NEW YORK – More than half of women in the United States will get a urinary tract infection (UTI) in their lifetime. This is compared with an estimated 14 per cent of men.

Despite being common, the condition is often an experience layered with frustration and stigma, said Dr Kalpana Gupta, a professor at Boston University Chobanian & Avedisian School of Medicine who does research on UTIs.

Patients “feel some personal responsibility”, she added. “Like, ‘I’m doing something wrong’.”

In most cases, UTIs – known as bacterial cystitis – are only loosely correlated with personal behaviour, she said.

The main reason these are more common in women is that they have shorter urethras than men, which makes it easy for bacteria to reach the urinary tract.

A UTI in a man is often part of a larger health issue, Prof Gupta said.

A vast majority of cases are caused by E. coli bacteria, which live in the gut and sometimes hang out on the perineum. How and in what circumstances the bacteria migrate into the urethra and infect the urinary tract are “not 100 per cent worked out”, she said.

A lot of the misconceptions around UTIs crop up because there is very little quality research into the issue, said Dr Ja-Hong Kim, a urologist at UCLA Health.

Here are some of the most common questions experts get from patients.

Is it a UTI if there is no burning sensation?

It can be. A UTI can occur anywhere along the urinary tract, which includes the urethra, bladder, kidneys, and, in men, the prostate, Dr Kim said.

For an issue to be considered a UTI, a patient must show some symptoms and have confirmed bacteria in his or her urine.

A lot of the widely known symptoms, such as a burning sensation and a constant feeling of needing to go to the bathroom, come from studies that are done on young, college-aged, otherwise healthy adult women, Prof Gupta said.

But symptoms can vary.

In older adults, UTIs might present as a fever or a feeling of fullness, she said.

Some patients have lower backaches, signalling that the UTI might be in the kidneys, which would make it a more acute case that can lead to sepsis and kidney damage, though those outcomes are “very, very rare”, Dr Kim said.

Is it because I had sex?

Not necessarily. Women are often advised to urinate before and after sex to flush out any bacteria, but that practice is not backed by evidence, said NYU Langone director of uro-gynaecology Benjamin Brucker.

“I don’t have a study to quote you that says peeing after or before sex reduces infections,” he added.

Anecdotally, though, that might work for some women, he said.

The most common hypothesis about a connection between sex and UTIs is that bacteria on the skin of the perineum are pushed into the urethra during penetrative sex, which can develop into a UTI, Prof Gupta said.

Another is that because products, such as spermicides, change the microbiome of the vagina, they can create an environment in which bacteria can blossom and migrate to the urethra.

But some women never develop UTIs with increased sexual activity, even if they do not urinate before or after.

Is this a hygiene problem?

Doctors often tell women that hygiene – like wiping front to back, not wearing a wet swimsuit for long periods and avoiding tight-fitting underwear – can reduce the risk of developing a UTI.

The thinking is that wiping front to back reduces the chance that bacteria from faecal matter will be pushed into the urethra, and that a wet swimsuit or tight underwear might irritate the vaginal area.

Those practices do not hurt, but they are not rooted in scientific evidence either, Prof Gupta said, adding that dispensing such advice in the context of a UTI can end up giving women anxiety about their cleanliness.

“The bottom line is that the risk for UTI is not related to how well you bathe, a wet swimsuit or your choice of clothing,” she added.

Are antibiotics the only option?

Not always.

“Imagine you got scratched by a tree when you were out hiking, and it got a little red. You don’t necessarily go and get antibiotics because your body can fight off that bacteria,” Dr Brucker said.

“UTIs are bacteria like anything else”, and many young, healthy patients find that the body can eventually flush the bacteria out on its own.

While antibiotics are part of the standard care protocol, he said, it is worth getting a culture done first, which takes time, to figure out the best medical intervention.

In mild cases, good hydration can help the body get rid of the infection, he said.

There are over-the-counter pain relievers, such as Tylenol, Ibuprofen and Azo, that can help reduce discomfort while the body does its job.

For menopausal women, decreasing levels of hormones can alter the vaginal environment and increase the risk of UTIs. In those scenarios, Dr Brucker said, vaginal oestrogen can be “an excellent way” of preventing infection. NYTIMES