Lived experience and clinical need of women of reproductive age with Ureaplasma urealyticum infection: a qualitative study

Abstract

Objectives

To explore the lived experiences and current clinical needs of women of reproductive age with Ureaplasma Urealyticum (UU) infection in the reproductive tract.

Materials and methods

A descriptive qualitative study was conducted using purposive sampling. Sixteen women of reproductive age with UU infection of the reproductive tract were included in the study. Data collection was based on in-depth interviews and on-site records of the researchers. Inductive thematic analysis was conducted.

Results

Five themes emerged: (a)physiological impact, (b)psychological impact, (c)social impact, (d)economic impact, and (e)clinical health care needs. The impact is diverse, radiating to various aspects of their physiology, psychology, society, and economy. The clinical needs of the relevant population mainly include information, psychological, and support needs.

Conclusions

Our findings indicate the need to strengthen intervention plan development; emphasize knowledge dissemination, psychological intervention, and social support for relevant populations; and provide assistance in disease treatment and management.

KEY MESSAGES

This article describes a qualitative case study focusing on the lived experiences and current clinical health care needs of women of reproductive age with UU infection in the reproductive tract. The interviewees reported that UU had a negative impact on their physical, psychological, social, and economic well-being, and they hoped that clinical staff could assist in providing information, psychological, and social support.

Ureaplasma Urealyticum (UU) is a common colonizing prokaryotic microorganism in the human urogenital tract [1], which can be transmitted through sexual contact and perinatal transmission [2]. When the microecological balance is disrupted, it can become an opportunistic pathogen and cause diseases [3]. Due to the diversity in geographic and socio-economic conditions, population structure, and patterns of sexual behavior, the reported UU colonization rates vary significantly across different regions, with some areas reporting colonization rates as high as 50% [4]. Infection may lead to inflammatory diseases such as cervicitis, endometritis, and salpingitis [5], and in severe cases, can cause infertility, miscarriage, and premature birth [6,7]. Currently, the global population infected with UU is showing a trend of younger age, propelled by shifting sexual norms, rising sexually transmitted diseases, and the absence of a vaccine, highlighting the necessity of paying more attention to this issue [8]. Additionally, UU infection can interfere with immune regulation, cause microbial imbalance, and increase the risk of other sexually transmitted infections [9,10].

Moreover, UU infection can have a far-reaching impact on the well-being of women [11]. When symptomatic, UU infection tends to trigger physical discomforts like unusual discharges and lower abdominal pain [12]. Beyond the physical aspects, it can also significantly affect the mental health of women [12,13]. Research has indicated that such infection may lead to confusion and self-rejection in their self-perception [14]. This can further result in emotional turmoil, characterized by anxiety and depression [14]. In terms of sexual health, UU infection may cause a decline in sexual desire and lead to painful intercourse [8]. From a social standpoint, the stigma associated with UU infection might make women feel isolated and ashamed during social interactions, thereby negatively affecting their interpersonal relationships and overall quality of life [15]. Meanwhile, due to the chronic, covert, and recurrent nature of UU infection, patients often struggle with adherence to treatment [16,17]. This issue of non-compliance not only affects the efficacy of treatment but also leads to the persistent spread and recurrence of the infection [18].

Although previous studies have partially summarized the impact of reproductive tract infections (RTIs) on the life experiences of females, there was still a lack of targeted research on the life experiences and clinical healthcare needs of women with symptomatic UU infections [19–22].These studies often grouped UU with other RTIs, failing to isolate its specific impact on quality of life [22]. Furthermore, they primarily focused on psychosocial impacts, neglecting a thorough analysis of the specific clinical healthcare problems and needs faced by this population [19,23,24]. Therefore, understanding the distinct impact of UU infection and the associated clinical needs is essential for optimizing interventions and improving treatment outcomes.

To address the aforementioned issues, this study employed semi-structured in-depth interviews to accurately capture the prominent problems and unmet needs of women with symptomatic UU infection in terms of physiological impact, psychological impact, social impact, economical impact, and clinical health care needs.

