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According to the Centers for Disease Control and Prevention, the HIV epidemic is not the only thing that black people have to worry about.  The CDC claims that nearly half (48 percent) of all African American women between the ages of 14 and 49 are infected with genital herpes. There is no cure for genital herpes (herpes simplex 2), which can cause recurring sores in the genitalia and increases the likelihood of HIV transmission.  It is also related to oral herpes, or herpes simplex 1. The challenge of developing guidelines for the diagnosis, management, treatment, and prevention of urinary tract infections (UTIs) is a daunting one. In this article, the discussion of UTIs has been structured according to walking-well, chronically ill, and institutionalized elderly patients in order to better elucidate the issues associated with each population. Other medical conditions may predispose elderly patients to urinary retention and, consequently, bacteriuria. Cystitis: Cystitis, an inflammation or infection of the urinary bladder, is seen more often in females in this population. Other conditions predisposing to cystitis include pelvic-relaxation syndromes from birth trauma, obesity, and advanced age, which in women cause the ligaments and muscles supporting the pelvic organs and the pelvic floor to stretch. Interstitial Cystitis: Also known as painful bladder syndrome, interstitial cystitis involves pelvic pain, urinary urgency, and frequency in the absence of bacteriuria.
Honeymoon Cystitis: In women, this condition is diagnosed when symptoms of UTI develop following sexual intercourse. Diabetes Mellitus: UTIs affect millions of people each year and are responsible for billions of dollars in health care spending.
A critical step in the infection process is the adhesion of pathogenic bacteria to the bladder mucosa. Pyelonephritis: The most prevalent upper UTI, pyelonephritis is an ascending infection that involves the renal pelvis and is often secondary to chronic disease or a previous UTI ascending from the lower tract. The frequency of pyelonephritis is approximately 250,000 cases per year, with 40% of cases leading to hospitalization.24 Urine cultures are positive in 90% of these cases. Mucosal trauma from the calculi can cause inflammation and create a site for the development of bacterial seeding and infection.
Published infection rates of UTIs in the institutionalized geriatric population range from 12% to 30%.27 The anatomical and functional changes occurring in this population are usually complicated by underlying or chronic disease. One of the most challenging problems in the clinical management of this population is asymptomatic bacteriuria, which is defined as the presence of more than 100,000 colony-forming units of bacteria without symptoms or signs.
Because the presence of bacteriuria does not predict mortality in the aged, screening for asymptomatic bacteriuria is not recommended unless the patient is scheduled to undergo a genitourinary procedure. Physical Characteristics: A patient with clinically significant UTI appears ill and in distress. Laboratory Findings: Laboratory findings in clinically significant UTI will vary depending on the area of the system that is involved. The most common organisms found on culture are E coli, Klebsiella, Gonococcus, and Chlamydia.39 When a chronic indwelling catheter is present, other organisms must be considered, including Proteus, Staphylococcus, Streptococcus, Enterococcus, and Candida. Pyelonephritis carries a higher risk of systemic complications and requires immediate assessment and initiation of treatment. Acute prostatitis requires empiric treatment with quinolones or sulfa agents for 4 to 6 weeks.
In the treatment of suspected UTIs in institutionalized geriatric patients with indwelling catheters, it is recommended that the Loeb criteria be followed as a guide to therapy initiation and adverse outcomes.34,42 In patients without catheters, the presence of fever and other symptoms warrants initiation of therapy.
In geriatric patients presenting with urethritis in which the causative agent is identified as Gonococcus or Chlamydia, empiric treatment as per current public recommendations is advised. Various geriatric populations, from the walking well to those with chronic disease to the institutionalized, are affected by UTIs. I'm a 25 year old city girl who was diagnosed with HSV2 (aka genital herpes) four years ago but who refuses to give up on the idea of love (and really good sex) despite it. The condition runs through diverse populations of the elderly, from the walking well to the chronically ill.
The incidence of urethritis secondary to sexually transmitted disease (STD) caused by Chlamydia or Gonococcus has been increasing in this population, according to the CDC.


