse increases the incidence of urinary tract infections.
Women who use spirals have an increased risk compared to those who use other forms of contraception. The use of condoms with spermicidal gel also leads to an increase in urinary tract infections in women. In general, women are more prone to urinary tract infections because they have a shorter urethra than men, so the bacteria travel only a short distance to the bladder.
It is most likely to get a urinary tract infection in case of urinary tract anomalies or in case of instrumental manipulations (for example, a urethral catheter).
Endocrine diseases such as diabetes increase the risk of UTIs by weakening the immune system and therefore reducing the body's resistance to infection.
Anatomical abnormalities in the urinary tract can also lead to UTIs. These disorders often occur in young children, but can also occur in adults.
So how do you spot a urinary tract infection?
If you are concerned about this issue, you should contact your doctor.
The main types of UTI diagnostics are laboratory tests of blood and urine. A urine sample is examined under a microscope, looking for signs of infection such as bacteria or white blood cells in the urine. It is recommended to take a urine culture to determine the microflora and sensitivity to antibiotics.
If you find blood in your urine, you should contact your doctor immediately. Blood in the urine can be associated with an infection, but it can also be a manifestation of other formidable diseases, such as urolithiasis or tumors of the bladder, kidneys.
How to treat urinary tract infections?
Simple UTIs are usually treated with a short course of oral antibiotics. A three-day course of antibiotics is sufficient. However, some infections require longer therapy, up to several weeks. Depending on the type of antibiotics used, take one dose per day or up to four daily doses. A few doses of the medication may relieve your pain or urge to urinate frequently, but you must still complete the full course of treatment prescribed by your doctor, even if all symptoms have gone. If a UTI is not fully treated, they may return more than once. You must also remember to drink plenty of fluids.
If you have a complicated UTI, longer antibiotics and medicines to improve your condition are needed. Kidney infections are generally considered to be complicated by UTIs.
What can I expect after treatment for urinary tract infections?
An uncomplicated UTI usually resolves after a few days of antibiotic therapy, and you don't need a urinalysis for culture to prove it's gone. If you have a complicated UTI, a urine culture is required both before and after treatment.
What happens to my kidneys if I have a UTI? If UTIs are treated in the early stages, then there will be no problems. Recurring or undertreated UTIs can lead to kidney damage if not treated promptly.
Why do I have a UTI? Most UTIs are one-time and never recur. Some patients have anatomical and genetic predispositions that tend to make one person more susceptible than another.
How to avoid urinary tract infections? There are a few simple steps women can take to avoid urinary tract infections:
Some forms of birth control, such as spermicidal gels and coils, are known to increase the risk of UTIs in women who use them as contraception.
Drink plenty of fluids - at least 2 liters per day.
Do not endure the urge for a long time and should not interrupt urination.
Women are advised to wipe from front to back after going to the toilet to prevent the transfer of bacteria from the anus to the vagina or urethra.
Urinating after intercourse may reduce the risk of developing a UTI. Sometimes taking a single dose of an antibiotic after unprotected intercourse can help prevent recurrent UTIs.
When to worry? If you continue to have symptoms of a UTI after treatment, or if you have symptoms of a UTI accompanied by nausea and vomiting, you should contact your doctor immediately. If you ever see blood in your urine, you should also see your doctor.
What if I'm pregnant? If you are pregnant and have symptoms of a UTI, you should contact your doctor immediately. A UTI during pregnancy can put the health of the mother and baby at risk if not dealt with quickly and correctly.