Urinary Tract Infection


What Is a Urinary Tract Infection?
About half of women will get a urinary tract infection or UTI at some point in life. It happens when germs infect the system that carries urine out of your body -- the kidneys, bladder, and the tubes that connect them. Bladder infections are common and usually not serious if treated promptly. But if the infection spreads to the kidneys, it can cause more serious illness.

UTI Symptoms: Bladder Infection
Most UTIs are bladder infections. Symptoms include:
Pain or burning during urination
The urge to urinate often
Pain in the lower abdomen
Urine that is cloudy or foul-smelling
Some people may have no symptoms

UTI Symptoms: Kidney Infection
An untreated bladder infection can spread to the kidneys. Signs of this include:
Pain on either side of the lower back
Fever and chills
Nausea and vomiting

When to See Your Doctor
See your doctor right away if you have signs of a urinary tract infection. A bladder infection is generally not a medical emergency – but some people have a higher risk for complications. This includes pregnant women, the elderly, and men, as well as people with diabetes, kidney problems, or a weakened immune system.

UTI or Something Else?
Although burning during urination is a telltale sign of a UTI, it can  also be a symptom of certain sexually transmitted diseases (STDs.) These  include chlamydia, gonorrhea, and trichomoniasis. Simple lab tests are  available to distinguish a UTI from an STD.

Honeymoon Cystitis
Few things can ruin a honeymoon like a UTI. But this is so common, it has its own name – "honeymoon cystitis." The reason is that sexual activity can push bacteria into the urethra. Of course, the problem is not confined to honeymoons. Some women get a bladder infection almost every time they have sex. Women who use a diaphragm for birth control are especially vulnerable.

Stealth UTI
Occasionally, UTIs occur without the classic symptoms. A person may have no symptoms at all. Yet, a urine test shows the presence of bacteria. This is known as asymptomatic bacteriuria. In many cases, no treatment is needed. But pregnant women, some children, and recipients of kidney transplants should be treated to avoid a kidney infection.

UTI Complications
The main danger associated with untreated UTIs is that the infection may  spread from the bladder to one or both kidneys. When bacteria attack the  kidneys, they can cause damage that will permanently reduce kidney function. In  people who already have kidney problems, this can raise the risk of kidney  failure. There’s also a small chance that the infection may enter the  bloodstream and spread to other organs.

How Do UTIs Begin?
Many types of bacteria live in the intestines and the genital area, but this is not true of the urinary system. In fact, urine is sterile. So when errant bacteria, such as the E. coli shown here, is accidentally introduced into the urinary system, it can start a UTI. Typically, bacteria travel up the urethra to the bladder, where an infection can take hold. Women are more susceptible than men, probably because they have shorter urethras.

What Boosts Your Risk?
UTIs are most common in sexually active women. Other factors that may increase your risk include:
Not drinking enough fluids
Taking frequent baths
Holding your urine
Kidney stones

Urinary Tract Infections in Men
Men are much less likely than women to get UTIs. When it does happen, it's often related to another underlying medical condition, such as a kidney stone or an enlarged prostate.

Diagnosing UTIs
The first step in diagnosing a UTI is usually a simple urine test called a urinalysis. It looks for bacteria, as well as abnormal counts of white and red blood cells. The dipstick test provides quick results. Your doctor may also send your urine to a lab for culture to confirm the type of bacteria. At-home test kits can help detect a UTI, but are not 100% accurate. Be sure to go over the results and your symptoms with your doctor.

Treating UTIs
Prescription antibiotics will almost always cure a UTI. Your health care provider may recommend drinking lots of fluids and emptying your bladder frequently to help flush out the bacteria. Kidney infections can often be treated with oral antibiotics, too. But severe kidney infections may require hospital care, including a course of intravenous antibiotics.

Treating Recurrent UTIs
Some women are prone to getting UTIs over and over again. If you have three or more a year, talk to your doctor about how to prevent or minimize these infections. Your options may include:
Taking a low dose of antibiotics long-term
Taking a single antibiotic dose after sex
Taking antibiotics promptly as self-treatment when symptoms appear

UTIs and Diabetes
People with diabetes are more vulnerable to UTIs for several reasons. First, their immune systems tend to be weaker. Second, high blood sugar can spill into the urine and encourage the growth of bacteria. Also, nerve damage related to diabetes can prevent the bladder from fully emptying. People with diabetes should talk with their doctor at the first sign of a UTI.

UTIs and Pregnancy
During pregnancy, there are several factors that boost the risk of UTIs, especially a kidney infection. Hormones cause changes in the urinary tract, and the uterus may put pressure on the ureters or bladder or both -- making it more difficult for urine to pass from the kidneys to the bladder and out.  Untreated UTIs can contribute to preterm labor, so be sure to alert your doctor if you suspect you have an infection.

