Department of Health | HIV, STD, and TB Services | Congenital Syphilis
Are Urinary Tract Infections Linked To Heart Attacks And Strokes?
Urinary tract infections (UTIs) may be a trigger for myocardial infarction (MI) or stroke, with an increased risk for both within the first 7 days of infection, according to the findings of a study published in BMJ Open.
Growing evidence suggests that acute infection plays a role in the pathogenesis of cardiovascular disease.
Researchers from Cardiff University in the United Kingdom conducted this self-controlled cases series using data from the Secure Anonymised Information Linkage (SAIL) Databank which houses nation-wide data from Wales. Patients (N=105,930) with MI (n=51,660) or stroke (n=58,150) between 2010 and 2020 were evaluated for general practitioner suspected or confirmed UTI before or after MI or stroke event. The peak risk period was defined as up to 90 days after UTI.
The MI and stroke cohorts consisted of 63% and 49% men, with mean ages of 69 and 74 years for men and 77 and 79 years for women, respectively.
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This finding was robust to a range of secondary and sensitivity analyses and warrants further work to better understand mechanisms and inform trials of primary prevention.
Among these, 2320 individuals in the MI cohort and 2840 in the stroke cohort had an identified UTI. In the UTI subgroups, men comprised 38.8% and 31.5% of the MI and stroke cohorts, with mean ages of 74 and 78 years, respectively. Women had mean ages of 76 and 79 years, and the electronic Frailty Index (eFI) was 0.23 for the MI group and 0.24 for the stroke group.
The MI cohort collectively had 3900 confirmed UTI events, of which 120 MIs occurred during the peak risk period. Overall risk for MI was higher in the 7 days after UTI (adjusted incidence rate ratio [aIRR], 2.49; 95% CI, 1.65-3.77) and at 15 to 28 days after UTI (aIRR, 1.60; 95% CI, 1.10-2.33).
The stroke cohort collectively had 4600 confirmed UTI events, of which 10 occurred prior to UTI and 200 in the peak risk period. Risk for stroke was higher in the 7 days after UTI (aIRR, 2.34; 95% CI, 1.61-3.40) and at 29 to 90 days after UTI (aIRR, 1.26; 95% CI, 1.05-1.52).
In secondary analyses, MI risk was increased in 8 to 14 days after suspected UTI with mixed bacteria growth on culture (aIRR, 2.07; 95% CI, 1.03-4.15), within 7 days after suspected UTI without urine culture (incidence rate ratio [IRR], 1.83; 95% CI, 1.54-2.18), and within 7 days after suspected UTI with no bacterial growth on culture (IRR, 3.69; 95% CI, 2.28-5.96).
For stroke, risk was higher in the first 7 days of all types of suspected UTI events.
Significant interactions between UTI and Escherichia (E) coli positivity for MI (P <.0001) and stroke (P <.0001) risk were observed, in which the magnitude for MI risk was lower with E coli than other organisms (IRR, 2.55 vs 3.54), whereas the magnitude for stroke risk was higher with E coli than other organisms (IRR, 3.06 vs 2.34), respectively.
This study may have been limited, as the precise date of UTI symptom onset was not known.
"We observed an increased risk of MI and stroke immediately following a UTI. This finding was robust to a range of secondary and sensitivity analyses and warrants further work to better understand mechanisms and inform trials of primary prevention," the researchers concluded.
This article originally appeared on Infectious Disease Advisor
Why UTIs Strike When You're Most Stressed - Rolling Out
Understanding the surprising link between your mental health and urinary infections
Urinary tract infections rank among the most common bacterial infections, affecting millions of people each year. While many understand the basic causes and symptoms of UTIs, fewer recognize the significant impact that psychological factors, particularly stress, can have on both developing these infections and experiencing more severe symptoms.
How UTIs develop in your bodyUrinary tract infections occur when bacteria enter and multiply within any part of the urinary system – the kidneys, ureters, bladder, or urethra. Most commonly, these infections affect the lower urinary tract (bladder and urethra), though more serious infections can spread to the kidneys.
