Recurrent Urinary Tract Infection

Recurrent Urinary Tract Infection

I get urine infection very often; do I have recurrent Urinary tract infection (rUTI)?

rUTI refers to getting at least 2 infections in six months or at least 3 infections in one year.

The episode of UTI must be confirmed with positive urine culture.

Is this common?

rUTI is one of the most common conditions affecting mainly women.

It is estimated that around 50–60% of women will develop UTIs in their lifetimes and Escherichia coli is the most common organism that causes UTI.

Is rUTI related to sex?

Yes. Sexual intercourse and the use of spermicide can be the cause of rUTI especially in young and pre-menopausal women.

What are the other causes of rUTI?

Young and pre-menopausal women Post-menopausal and elderly women

Sexual intercourse

Use of spermicide

A new sexual partner

A mother with a history of UTI

History of UTI during childhood

Blood group antigen secretory status

History of UTI before menopause

Urinary incontinence

Atrophic vaginitis due to oestrogen deficiency

Increased post-void urine volume

Blood group antigen secretory status

Adapted from European Association of Urology (EAU) guidelines

Am I genetically at risk of getting rUTI?

Yes, it is possible. The different blood groups secretor substances may influence the availability of these receptors on the urothelial cells (cells on the surface of the bladder) thereby affecting bacterial adherence and the susceptibility to UTI.

The frequencies of secretor status in different ABO blood groups are 70.1% in group A, 67.8% in group B, 67.9% in group AB, and 88.3% in group O.

Hence blood group B and AB individuals are at risk of getting recurrent UTI.

What should I expect at my first visit to a Urologist?

Your Urologist will first take a history, perform physical examination and do a series of tests to establish the diagnosis of rUTI. These may include:

  • Midstream urine analysis
  • Urine Culture and Sensitivity analysis of the bacteria involved
  • Bedside ultrasound examination of the kidneys and bladder
  • Uroflowmetry and post void residual urine

Depending on your symptoms, further tests such as CT scan or Cystoscopy might be offered by the Urologist.

The purpose of these tests is to exclude any organic causes to the recurrent nature of the UTI. These include stones, downstream obstruction such as prostate enlargement or by prolapsed organs (women) and most importantly to rule out underlying cancers that could account for the symptoms.

What is the prevention for rUTI?

  • Lifestyle and behavioral modification
  • Probiotics, cranberry and D mannose prevention
  • Antibiotics prevention
  • Immunoactive prophylaxis or oral vaccines

Prevention is better than cure!

Lifestyle and behavioral modification

  • Drink plenty of fluids
  • To urinate regularly
  • Not holding urine for a long time . This allows bacteria to multiply within the urinary tract, resulting in UTI.
  • Pass urine after sexual intercourse
  • Avoid spermicidal contraceptives if possible, diaphragms and vaginal douching with shower cream, soap or lotions. This will irritate the vagina and urethra area and facilitate the entry and colonisation of bacteria. They could alter vaginal flora and cause UTI.
  • To wipe from front to back, which will reduce the spread of E. coli from the perigenital area to the urethra.
  • Vaginal estrogen creams or rings may also reduce the risk of UTI in postmenopausal women

Probiotics, cranberry and D mannose prevention

Taking regular probiotics, cranberry supplements and D mannose has been shown to have positive effects towards rUTIs.

Do remember not all Lactobacillus strains are effective for vaginal flora restoration and rUTI prevention.

The highest efficacy was shown with L. rhamnosus GR-1, L. reuteri B-54, L. reuteri RC-14, L. casei shirota, and L. crispatus CTV-05.

Antibiotics prevention

  1. Self-start regime – If you are familiar with the symptoms and it has been proven with a urine culture before, the urologist may advise you to self-start antibiotic treatment whenever you are experiencing the start of the UTI symptoms.
  1. Post sexual intercourse self-start – If the UTI happens mostly after sexual intercourse, your Urologist may advise you to self start a 3-day prophylactic course of antibiotics after sexual intercourse.
  1. Long term low dose antibiotic regime – Your urologist may advise you to take a 3 to 6 month daily course of low dose antibiotics to prevent recurring UTI. This is usually advised when all conservative measurements fail.

Immunoactive prophylaxis or oral vaccines

The 2 most common used oral vaccines in the market are OM-89 and MV 140.

Several meta-analyses and systematic reviews based on Randominsed controlled trials have shown that oral immunotherapy is effective and safe method for the prevention of rUTIs compared to placebo at short-term follow up to 12months.