UTIs and Menopause
Estrogen has a protective effect in the urinary tract, but levels of this hormone drop off significantly during menopause. Low estrogen levels can make it easier for bacteria to thrive in the vagina or urethra. For this reason, women may be more susceptible to UTIs after menopause.

UTIs and Hospital Stays
A hospital stay can put you at risk for a UTI, particularly if you need to use a catheter. This is a thin tube that's inserted through the urethra to carry urine out of the body. Bacteria can enter through the catheter and reach the bladder. This is more often a problem for older adults who require prolonged hospital stays or who live in long-term care facilities.

UTIs in the Elderly
UTIs are among the most common infections in the elderly. But the symptoms may not follow the classic pattern. Agitation, delirium, or other behavioral changes may be the only sign of a UTI in elderly men and women. This age group is also more likely to develop serious complications as a result of UTIs.

UTIs in Infants
Babies occasionally develop UTIs, but they can’t tell you what they feel. Here are some signs to watch for:
An unexplained fever
Strange-smelling urine
Poor appetite or vomiting
Fussy behavior
 It’s vital to treat a baby’s UTI quickly to prevent kidney damage. Promptly changing a dirty diaper can help prevent bladder infections. And of course, wipe from front to back whenever changing a baby's diaper.

UTIs in Children
About 1% of boys and 3% of girls develop UTIs by age 11. This includes some children who repeatedly delay a bathroom trip. Their muscles may not relax enough later to fully empty the bladder and flush away any bacteria. More regular bathroom trips and drinking plenty of liquids may help. A small number of children have a structural problem that obstructs urine flow or lets urine flow back from the bladder to the kidneys, triggering chronic kidney infections. This can lead to kidney damage.

UTI or Potty Training Problem?
Accidents are par for the course during toilet training. Even kids who have mastered the art of the potty may sometimes have a relapse. Other children may scream or cry when taken to the potty, as a way of rebelling against the process. These are generally not signs of a UTI.

Preventing UTIs
Here are several strategies to reduce your risk of UTIs:
Drink plenty of water.
Visit the toilet before and after sex.
Wipe from front to back.
Avoid feminine hygiene sprays.
Take showers instead of baths.

The Cranberry Connection
Maybe Mom told you that cranberry juice cures a UTI. She’s close. Some studies suggest it can prevent, but not treat an infection, and is more effective in young and middle-aged women. Cranberries contain a substance that prevents E. coli bacteria from sticking to the walls of the bladder. If you don’t like the taste of cranberry juice, capsules or tablets may work, too. People with a history of kidney stones should check with a doctor, first.


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Cervical Cancer


What Is Cervical Cancer?javascript:void(0)
Cervical cancer occurs when abnormal cells develop and spread in the cervix, the lower part of the uterus. More than 12,000 new cases are diagnosed each year in the U.S. A unique fact about cervical cancer is that most cases are triggered by a type of virus. When found early, cervical cancer is highly curable.

Symptoms of Cervical Cancer
When cervical cells first become abnormal, there are rarely any warning signs. As the cancer progresses, symptoms may include:
Unusual vaginal discharge
Vaginal bleeding between periods
Bleeding after menopause
Bleeding or pain during sex

Top Cause of Cervical Cancer: HPV
The human papillomavirus (HPV) is a large group of viruses. About 40 types can infect the genital areas, and some have high risk for cervical cancer. Genital HPV infections usually clear up on their own. If one becomes chronic, it can cause changes in the cells of the cervix. And it's these changes that may lead to cancer. Worldwide, over 90% of cervical cancers are caused by an HPV infection.

Symptoms of HPV
HPV infections usually have no symptoms and go away on their own. Some types of the HPV virus may cause genital warts, but these are not the same strains linked to cervical cancer. It's important to note that genital warts will not turn into cancer, even if they are not treated. The dangerous types of HPV can stay in the body for years without causing any symptoms.

Who Is at Risk for HPV?
HPV is so common that most people who have ever had sex -- both women and men -- will get the virus at some point in life. Because HPV can linger quietly, it's possible to carry the infection even if it has been years since you had sex. Condoms can lower your risk of getting HPV, but they do not fully protect against the virus. HPV is also linked to cancers of the vulva, vagina, penis, and to anal and oral cancers in both sexes.

How HPV Causes Cervical Cancer
If one of the high-risk strains of HPV lingers in the body, it can cause abnormal cells to develop in the cervix. These precancerous changes do not mean that you have cervical cancer.  But over time, the abnormal cells may give way to cancer cells. Once cancer appears, it tends to spread in the cervix and surrounding areas.

What Else Raises Your Risk?