The majority of UTIs develop when bacteria from the digestive tract, typically E. Coli, spread from the anus to the urethra. Because people with vaginas have shorter urethras positioned closer to the anus, they experience UTIs more frequently, though people of any gender can develop these infections.
Once bacteria enter the urinary tract, they can multiply rapidly in the warm, moist environment. If the body's natural defense mechanisms fail to eliminate these invaders, infection takes hold, triggering the immune system's inflammatory response that creates the characteristic symptoms.
The body naturally flushes bacteria from the urinary tract during urination. However, certain factors can compromise this natural defense, including dehydration (which reduces urination frequency), structural abnormalities in the urinary tract, or weakened immune function – which is where stress enters the picture.
Recognizing UTI symptoms earlyIdentifying UTI symptoms promptly can help prevent progression to more serious infections. The most common indicators include:
Pain or burning sensation during urination often represents the first noticeable sign of infection. This discomfort results from irritation and inflammation of the urethra as urine passes through the infected area. The sensation can range from mild discomfort to intense burning that causes significant distress.
Frequent urination urges, sometimes occurring every 30-60 minutes, signal the bladder's irritated state. Even more frustrating, these frequent trips to the bathroom often produce only small amounts of urine, creating a feeling of urgency without relief.
Pelvic pressure or discomfort manifests as a persistent ache or heaviness in the lower abdomen. This symptom results from inflammation of the bladder and surrounding tissues as the infection progresses.
Cloudy, strong-smelling, or blood-tinged urine indicates the presence of white blood cells, bacteria, and sometimes red blood cells in the urine. The characteristic odor comes from bacterial byproducts, while visible blood results from inflammation damaging the delicate tissues lining the urinary tract.
More severe infections may involve fever, flank pain, and systemic symptoms like fatigue. These signs typically indicate the infection has spread to the kidneys (pyelonephritis) and requires immediate medical attention.
The surprising stress-infection connectionThe relationship between stress and UTIs involves complex interactions between the nervous, endocrine, and immune systems. Under stress, your body initiates a cascade of physiological responses that, while designed for short-term survival benefits, can compromise immune function when prolonged.
Acute stress triggers the "fight-or-flight" response, releasing hormones like adrenaline and cortisol that temporarily enhance certain aspects of immunity. However, chronic stress – the kind experienced during ongoing work pressure, relationship difficulties, or financial problems – creates sustained high cortisol levels that suppress immune function over time.
Specifically, chronic stress reduces the production and effectiveness of white blood cells responsible for fighting bacterial invaders. These immune cells, including neutrophils and natural killer cells, play crucial roles in preventing bacteria from establishing infections in the urinary tract.
Beyond direct immune suppression, stress increases inflammation throughout the body. This systemic inflammatory state can exacerbate UTI symptoms and potentially slow healing once infection develops. The inflammatory response, while necessary for fighting infection, becomes counterproductive when excessive.
Stress also influences behavior in ways that increase UTI risk. Stressed individuals often neglect self-care habits that prevent UTIs – they may forget to stay hydrated, postpone bathroom trips despite feeling the urge to urinate, or neglect proper hygiene practices due to time constraints or mental distraction.
Additionally, stress can alter urinary habits directly through its effects on pelvic floor muscles. Chronic tension often leads to pelvic floor dysfunction, potentially interfering with complete bladder emptying – a significant risk factor for UTIs, as residual urine provides an excellent environment for bacterial growth.
UTIs versus stress-related urinary symptomsComplicating the picture further, stress can create urinary symptoms that mimic UTIs even without infection. These conditions, collectively called lower urinary tract symptoms (LUTS), include:
Interstitial cystitis/bladder pain syndrome causes chronic bladder pressure, discomfort, and frequent urination without infection. Often triggered or worsened by stress, this condition involves inflammation of the bladder wall but differs from UTIs in that bacteria aren't present. Many patients report flare-ups during particularly stressful life periods.
Overactive bladder syndrome creates sudden, urgent needs to urinate that may be difficult to control. While various factors contribute to this condition, research demonstrates that psychological stress can trigger or worsen symptoms through its effects on bladder muscle control and nerve signaling.
