The ABCs of UTIs: from symptoms to effects on fertility

You're scurrying back and forth to the bathroom and there's a burning sensation when you pee. It's the worst. But what exactly is going on? A strong (and never-ending!) urge to urinate could indicate that you have a urinary tract infection (UTI).

UTIs are incredibly common. They're like the "bread and butter for an OB-GYN or PCP practice," explains OB-GYN and Modern Fertility medical advisor Dr. Eva Luo, MD, MBA. Because they're so common, detecting and treating UTIs can become easier with time. "Once a patient has had a UTI, they become very familiar with those symptoms and are oftentimes right [about having a UTI] when they feel the same symptoms."

To help you get even more familiar with UTIs, their symptoms, and the typical treatment regimens, we're covering all the basics below. But before we get into it, here are the highlights:

• What's a UTI? Urinary tract infections (UTIs) are infections in any part of your urinary system (kidneys, ureters, bladder, and/or urethra). UTIs are more common in people with vulvas because of the short distance between the urethra and the anus.

• What does it feel like to have a UTI? Needing to pee frequently, burning when peeing, cloudy or discolored urine, strong-smelling urine, and pain in the back, side, or pelvis can all be symptoms of a UTI.

• Are UTIs the same thing as pelvic inflammatory disease (PID)? No, though some of the symptoms (and causes) do overlap.

• How are UTIs diagnosed? Your healthcare provider will take a urine sample and examine its color, concentration, and contents.

• How are UTIs treated? Through a course of antibiotics prescribed by your healthcare provider.

• Can UTIs impact your fertility? No. But UTIs during pregnancy, if left untreated, can cause complications.

Whether you've had a UTI before, you're experiencing one for the first time (we are so sorry), or you're just generally curious, we're here for you. Read on!

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A urinary tract infection (UTI) is an infection in any part of your urinary system — your kidneys, ureters, bladder, and/or your urethra. While anyone can get a UTI, people with vulvas are at higher risk because the distance between the urethra and the anus is much shorter than it is in people with penises.

There are two kinds of UTIs:

• Cystitis, the most common type of UTI, is an infection of the bladder. Cystitis is called a "simple" or "uncomplicated" UTI because the symptoms are confined to the lower urinary tract.

• Pyelonephritis is a condition in which the infection extends up into the kidney/upper urinary tract (these are also referred to as kidney infections). Because pyelonephritis involves the upper and lower urinary tract, it's considered a "complicated" UTI.

The most common symptoms of UTIs include:

• Frequent urge to urinate

• Frequent urination resulting in small amounts of urine

• A burning sensation when urinating

• Urine that appears cloudy

• Urine that appears red, bright pink, or cola-colored (signs of blood in the urine)

• Strong-smelling urine

• Back/side pain

• Pelvic pain (especially in the center of the pelvis and around the area of the pubic bone)

What can be confusing is that some of the symptoms of UTIs, especially that burning sensation when you pee, overlap with pelvic inflammatory disease (PID) — an infection of the uterus, fallopian tubes, ovaries, and cervix. Because of these similarities, "taking a good history, doing a physician exam, and collecting cultures can be very important to distinguish a UTI versus a pelvic infection," explains Dr. Luo. Experiencing abnormal vaginal discharge might also be a sign that a UTI isn't the cause of symptoms.

Sexual intercourse, especially after the first time or after an uptick in activity, is the most common cause of UTIs. This is so common that UTIs have been nicknamed the “honeymoon disease."

During sex, you’re potentially introducing bacteria from the genital area and anus to the urethra. This isn’t solely restricted to penis-in-vagina sex — toys, fingers, and anything belonging to your sexual partner or foreign to your body can bring germs and bacteria into your urethra and urinary tract.

While sex is typically the cause of a UTI, there are several factors that can make it more likely that you'll get recurrent UTIs (they show up two or more times in six months, or three or more times in a year):

• UTI history: If you've had a UTI before or they tend to run in your family, you could be more likely to keep on getting them.

