الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
UTIs are the most common bacterial infection requiring medical care.
Although UTI affects both genders, women at reproductive age group (15-44 years) are the most vulnerable, may be due to their anatomy and reproductive physiology. Women are particularly at risk of developing UTIs because of their short urethra, and certain behavioral factors which include delay in micturition, sexual activity and use of local contraceptives which promote colonization of the periurethral area with coliform bacteria. (3)
Previous studies identified urinary tract infection as a complication of contraceptive use. The predisposition of women to urinary tract infection (UTI), facilitated by the heavy colonization of their lower vagina and periurethral area by uropathogenic bacteria, is aggravated by contraceptive use.
The aim of the present study was to verify and outline the problem of symptomatic urinary tract infections among contraceptive users in Edko, Behira governorate to facilitate its prevention. A descriptive cross sectional survey was conducted to achieve the study objectives.
Consented female contraceptive users attending family health center in Edko, Behira governorate irrespective of age and parity were included in the present study (385females). Women who had known underlying renal pathology, chronic renal disease, diabetes mellitus, Women under immunosuppressive therapy for malignancy and rheumatic diseases or antibiotics use of less than 7 days from the last antibiotic dose were excluded. The study were conducted over 3 month’s period.
A structured interview questionnaire was designed to collect data regarding socio-demographic characteristics, obstetric and gynecologic risk factors, nutritional risk factors, Sexual activity, hygienic behavior, symptoms and history of UTIs
Urine analysis was performed for all symptomatic females included in the study. Urine culture was performed for symptomatic women only with bacteria count greater than 100,000 CFUs/ml.
The followings were the main results of the present study:
- Concerning sociodemographic characteristics of the studied women, more than half of them aged less than 40 years which is the peak age interval of using contraceptives. More than half of them had either secondary or university education, while only 18.2% are working.
- About two thirds of women (66.5%) reside at urban areas and the majority (95.1%) have running water supply.
- The majority have gravida 2 or 3
- Concerning distribution of the studied women according to current contraceptive methods, 44.4%of them (n=171) were using the loop, followed by oral contraceptive pills 30.9%, while monthly contraceptive injections represent only 12.7%. Contraceptive injections every 3 months represent 9.1%of cases and condom and natural methods represent together 2.9% of cases. According to the source of the method, Family health center represent the majority of cases65.97%.
- Only one third of women (31.9%) are drinking less than one liter/ day of water and about 23.1% are eating fruits and vegetables less than three times weekly and only 29.9% of them are eating fruits and vegetables daily.
- The majority of women (94.3%) mentioned that they are washing the urination site after urination. About half of them (51.9%) use polyester underwear. Regarding the usage of cotton towels for dryness, (51.4% ) of women are not use cotton towels for dryness. (48.8%) of cases are changing their under wear twice per day.
- The direction of dryness after washing was from backward to forward in (59.5%) of women. As regard usage of vaginal douches, the majority of women (83.1%) are not use vaginal douches.
- Regarding the health habits during menstruation, the type of pads used among about two thirds of women (64.9%) are sanitary pads and about half of them (54.0%) changing sanitary pads twice daily, one third (34.5% ) changed once daily and only (11.4%) changing pads more than two times daily.
- Prevalence of UTI was found to be (37.7% = 145 cases out of 385 cases).
- Out of 145 cases there is pus cells count ≥100 in 44%of them and pus cells count<100 in 55.9%.
- Urine culture was done for those with pus cells count ≥100 (n=64) which represent 44.1% of cases. Escherichia coli (84.38 %) was found to be the most common bacteria causing UTI.
- Regarding risk factors that were significantly associated with UTI among contraceptive use, The following was found:
Increased frequency of sexual intercourse was significantly associated with UTI p ≤ 0.041.
The majority of cases (74.3%) did not micturate before intercourse while (61.3%) of them micturate after intercourse. In cases who micturate after intercourse 70.3% of them had negative urine analysis, on the other hand those who did not micturate after intercourse 50.3% of them had UTI which is statistically significant (p>0.001).
Our study confirmed that a previous UTI may predispose to subsequent UTI as Two thirds (67.9%) of those with positive history of previous UTI had UTI. On the other hand, (70.4%) of those with negative history of UTI had negative urine analysis, the difference was statistically significant (p >0.001).
On studying the relation between symptomatic UTI and different type of contraception we found that none of those using natural methods of contraception had UTI. On the other hand ,50% of those using condom as a method of contraception had symptomatic UTI, followed by 40.9% of those using loop had symptomatic UTI, as regard hormonal methods (contraceptive injections every 3 months, monthly contraceptive injections, oral contraceptive pills) they represent 48.6%, 32.7% ,31.1% respectively .The difference was statistically not significant (p=0.232).