UTI Symptoms & Treatment — A Melbourne Urologist's Guide

Urinary tract infections are one of the most common reasons people see a doctor — and one of the most common reasons they end up frustrated. A single infection is usually straightforward. Infections that keep coming back, or that don't settle with antibiotics, are a different problem, and one that often needs a urologist rather than another prescription.

This guide explains what a UTI actually is, how to recognise the symptoms, how they are treated in Australia, the warning signs of a kidney infection, and the point at which repeated infections should be investigated by Dr Brendan Dias in Melbourne.

What Is a Urinary Tract Infection?

A urinary tract infection is a bacterial infection anywhere in the urinary system — the kidneys, ureters, bladder, or urethra. In the overwhelming majority of cases the bacteria (usually Escherichia coli from the bowel) travel up the urethra and multiply in the bladder.

Where the infection sits determines how serious it is:

• Urethritis — infection of the urethra alone; stinging on urination is the main symptom
• Cystitis — infection of the bladder; the classic "UTI" and by far the most common form
• Pyelonephritis — infection that has ascended to the kidney; causes fever and flank pain and is a medical emergency
• Urosepsis — the infection has entered the bloodstream; requires immediate hospital care

Symptoms of a Urinary Tract Infection

Bladder infections and kidney infections produce quite different symptom patterns, and telling them apart matters because the treatment is different.

In older adults the picture can be much less obvious. New confusion, unsteadiness, falls, or a general decline without any urinary symptoms at all can be the only sign of infection, and should prompt a urine test.

When to Seek Urgent Care

Go to an emergency department, or call your doctor immediately, if you have:

• Fever above 38°C or shaking chills alongside urinary symptoms
• Pain in the back or side over the kidney
• Nausea and vomiting that prevents you keeping tablets down
• New confusion or drowsiness, particularly in an older person
• Complete inability to pass urine (urinary retention)
• A UTI during pregnancy, or in someone with a single kidney or a transplant

How UTIs Are Diagnosed

Diagnosis is usually straightforward and starts in general practice:

• Urine dipstick — an immediate bedside test looking for nitrites and leucocytes, which suggest bacterial infection
• Midstream urine culture — the sample is sent to a laboratory to identify the exact organism and which antibiotics it is sensitive to. This is the test that matters for recurrent infections
• Blood tests — used when a kidney infection is suspected, to assess kidney function and the severity of the inflammatory response
• Ultrasound or CT scan — arranged when there is fever, an abnormal result, suspected obstruction, or infections that keep returning
• Flexible cystoscopy — a thin camera passed into the bladder in the rooms, used in the assessment of recurrent infection or persistent blood in the urine

UTI Treatment

Uncomplicated Bladder Infection

A short course of oral antibiotics is the standard treatment. In Australia, trimethoprim or nitrofurantoin for three to five days is typical first-line therapy for an uncomplicated infection in a non-pregnant woman. Symptoms usually begin improving within 24–48 hours.

Alongside antibiotics:

• Drink enough water to keep urine pale — this dilutes the bladder and flushes bacteria
• Simple analgesia (paracetamol) for discomfort
• Urinary alkalinisers from the pharmacy can ease stinging but do not treat the infection
• Complete the full antibiotic course even once you feel better

Complicated and Kidney Infections

UTIs in men, in pregnancy, with a catheter, with stones, or with any obstruction are classified as complicated and need a longer antibiotic course — usually 7–14 days — guided by culture results. Pyelonephritis with fever generally requires intravenous antibiotics in hospital, and an obstructed, infected kidney is a surgical emergency requiring urgent drainage with a ureteric stent or nephrostomy.

Recurrent UTIs — Why They Keep Coming Back

Recurrent UTI is defined as two or more infections in six months, or three or more in twelve months. At this point the useful question is no longer "which antibiotic?" but "why does this keep happening?". Common underlying causes include:

• Incomplete bladder emptying — residual urine is a reservoir for bacteria; measured with a simple bladder scan
• Enlarged prostate (BPH) — the most common cause of recurrent UTI in men over 50
• Bladder or kidney stones — bacteria live within the stone and are protected from antibiotics
• Post-menopausal changes — falling oestrogen alters the vaginal flora that normally protects against colonisation
• Long-term catheters — see our catheter care guide
• Diabetes — poorly controlled blood glucose increases infection risk
• Urethral stricture or other anatomical abnormality

Prevention Strategies That Work

• Fluid intake — increasing water intake meaningfully reduces recurrence in women who drink little
• Complete bladder emptying — take your time; double voiding can help if there is residual urine
• Vaginal oestrogen — one of the most effective interventions after menopause
• Post-coital antibiotic — a single dose after intercourse where infections are clearly related
• Low-dose prophylaxis — a nightly low-dose antibiotic for 3–6 months in selected patients
• Cranberry or D-mannose — modest evidence; reasonable to trial, not a replacement for investigation
• Treating the cause — removing a stone or relieving prostatic obstruction is often what finally breaks the cycle

UTIs in Men — Always Worth Investigating

Because of the longer male urethra, UTIs are far less common in men and are never assumed to be simple. A single confirmed infection in an adult man warrants assessment for an underlying cause — most often an enlarged prostate causing incomplete emptying, but sometimes stones, a stricture, or prostatitis. Treating the obstruction usually resolves the infections.

When to See Dr Dias

A referral to Dr Brendan Dias is appropriate if you have recurrent infections, any UTI as a man, infections associated with stones or a catheter, blood in the urine that persists after treatment, or infections that return with the same organism despite correct antibiotics.

Assessment typically includes a bladder scan, urine culture review, imaging of the kidneys and bladder, and flexible cystoscopy where indicated — with the aim of finding and treating the cause rather than managing each infection separately. Dr Dias consults across Melbourne's western and northern suburbs, and referrals are seen within two weeks.

Frequently Asked Questions

The Bottom Line

A single urinary tract infection is common and usually clears with a short antibiotic course. Fever, flank pain, or vomiting change the picture entirely and need urgent care. And if infections keep returning — or if you are a man with a confirmed UTI — the infection is a symptom, not the diagnosis. Finding what is driving it is what stops the cycle.