• Your choice of birth control: Using a diaphragm or spermicide can mean more frequent UTIs.

• Body-fat percentage: People who have a higher body-fat percentage 

• Pregnancy: During pregnancy, that expanding fetus can make it difficult for you to fully empty your bladder and bowels, and changes in your hormones can leave you more susceptible to the bacteria most commonly associated with UTIs: Escherichia coli (E. coli).

• Menopause: Physical and hormonal changes during menopause can also impact your urinary tract — making you more vulnerable to UTIs.

• Diabetes: If you have diabetes, you’re at risk for recurrent UTIs.

• Physical disabilities: People with spinal cord injuries or nervous system conditions (like multiple sclerosis) are also susceptible to recurrent UTIs.

An important note on UTIs during pregnancy

If you get a UTI during pregnancy and it spreads into the kidneys, becoming pyelonephritis, the infection can get into your bloodstream (this is called urosepsis) and lead to an increased risk of preterm birth. That said, UTIs in pregnancy are very treatable with the use of antibiotics. If you know you have recurrent UTIs and are planning a pregnancy, talk to your doctor — and if you're pregnant and experience a UTI, it's also important to reach out to your doctor.

Like we touched on a bit earlier, your healthcare provider will ask for a urine sample if you think you have a UTI. According to Dr. Luo, there are three types of urine tests available for UTIs — two of which are simpler and faster than the other:

"A urine dipstick is a super-fast test that helps a provider decide quickly how probable it is that the patient is experiencing a UTI," explains Dr. Luo. A microscopic urinalysis, in comparison, looks for the same components in the urine but takes longer because the sample needs to be sent out to a lab. The gold standard of UTI diagnosis, however, is a urine culture: "Certain bacteria have developed resistance to some antibiotics over time," says Dr. Luo. "The culture will help guide which types of antibiotics would be most effective for treatment."

If you've had a UTI before, you might have visited your healthcare provider to give a urine sample and get a prescription for antibiotics — the usual treatment for a UTI. But what kinds of antibiotics you get, and how long you have to take them, depends on the type of UTI and the type of bacteria in your urine.

Here's what you can expect, treatment-wise, for different types of UTIs:

• Cystitis: To treat a "simple" or "uncomplicated" UTI, your doctor may prescribe a short course of antibiotics — and your infection should clear up within a few days.

• Pyelonephritis: If you have a "complicated" UTI, antibiotics are also part of the treatment — possibly along with a pain reliever and fever reducer.

As of right now, there are no over-the-counter antibiotic treatments for UTIs. Dr. Luo explains that the medications you may find are simply for pain relief — which can only make the UTI a little less uncomfortable. "An analogy is that if you have pneumonia, taking Tylenol to reduce the fever doesn't actually treat the pneumonia," says Dr. Luo. "It just makes you a little less miserable." Antibiotics are what's needed to actually treat the condition.

What happens if a UTI goes untreated? That can lead to bacteria spreading throughout the body, resulting in kidney damage, sepsis, or other adverse outcomes. If you think you have a UTI, it's important to get to a healthcare provider ASAP.

When it comes to UTI prevention, rumors and misconceptions abound. But, for the most part, these are the typical prevention recommendations for people with recurrent UTIs (which vary depending on why you keep getting them):

• A new birth control: If recurrent UTIs are caused by using diaphragms or spermicide, you can talk to your healthcare provider about alternative contraceptives.

• Topical estrogen: If you're getting UTIs because you're postmenopausal, your healthcare provider may prescribe topical estrogen.

• Antibiotic prophylaxis: If your UTIs can be traced to sexual activity, you might be prescribed an antibiotic prophylaxis, or a proactive course of antibiotics like Keflex or Cipro, and advised to take it before or after sex.