Pelvic floor dysfunction often develops or worsens during stressful periods. The pelvic floor muscles, which support the bladder and other pelvic organs, can become overly tense or uncoordinated during stress. This dysfunction creates urinary symptoms similar to UTIs, including frequency, urgency, and discomfort.
Distinguishing between infection and stress-related symptoms requires laboratory testing of urine samples to detect bacteria. This distinction proves crucial for proper treatment – antibiotics effectively address bacterial infections but won't help stress-related urinary symptoms and may cause side effects or contribute to antibiotic resistance when used unnecessarily.
Effective stress management for urinary healthAddressing stress represents a powerful yet often overlooked strategy for both preventing UTIs and managing related urinary symptoms. Effective approaches include:
Mindfulness practices reduce stress by focusing attention on the present moment without judgment. Regular meditation, even just 10-15 minutes daily, decreases cortisol levels and inflammation while enhancing immune function. Simple breathing exercises can activate the parasympathetic nervous system, counteracting stress responses throughout the day.
Physical activity provides perhaps the most effective natural stress reliever. Exercise reduces cortisol levels, increases endorphins, improves sleep quality, and enhances overall immune function. Even moderate activities like walking, swimming, or yoga offer significant benefits for both stress reduction and urinary health.
Adequate sleep proves essential for stress management and immune function. During sleep, the body repairs tissues, produces immune cells, and processes emotional stress. Establishing regular sleep patterns, creating a restful environment, and limiting screen time before bed can significantly improve sleep quality.
Social connections buffer against stress effects, with research showing that meaningful social relationships reduce stress hormone levels and inflammation. Regular interaction with supportive friends or family members, even virtually, provides emotional outlets and practical assistance during stressful periods.
Professional support through therapy offers valuable tools for managing chronic stress. Cognitive-behavioral techniques help identify stress triggers and develop healthier responses, while other therapeutic approaches address underlying causes of chronic stress and anxiety.
Direct prevention strategies for UTIsBeyond stress management, specific preventive measures significantly reduce UTI risk:
Hydration stands as perhaps the simplest yet most effective prevention strategy. Drinking plenty of water dilutes urine and increases urination frequency, helping flush bacteria from the urinary tract before infection establishes. Aim for pale yellow urine as an indicator of adequate hydration.
Post-intercourse urination represents a crucial habit for sexually active individuals. Sexual activity can introduce bacteria into the urethra, but urinating within 30 minutes afterward helps flush these potential pathogens out before they can multiply and cause infection.
Proper wiping technique – front to back after using the toilet – prevents introducing intestinal bacteria to the urethral area. This simple habit significantly reduces UTI risk, particularly for people with vaginas.
Avoiding irritants like scented hygiene products, douches, or harsh soaps around the genital area helps maintain healthy bacterial balance and prevents irritation that might increase infection susceptibility. The genital area's natural microbiome provides protection against pathogenic bacteria when left undisturbed.
Cranberry products have shown some preventive benefit, particularly for those with recurrent UTIs. While not universally effective, compounds in cranberries may prevent bacteria from adhering to urinary tract tissues. Unsweetened cranberry juice or supplements provide this benefit without added sugars.
When to seek medical attentionDespite preventive efforts, UTIs sometimes develop and require proper medical care:
Persistent symptoms lasting more than 24-48 hours warrant medical evaluation. Early treatment prevents infection spread to the kidneys and reduces complication risks.
Severe symptoms including fever, flank pain, nausea, or vomiting indicate possible kidney involvement requiring immediate medical attention. Kidney infections can lead to serious complications if not promptly treated.
Recurrent infections – typically defined as three or more UTIs within a year – justify comprehensive evaluation. Underlying anatomical abnormalities, immune system issues, or resistant bacteria may contribute to this pattern and require specialized management approaches.
Standard treatment typically involves antibiotics targeted to the specific bacteria causing infection. Completing the full prescribed course remains essential even when symptoms improve quickly, as partial treatment can lead to recurrence or antibiotic resistance.