OM-89 or Uro-Vaxom® has been shown effective in preventing E coli rUTI in women compared to placebo. It is an oral capsule to be taken once a day for 3 months with or without subsequent booster dose.

On the other hand, MV 140 or Uromune™, a Sublingal spray to be taken twice a day for 3 months is effective in preventing 4 different types of bacteria causing rUTI ( Ecoli, Klebsiella pneumoniae, Proteus vulgaris and Enterococcus Faecalis).

These 2 oral vaccines have been recommended in European Association of Urology (EAU) in its guidelines. In Singapore, these vaccines are brought in through HSA’s Special Access Route.

Please visit your Urologist today to find out more.

Contributed by:
Dr Shirley Bang
Urologist

Advanced Urology Associates
Appointments: +65 6738 1838
Email: enquiry@urology.com.sg
https://urology.com.sg/

What is Hyperthyroidism?

What is Hyperthyroidism?

First and foremost, you might be wondering, what is a “thyroid”? The thyroid is a butterfly shaped structure that produces thyroid hormones, and it is in the anterior aspect of one’s neck Thyroid hormones come in different forms, and it plays a very important role in us. It helps with metabolism, growth, various bodily functions and more. When there is too much thyroid hormones being produced, it results in hyperthyroidism which is what we are sharing about this month. 

The most common cause of hyperthyroidism is known as Grave’s Disease. Other causes include toxic nodules and the thyrotoxic phase of thyroiditis (2). In Singapore, thyroid disorders are more common in women aged 20 to 50 (3).

Symptoms of Hyperthyroidism

Symptoms vary in severity, but commonly include:

  • Nervousness, anxiety, or irritability
  • Weight loss despite an increased appetite
  • Rapid or irregular heartbeat
  • Heat intolerance and excessive sweating
  • Trembling hands or muscle weakness
  • Enlarged thyroid gland (goiter)
  • Eye problems, such as bulging eyes (common in Graves’ disease)

It is essential to seek medical advice if you notice these symptoms, as they may overlap with other conditions (4).

Causes of Hyperthyroidism

Several factors can lead to hyperthyroidism, including:

  1. Graves’ Disease: An autoimmune disorder causing excess hormone production (accounts for 70-80% of cases) (5).
  2. Toxic Nodular Goitre: Overactive thyroid nodules that increases hormone production (6).
  3. Excess Iodine Intake: High iodine levels, often from supplements or medications, can trigger hyperthyroidism.
  4. Family History: A family history of thyroid disorders increases susceptibility.

When Should You See a Doctor?

If you experience persistent symptoms like weight loss, heart palpitations, or anxiety, it’s crucial to consult a Doctor. Early diagnosis can prevent complications such as osteoporosis, atrial fibrillation, or in rare cases, thyroid storm—a life-threatening condition (7).

Doctors commonly conduct the following tests (non-exhaustive) (8):

  • Physical Examination: To detect signs like goiter or rapid heart rate.
  • Blood Tests: To measure various thyroid markers
  • Imaging Tests: Imaging studies, like ultrasounds, to evaluate the thyroid gland

Early detection and proper management can make a significant difference in maintaining your overall well-being. Stay informed, stay proactive, and take control of your health in 2025.

References

  1. Szylvian, C. (2009). Thyroid Disorders: A Multi-Disciplined Analysis. Retrieved December 12, 2024, from https://core.ac.uk/download/pdf/151480655.pdf
  2. Lee, S.Y. and Pearce, E.N. (2023). Hyperthyroidism. JAMA, [online] 330(15), pp.1472–1472. doi:https://doi.org/10.1001/jama.2023.19052.
  3. www.singhealth.com.sg. (n.d.). Hyperthyroidism. [online] Available at: https://www.singhealth.com.sg/patient-care/conditions-treatments/hyperthyroidism.
  4. Reid, J.R. and Wheeler, S.F. (2005). Hyperthyroidism: Diagnosis and Treatment. American Family Physician, [online] 72(4), pp.623–630. Available at: https://www.aafp.org/pubs/afp/issues/2005/0815/p623.html.
  5. Graves’ Disease. (2005). Thyroid Disease, [online] pp.21–30. doi:https://doi.org/10.1385/1-59259-944-3:021.
  6. Linnell, J.W. (1956). Hyperthyroidism. International Journal of Clinical Practice, 10(4), pp.209–215. doi:https://doi.org/10.1111/j.1742-1241.1956.tb00521.x.
  7. Cleveland Clinic (2024). Hyperthyroidism: Symptoms, Causes, Treatment & Medication. [online] Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/diseases/14129-hyperthyroidism
  8. Meng, W. (2001). Diagnosis of hyperthyroidism. Zeitschrift fur arztliche Fortbildung und Qualitatssicherung, [online] 95(1), pp.51–60. Available at: https://pubmed.ncbi.nlm.nih.gov/11233497/.