One of the more common causes is poor hygiene resulting in urethral contamination with fecal bacteria that then pass directly into the bladder. Vaginal intercourse promotes the entry of bacteria through the urethra and into the bladder. Women with type 2 diabetes and asymptomatic bacteriuria have been found to have an increased risk of developing a UTI during 18-month follow-up (27% of those with diabetes vs. It may present with fever, chills, nausea and vomiting, abdominal pain radiating to the back, and tenderness in the flank (costovertebral angle [CVA]) or bladder area.
In addition to the changes seen in the walking well, the kidneys may be less able to excrete acid and urea and may fail to maintain normal osmolality.
In long-term care facilities, concerns over bedwetting or soiling, skin breakdown, and secondary infection and patient hygiene associated with urinary incontinence may lead to placement of a permanent urinary catheter.29 This situation increases the risk of urosepsis (defined as bacteremia with systemic infection and potential vascular collapse). Urinary frequency, urgency, or dysuria may or may not occur or may not be reported because of the underlying functional status of the patient. This condition may be present in up to 30% of ambulatory elderly and up to 50% of institutionalized elderly.32 It also is found in nearly all catheterized patients. Treatment does not prevent recolonization in these patients and does not reduce the risk of development of a clinically significant UTI. Physical findings, while variable, generally include fever (body-temperature change may be small and dependent on individualized baselines). Typically, urinalysis shows proteinuria and red blood cells (from inflammation and injury), and tests are nitrite positive (because bacteria that colonize in the urine convert nitrates to nitrites).
In the nonhospitalized patient, initial empiric treatment can be a first-line antibiotic with adjustment within 48 hours based on urine culture and sensitivity results.
Empiric treatment and prophylaxis are ineffective and counterproductive and could lead to increased antibiotic resistance and other complications associated with prolonged antibiotic use. Each of these populations is impacted in different ways and requires a different treatment approach. In a patient with a suspected infection, diagnosis should be made based on the individual patient’s presenting symptoms, physical examination, and laboratory findings.
The treatment must be based on the patient’s overall health, underlying chronic conditions, and ability to care for himself or herself.
Each population has unique characteristics and requires a tailored approach to diagnosis and treatment.
In men, benign prostatic hyperplasia (BPH) causes urinary retention or incomplete voiding, promoting bacterial growth in the urine.
Acute prostatitis becomes chronic if symptoms persist for more than 3 months.10 However, even in acute cases, the recurrence rate is greater than 50% in the elderly.
In males, cystitis most commonly results from urinary tract obstruction; it usually is secondary to BPH and urinary retention, but it may be secondary to bladder enervation resulting from spinal-cord injury or multiple sclerosis. The low urinary pH caused by bacterial metabolism does not inhibit bacterial growth in this population. The presence of nitrite and leukocytes in the urine, as well as leukocytosis with a left shift, is generally sufficient for diagnosis. Treatment failure may be caused by resistant organisms or comorbid conditions such as obstructive abnormalities or immunocompromization. The consequences are increased perineal colonization, vaginitis, and bacterial colonization in the bladder. Geriatric patients with bacteriuria and bacteremia may not have fever or exhibit other signs of general infection. Abdominal examination usually demonstrates tenderness over the suprapubic area, usually without rebound tenderness.
If there is no improvement after a short course of therapy, a urine culture and sensitivity test should be performed and treatment instituted based on the findings. This requires prostatic massage with culture and sensitivity of the prostatic fluid and initiation of empiric treatment with sulfas and quinolones as above with adjustment based on laboratory findings.


Various treatments are available for UTI, and therapy should be based on the causative agent as well as on the pathophysiology and underlying comorbidities present.
Criteria for urinary tract infection in the elderly: variables that challenge nursing assessment. Acute bacterial prostatitis: two different sub-categories according to a previous manipulation of the lower urinary tract.
Frequency, risk factors, and responsible pathogenic microorganisms of asymptomatic bacteriuria in patients with type 2 diabetes mellitus.
Pathogenesis and management of bacterial urinary tract infections in adult patients with diabetes mellitus. Effect of glucose and pH on uropathogenic and non-uropathogenic Escherichia coli: studies with urine from diabetic and non-diabetic individuals.
Urinary tract infections: how to manage nursing home patients with or without chronic catheterization. Urinary tract infection in women over the age of 65: is age alone a marker of complication?
Clinical studies of cerebral and urinary tract function in elderly people with urinary incontinence.
Development of minimum criteria for the initiation of antibiotics in residents of long-term-care facilities: results of a consensus conference. Assessing adherence to evidence-based guidelines for the diagnosis and management of uncomplicated urinary tract infection.
National trends in emergency department antibiotic prescribing for elders with urinary tract infection, 1996–2005. Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women.
Etiologies of nongonococcal urethritis: bacteria, viruses, and the association with orogenital exposure.
I have been chronicling my life relating to the virus and social stigma with the hope of creating a support system and hopefully being there for anyone going through the same thing since 2011. Fecal soiling and poor perineal hygiene also may predispose patients to bacteriuria.5,6 Medications also may predispose elderly patients to bacteriuria. Risk factors for acute prostatitis include urethral stricture, lower UTI (cystitis or urethritis), BPH, instrumentation of the lower urinary tract, and prostatic biopsy. Diabetes is frequently associated with cystitis since glycosuria provides an ideal environment for infection. Further evaluation may reveal CVA tenderness, which may be considered a hallmark of pyelonephritis or stones.
Recurrent or chronic cystitis requires treatment based upon results of urine culture and sensitivity, as about 30% of cases are resistant to first-line antibiotics. Other organisms to be considered in the sexually active geriatric population include adenoviruses, Mycoplasma, Ureaplasma, and Gardnerella vaginalis.44 Treatments for these organisms are dictated by culture and sensitivity results.
Drugs such as anticholinergics used to treat Parkinson’s disease, antihistamines, psychotropics, and pain medications can lead to decreased parasympathetic tone and reduced motility and urinary flow. Get informed, get educated and always use protection!Please check out the FAQs before submitting questions to make sure they haven't already been answered. For us to change the narrative and get rid of HSV stigma, we first have to change our own narrative and start by noting how we unconsciously propagate it ourselves.




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