By understanding the intricate connection between stress and urinary health, you gain powerful tools for preventing UTIs and managing related symptoms. This holistic approach – addressing both psychological factors and specific preventive practices – offers the most effective strategy for maintaining urinary wellness and overall health.
Your Guide To Blujepa For Bladder Infections - WebMD
Blujepa (gepotidacin) is a new antibiotic recently approved by the FDA for treating bladder infections caused by certain bacteria in women and girls ages 12 and older. Blujepa works differently than other medicines. It blocks bacteria from copying their DNA, which helps to stop the infection from spreading. In clinical trials, Blujepa worked just as well as or better than another medicine that is commonly used to treat bladder infections.
Bladder infections are the most common type of urinary tract infection (UTI). UTIs are very common, affecting more than half women in their lifetime. The most common germ causing UTIs is bacteria.
Health care providers may prescribe antibiotics to treat these infections, sometimes without testing the bacteria to see if it will resist the medicine. These infections may be hard to treat because bacteria in some locations may have developed resistance to certain antibiotics. As antibiotic resistance grows, these infections have become harder to treat.
The FDA approved Blujepa in March 2025. Blujepa's approval marks the first new oral antibiotic medicine for UTIs in nearly 30 years. Below are common questions and answers about Blujepa for bladder infections.
To decide if Blujepa is right for you, your health care provider will look at things like your age, weight, medical history, and the cause of your bladder infection.
Specifically, Blujepa is FDA-approved to treat simple (uncomplicated) bladder infections in females ages 12 and older who weigh at least 40 kilograms and the UTI is caused by certain types of bacteria. Below are more details about Blujepa's approved use.
Blujepa may not be the right medicine for some bladder infections, depending on which germs are causing the infection.
Before prescribing Blujepa, your health care provider may test your urine to find out the type of bacteria causing the infection. They can also do tests, known as urine culture and sensitivity tests, to check if the bacteria have developed resistance to certain antibiotics. Your health care provider will likely use these test results to choose or adjust your treatment. If test results are not available, local patterns of bacterial resistance can help health care providers decide on the best treatment for your UTI.
Blujepa contains the active ingredient gepotidacin. It belongs to a group of medicines called antibiotics. Blujepa is the first medicine in a new class of antibiotics known as triazaacenaphthylenes. It is a bactericidal antibiotic, which means the medicine works by killing bacteria.
Blujepa treats bladder infections by blocking enzymes in certain bacteria. These enzymes, called type II topoisomerases, are important for bacteria to copy their DNA and reproduce. By blocking these enzymes, Blujepa essentially stops the bacteria from growing and multiplying, causing them to die.
The effectiveness of Blujepa was tested in two clinical trials called EAGLE-2 and EAGLE-3. These trials compared two different treatments for bladder infection in more than 3,000 females (people assigned female at birth) total. The studies involved patients from 219 medical centers worldwide, but most of the participants were in the United States.
In the EAGLE-2 and EAGLE-3 studies, the average age of participants was 48-50. About 82%-84% of participants were White, 5.2%-8.9% were Black or African American, 2.9%-7.2% were Asian, 0.2%-0.3% were American Indian or Alaskan Native, 0.1%-0.3% were Native Hawaiian or Pacific Islander, and the remainder identified as more than one race, did not report, or had an unknown race.
Everyone in the studies had at least two symptoms of a bladder infection, such as painful, frequent urination or lower abdominal pain, with test results showing signs of infection, such as pus in the urine.
People were not allowed to enter the studies if they were pregnant or had a complicated urinary tract infection (UTI). A complicated UTI is a more serious bladder infection that can be harder to treat and may involve upper parts of the urinary tract, such as the kidneys.
Less than half (40%-41%) of the people in the studies had a history of bladder infections that kept coming back (recurrent infections).
In both studies, people were randomly assigned to take either Blujepa twice a day for five days or another antibiotic, nitrofurantoin (Macrobid), twice a day for five days. Nitrofurantoin is commonly used to treat bladder infections. No one knew which treatment they were getting.