Understanding the Legal Aspects of Employee Benefits in Singapore

Understanding the Legal Aspects of Employee Benefits in Singapore

Employee health benefits are crucial in attracting and retaining top talent in Singapore’s competitive market. However, navigating the legal landscape surrounding benefits can be daunting for SMEs. Here are some essential statutory requirements and regulations you must understand as an employer in Singapore, along with additional details to ensure complete compliance.

Complying with the Law: Avoiding Pitfalls and Building Trust

Singapore has a robust legal framework governing employee benefits. The Ministry of Manpower (MOM) enforces strict regulations to protect workers’ rights and ensure fair treatment. Failing to comply with these regulations can result in:

  • Penalties: The MOM can impose fines for non-compliance with various benefit-related laws. These fines can be significant and have a negative financial impact on your business. For example, non-payment of CPF contributions can lead to breach of Central Provident Fund Act 1953 that resulted in penalties.
  • Legal Disputes: Employees who believe they haven’t received proper benefits may pursue legal action against your company. Legal disputes can be costly and time-consuming; even a losing case can damage your employer’s brand.
  • Reputational Damage: Non-compliance with employee benefit regulations can quickly become public knowledge, especially in today’s digital age. This can negatively impact your employer’s brand, making attracting and retaining qualified personnel harder. Potential hires may hesitate to work for a company with a reputation for unfair labour practices.

Beyond Compliance: Building a Competitive Benefits Package

While complying with legal requirements is essential, building a competitive benefits package surpasses the minimum standards. Here are some additional tips to consider:

  • Conduct a Benefits Needs Assessment: Survey your employees to understand their needs and preferences before designing your benefits package. This will help you tailor your offerings to maximise employee satisfaction.
  • Offer Flexible Benefits Options: Consider offering a flexible benefits plan, allowing employees to choose from various benefits based on their needs. This can be a desirable option for a diverse workforce.
  • Stay Updated on Industry Trends: Employee benefits trend are constantly evolving. Regularly research what your competitors offer and adapt your package to stay competitive in the talent market.

Building a Compliant and Competitive Benefits Strategy

At MHC Asia Group, we understand the complexities of managing employee benefits in Singapore. We offer a comprehensive suite of services designed to simplify the process for SMEs and ensure you stay compliant with all legal regulations:

  • Compliance Specialist: Our team of experienced professionals stays up-to-date on the latest legal requirements and can guide you in developing a compliant benefits programme.
  • Customisable Solutions: We work closely with you to understand your company’s unique needs and budget. We will then design a customised benefits package that is attractive to your target talent pool and aligns with your overall business goals.
  • Benefits Administration Support: Managing employee benefits can be time-consuming and complex. MHC Asia is able to handle benefits administration for you, from claims processing to flexible benefits . This frees up your time and resources to focus on other core business functions.
  • Technology-Driven Solutions: We offer a user-friendly online platform that allows you to manage your benefits programme efficiently. Employees can also access the platform to view their benefits information, submit claims, and change their elections (if applicable, with a flexible benefits plan).
  • Ongoing Support: The legal landscape surrounding employee benefits can change frequently. MHC Asia will provide ongoing support to ensure your benefits programme complies with all current regulations.

Your Partner for a Streamlined and Successful Benefits Programme

By partnering with MHC Asia Group, you can gain peace of mind knowing your employee benefits administration is legally compliant, cost-effective, and attractive to top talent. We empower you to focus on running your business. At the same time, we handle the complexities of employee benefits management.

Benefits of Partnering with MHC Asia:

  • Reduced Risk of Non-Compliance: Our specialty helps you avoid costly penalties and legal disputes associated with non-compliance.
  • Improved Employee Satisfaction: A well-designed benefits package can significantly boost employee morale, engagement, and retention.
  • Enhanced Employer Brand: Offering health initiatives for employees portrays your company as a caring and responsible employer, making you more attractive to potential hires.
  • Cost Savings: MHC Asia can help you optimise your benefits programme to maximise value and minimise administrative costs.

Contact MHC Asia Group today for a free consultation. Let’s discuss your needs and explore how we can help you design a compliant, competitive, cost-effective benefits programme that empowers your workforce and drives your business success.