You wake up with that familiar urgency to go to the toilet and burning when you pee – and no matter how many times you go, that urgency doesn’t let up. You know exactly what it is: a urinary tract infection, or UTI.
UTIs are common, affecting half of all women at some point. They occur when bacteria enter the urinary tract, causing symptoms such as burning, urgency, frequent urination and lower abdominal pain.
Now many women can go straight to the pharmacy and get antibiotics without having to wait to see a doctor. This will mean faster treatment and fewer delays, as well as less pressure on general practice.
But this approach is designed for simple, or “uncomplicated”, infections in otherwise healthy people. It excludes men, those with recurrent UTIs (usually more than two UTIs in six months), pregnant women, and those with more complex cases or underlying kidney or urinary conditions.
So how does prescribing work for simple UTIs? And what might you need for more complicated infections?
What happens when you see a pharmacist for a UTI?
Pharmacists will ask a series of questions to check it’s safe to treat you, and if it is, they can provide a short course of antibiotics.
These services are limited to women because UTIs are less common in men and more likely to be complicated, often requiring further investigation.
The most common antibiotics used include nitrofurantoin and fosfomycin. These target the bacteria most often responsible, especially Escherichia coli, which causes around 75% of uncomplicated UTIs.
The antibiotics pharmacists give you without a GP prescription can help with straightforward UTIs, but not the ones that keep coming back.
If you have a fever, back pain, or feel unwell, the infection may have spread beyond the bladder – and the pharmacist won’t be able to prescribe to treat this type of infection.
If your symptoms keep coming back, or don’t improve, you need to see a GP.
Why some infections don’t go away
For most people, antibiotics clear the infection and symptoms settle within a few days.
But some bacteria are surprisingly good at surviving. Instead of staying in the urine, they can invade the cells lining the bladder. Here, they are harder to detect and harder to kill, effectively “hiding” from the antibiotics and the body’s immune system.
Other times, the antibiotic simply doesn’t work. This is known as antibiotic resistance. It means the bacteria have adapted in a way that makes the drug less effective.
There are also other factors that increase the risk of repeat infections. Hormonal changes, especially after menopause, can alter the urinary tract and make it easier for bacteria to grow. Sexual activity, certain contraceptives and incomplete bladder emptying can also play a role.
What are your options if it keeps coming back?
If infections keep coming back, a doctor may test your urine to identify the exact bacteria causing the infection. This helps guide treatment, rather than relying on best guess.
Treatment might include a longer course of antibiotics, or a low-dose antibiotic taken over a longer period to prevent recurrence.
For postmenopausal women, vaginal oestrogen can help restore the natural balance of the urinary tract and reduce infections.
Researchers are also exploring vaccines. One example, Uromune, targets common urinary bacteria and aims to train the immune system to respond more effectively.
Read more: Oral vaccines could provide relief for people who suffer regular UTIs. Here’s how they work
Alongside medical treatment, simple strategies can help reduce the risk of a UTI: staying hydrated, urinating after sex, and avoiding harsh soaps or products that may irritate the area. These steps won’t eliminate the chance of getting a UTI, but they can make a small difference.
What happens if it’s not treated properly?
Most UTIs stay in the bladder. But sometimes bacteria travel upwards to the kidneys, resulting in a kidney infection. This is more serious. Symptoms can include fever, lower back or side pain and nausea. It often requires stronger treatment.
Repeated infections can damage kidney tissue over time, affecting how well the kidneys filter waste.
In rare cases, the infection can enter the bloodstream. This can lead to sepsis, a life-threatening condition in which the body’s response to infection damages its own organs.
While uncommon, this shows why ongoing symptoms should not be ignored.
What complicates UTI treatment?
People with recurring symptoms and chronic UTIs often need ongoing, coordinated care. This may involve a GP for ongoing management, urine testing and preventative treatment. Sometimes, you may need a referral to a urologist to investigate underlying causes. Coordinated care can be difficult to access, especially if doctors dismiss symptoms.
Testing is also a challenge. Standard urine tests don’t always pick up hidden infections, leaving some people without clear answers. On top of this, antibiotic resistance complicates treatment.
For people living with recurrent infections, this is not a minor inconvenience. It affects sleep, work, relationships and quality of life. The good news is that, with the right care, many people can get their symptoms under better control.
So if your symptoms don’t improve, or keep coming back, it’s important to see a doctor. And if you feel your concerns are dismissed, find another doctor who listens and takes your symptoms seriously.
You can also ask your doctor about further testing, such as a urine culture to identify the exact bacteria, whether a longer or preventive course of treatment is appropriate, and if referral to a specialist may be needed.
If you have fever, severe back or side pain, or feel very unwell, seek urgent medical care, as this may indicate a more serious infection.
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