There are a few other possible methods that could prove helpful for UTI prevention, but the clinical evidence for them is lacking:

• Cranberry juice: The jury's still out on this one. The beverage could have a small positive effect on reduction, but research hasn't shown significant enough benefits to make it a clear recommendation.

• Probiotics: Most of the studies that have looked at probiotics and UTI prevention haven't been very well-designed, explains Dr. Luo — but oral probiotics appear to be especially ineffective. However, one 2011 study did show that lactobacillus, delivered via a vaginal capsule, led to a high level of lactobacillus colonization in the vagina that was associated with a decrease in the incidence of UTIs. "Given the lack of strong evidence, this practice can't be recommended," says Dr. Luo, "but it's worth a shot if you can tolerate the cost."

• Methenamine salts and D-mannose: According to Dr. Luo, biology suggests that these supplements could be helpful, but the research isn't quite there yet. "However, if you find symptomatic benefit in using either of these," caveats Dr. Luo, "they are not harmful — and will not be discouraged by your providers."

You've likely also heard about behavioral modifications you can make to reduce the risk of getting a UTI. Here's where the science stands on some of the most common ones:

• Drinking more water: While drinking water is always a good idea, there's only minimal evidence that it can be especially helpful in the context of UTIs: A small randomized trial of 140 women who had at least three UTIs in the last year and reported low fluid intake showed a reduction in UTIs by increasing fluid intake by 50% — but this outcome wasn't viewed as statistically significant.

• Peeing before or after sex: This has never been shown in controlled studies to reduce the risk of UTIs. "But it's a harmless behavioral change," says Dr. Luo.

• Wiping from front to back after you pee: "This has also not been shown in controlled studies to be beneficial," says Dr. Luo. "But, again, it is a reasonable prevention measure."

What about avoiding douches and "feminine hygiene sprays"? Doctors don't recommend using either, but the reason isn't to prevent UTIs: Douching changes the balance of "good" bacteria that lives in your vagina, which can cause yeast infections or bacterial vaginosis — and any type of spray or deodorant that goes on the vulva can irritate it.

No — UTIs don't affect your ability to conceive.

Also, despite what you might read elsewhere on the internet, a UTI can't turn into pelvic inflammatory disease (PID) and impact your fertility either. PID comes from untreated sexually transmitted infections (STIs) or a mix of bacteria that's traveled up the reproductive system and caused an infection — not UTIs. PID doesn't even touch the urinary system.

What is true, says Dr. Luo, is that PID can be what's called a polymicrobial infection — an infection caused by the same fecal bacteria that lead to UTIs. In these situations, explains Dr. Luo, the fecal bacteria "travel up the reproductive tract instead of the urinary tract" and trigger the infection.

UTIs are most common in people with vulvas, but if you have a penis, you can also get one if bacteria build up in the urinary tract (sometimes from an STI). UTIs may develop in the urethra, bladder, prostate, or kidneys. Because kidney stones and enlarged prostates (which can lead to UTIs) often happen in folks over 50, UTIs are more likely to occur in older people with penises.

UTIs in people with penises can damage fertility, usually because white blood cells show up to fight the infection — and these blood cells release substances that can be toxic to sperm. A healthcare provider can detect the presence of large amounts of white blood cells through a semen analysis and prescribe antibiotics to improve fertility.

Now that you've got the basics down, one way to stay on top of UTIs is to arm yourself with knowledge. Ask your doctor any questions you may have around UTIs and reach out if you think you might have one.

This article was medically reviewed by Dr. Eva Marie Luo, MD, MBA, OB-GYN at Beth Israel Deaconess Medical Center and Clinical Lead for Value at the Center for Healthcare Delivery Science at Beth Israel Deaconess Medical Center.

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

August 15, 2021

Written by

Chanel Dubofsky

Fact checked by

Eva Marie Luo, MD, MBA, FACOG

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About the medical reviewer

Eva Marie Luo, MD, MBA, FACOG