Hispanic and African-American women have higher rates of cervical cancer than white women. The risk is also higher in infected women who:
Smoke
Have many children
Use birth control pills for a long time
Are HIV positive or have a weakened immune system

Early Detection: Pap Test
The Pap test is one of the great success stories in early detection. A painless swab of the cervix can reveal abnormalities, often before cancer appears. Women should start having Pap tests three years after becoming sexually active and no later than age 21. How often tests are done depends on the type of test, your personal risk factors, and your medical history.  Skipping Pap tests raises your risk for invasive cervical cancer.
Of note: You'll still need Pap tests after getting the HPV vaccine because it doesn't prevent all cervical cancers.

What If Your Pap Test Is Abnormal?
If test results show a minor abnormality, you may need a repeat Pap test. Your doctor may schedule a colposcopy -- an exam with a lighted magnifying device -- or biopsy to get a better look at any changes in the cervical tissue. If abnormal cells are precancerous, they can then be removed or destroyed. Treatments are highly successful in preventing precancerous cells from developing into cancer.

Early Detection: HPV DNA Test
In some cases, doctors may offer the option of the HPV DNA test in addition to a Pap test. This test checks for the presence of high-risk forms of HPV. It may be used in combination with a Pap test to screen for cervical cancer in women over 30. It may also be recommended for a woman of any age after an abnormal Pap test result.

Diagnosing Cervical Cancer: Biopsy
A biopsy involves the removal of cervical tissue for examination in a lab. A pathologist will check the tissue sample for abnormal changes, precancerous cells, and cancer cells. In most cases, a biopsy takes place in a doctor's office with local anesthesia. A cone biopsy allows the pathologist to check for abnormal cells beneath the surface of the cervix, but this test may require general anesthesia.

Stages of Cervical Cancer
Stage 0 describes cancer cells found only on the surface of the cervix.  More invasive cancers are separated into four stages. Stage I is when the cancer has not spread beyond the cervix. Stage II means the tumor has spread to the upper part of the vagina. A Stage III tumor extends to the lower part of the vagina and may block urine flow. In Stage IV, the tumor has reached the bladder or rectum, or cancer cells have spread to other parts of the body and formed new tumors.

Treatment: Surgery
If the cancer has not progressed past Stage II, surgery is usually recommended to remove any tissue that might contain cancer. Typically this involves a hysterectomy, the removal of the cervix and uterus as well as some of the surrounding tissue. The surgeon may also remove the fallopian tubes, ovaries, and lymph nodes near the tumor.

Treatment: Radiation
External radiation therapy uses high-energy X-rays to kill cancer cells in a targeted area. It can also help destroy any remaining cancer cells after surgery. Internal radiation, or brachytherapy, uses radioactive material that is inserted into the tumor. Women with cervical cancer are often treated with a combination of radiation and chemotherapy. Side effects can include low blood cell counts, feeling tired, upset stomach, nausea, vomiting, and loose stools.

Treatment: Chemotherapy
Chemotherapy uses drugs to reach cancer wherever it is in the body. When cervical cancer has spread to distant organs, chemotherapy may be the main treatment option. Depending on the specific drugs and dosages, side effects may include fatigue, bruising easily, hair loss, nausea, vomiting, and loss of appetite.

Coping With Cancer Treatments
Cancer treatments may make you tired or uninterested in food. But it's important to take in enough calories to maintain a healthy weight. Check with a dietitian for tips on eating well during cancer treatment. Staying active is also important. Gentle exercise can increase your energy while reducing nausea and stress. Check with your doctor to find out which activities are appropriate for you.

Cervical Cancer and Fertility
Treatment for cervical cancer often involves removing the uterus and may also involve removing the ovaries, ruling out a future pregnancy. However, if the cancer is caught very early, you still may be able to have children after surgical treatment. A procedure called a radical trachelectomy can remove the cervix and part of the vagina while leaving the majority of the uterus intact.

Survival Rates for Cervical Cancer
The odds of surviving cervical cancer are tied to how early it's found. Depending on the stage, between 93% and 15% of women will survive for at least five years after diagnosis. Keep in mind that these numbers are based on women treated between 2000 and 2002. The treatments and outlook may be better for those diagnosed today. And statistics don't predict how well any one individual will respond to treatment.

Vaccine to Help Prevent Cervical Cancer
Vaccines are now available to ward off the two types of HPV most strongly linked to cervical cancer. Both Cervarix and Gardasil require three doses over a six-month period. Studies suggest the vaccines are effective at preventing chronic infections with the two types of HPV that cause 70% of cervical cancers.  Gardasil also protects against two types of HPV that cause genital warts.

Who Should Get the HPV Vaccine?
The vaccines are only used to prevent, not treat, HPV infection. They are most effective if administered before an individual becomes sexually active. The CDC recommends girls get an HPV vaccine series when they are 11 or 12.  It can also be given as a catch-up vaccine for girls and women from ages 13 to 26.


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