The main goal of the EAGLE-2 and EAGLE-3 clinical trials was to see if the treatments successfully resolved symptoms and reduced bacteria in the urine at a follow-up assessment.
The effectiveness of the treatment was evaluated at a follow-up visit, which took place on day 10 to 13 of the study. During this visit, the researchers looked at two specific outcomes.
Both of these outcomes were considered together to assess whether the treatment worked. The treatment could only be considered successful if a patient showed improvement in both their symptoms and urine bacteria levels. This combined result, which looks at more than one measure to determine overall treatment success, is known as a composite response.
Effectiveness was measured at a follow-up visit on day 10 to 13 of the studies. The results showed that Blujepa worked just as well as or better than nitrofurantoin (Macrobid) to successfully treat bladder infections.
The tables below summarize the results of the EAGLE-2 and EAGLE-3 clinical trials. More specifically, results are shown as the percentages of people who experienced an overall treatment success, a clinical cure, and a microbiological response.
EAGLE-2 Results
Nitrofurantoin
Blujepa
Overall treatment success (composite response)
47%
51.8%
Symptoms resolved (clinical cure)
65.8%
66.7%
Urine bacteria reduced (microbiological response)
66.8%
72.6%
EAGLE-3 Results
Nitrofurantoin
Blujepa
Overall treatment success (composite response)
44%
58.9%
Symptoms resolved (clinical cure)
63.6%
68.2%
Urine bacteria reduced (microbiological response)
57.5%
72.9%
Together, these studies support Blujepa as an effective treatment option for uncomplicated bladder infections caused by certain types of bacteria in women and girls ages 12 and older. Your results may be different from what was seen in studies.
Blujepa starts to work soon after you take your first dose. Blujepa is typically prescribed for five days. It may take longer than five days for the medicine to cure the infection. This is because Blujepa continues to work in your body to kill bacteria after you finish taking it.
Blujepa comes in 750-milligram tablets.
The typical dosage is 1,500 milligrams (two 750-milligram tablets) taken by mouth twice a day for five days. It is recommended to take doses of Blujepa 12 hours apart. Take each dose after a meal to lessen the chance of stomach discomfort.
Even if the symptoms of your bladder infection start to ease early on, it is important to take Blujepa exactly as your health care provider has directed. Do not skip doses or stop the medicine early. If you do, it could make the treatment less effective and increase the chances of the bacteria becoming resistant. This means Blujepa may not work for you in the future, and other antibiotics might also become less effective.
Be sure to follow your prescriber's directions while taking Blujepa.
The list below includes some details about the common side effects of Blujepa and possible ways to help manage them. This is not a complete list of side effects. Tell your health care provider if these side effects bother you or do not go away. They may let you know about other ways to prevent or manage Blujepa side effects.
Diarrhea. Diarrhea is the most common side effect of Blujepa and often starts within the first two days of treatment. Your bowel movements may be watery or soft. For most people, this side effect is usually mild and goes away within a few days.
Nausea or vomiting. Nausea is a more common side effect of Blujepa, while vomiting is relatively less common. Taking Blujepa after a meal may help lessen these side effects.
Stomach pain or gas. It is common to have pain in your belly (abdomen) while taking Blujepa. As mentioned, timing your dose after you eat can help make this side effect less bothersome.
Headache or dizziness. Some people may have a headache or feel dizzy while taking Blujepa. These effects usually go away on their own. Drinking plenty of water and resting can help. If needed, a health care professional can recommend an OTC pain reliever that is safe for you, such as acetaminophen (Tylenol).
Vaginal yeast infections. The most common symptom is itchiness in and around the vagina, along with possible burning, swelling, and a thick, white discharge. A health care provider can confirm the yeast infection and recommend the best treatment for it. Yeast infections are typically treated with antifungal medicines, which are available OTC and by prescription.
Blujepa may cause serious side effects such as rare heart rhythm problems, severe antibiotic-associated diarrhea (C. Difficile), or allergic reactions. Tell your health care provider or get help right away if you have side effects that feel severe or do not go away.
Blujepa requires a prescription from a health care provider. You cannot buy it over the counter.
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