1. Material and methods

Qualitative descriptive methods and semi-structured in-depth interviews were used in this study to explore two main aspects: (a) to investigate the lived impacts of UU infections on reproductive-age women, and (b) to understand the clinical health care needs of these women to help in proposing appropriate clinical care programs.

2.1. Participants, sampling strategies and recruitment process

Purposeful sampling was conducted to explore the specifics of the impact and experience of reproductive tract UU infections in women of reproductive age. The research participants came from multiple departments of two tertiary hospitals in Hengyang City, China, including gynecology, obstetrics, and reproductive medicine centers, and all samples were from clinical practice.

The inclusion criteria were as follows: (a) female; (b) aged 15–45 years, defined as women of reproductive age [25]; (c) diagnosis of UU infection by a clinician through laboratory polymerase chain reaction(PCR) results; (d) symptomatic UU infection, confirmed by clinical presentation and laboratory PCR results; (e) no-co-infections with other RTIs at the time of enrollment; (f) good understanding of written and verbal Chinese; (f) voluntary participation in the research. The exclusion criteria were patients with any other RTIs or medical condition that could confound the specific impact of UU infection.

In qualitative research, there was no formula for the prior calculation of the sample size [26]. Category saturation referred to the fact that only duplicates of existing codes or themes could be found in newly collected data without new codes or themes appearing [27]. Recruitment ended when the data analysis process reached this state.

2.2. Data collection

Semi-structured in-depth interviews were conducted with the participants from August 2023 to March 2024. All interviews were conducted face-to-face in a gynecological outpatient communication room. Based on the results of the literature review and pilot interviews, the final interview guidelines were developed after joint consultation with the research team. Table 1 provides an overview of the interviews conducted for this study. The specific time of the interview was determined according to the depth of the participants’ answers, and the recording was transcribed within 24 h. After transcribing the interviews, the interviewer checked the information with the interviewees to avoid misunderstandings.

Table 1.

Semi-structured interview guide.

(a) to explore the lived impacts of UU infection in women of reproductive age

To what extent has the infection affected you overall? How has your illness affected your life? In what ways?

(b) to understand the clinical needs of UU infection in women of reproductive age

Did you encounter any difficulties during the infection? What support and help would you like to receive during your treatment?

2.3. Data analysis

After all interviews had been completed, the first author transcribed and de-identified all the interview results to protect patient privacy. All responses were combined using NVIVO (version 12) to manage the data. Reflective thematic analysis was used to reveal underlying conceptualizations and obtain meaningful results from the data [28]. Two of the authors independently completed the following steps: (a) Familiarization coding: the raw data were read repeatedly, and an initial outline of themes was listed. (b) Initial coding: Initial manual coding of data was performed. (c) Identifying initial potential themes: All relevant codes were organized, and data were extracted into the identified potential themes. (d) Review of potential themes: A thematic review was conducted to ensure internal consistency and heterogeneity. Finally, theme naming was adopted through joint deliberation among the research team members, and relevant comments from the participants were integrated to maintain the credibility of the study. In addition, participant characteristics were analyzed using SPSS 20.0.

2.4. Rigor

This study followed the Comprehensive Criteria for Qualitative Research Reports (COREQ) [29] to present research findings. The research design was based on evidence-based methods and optimized through pre-testing, aiming to ensure logical rationality. Methodological triangulation was employed by inte­grating and cross-verifying data from semi-structured interviews, focus group discussions and researchers-reflexive field notes, thereby enhancing the credibility and depth of interpretation. The recruitment of participants adopted a purposive sampling strategy, with data collection covering multi-dimensional scenarios, and sample characteristics having certain representativeness and universality. The data collection and analysis process followed methodological standards strictly, and the reliability of the results was improved through cross-validation by multiple researchers and feedback evaluation from subjects. In addition, the research team received systematic training on qualitative research methods and pathogen-related knowledge before the experiment, laying the foundation for the rigor of the research.

2.5. Ethics

This study was approved by the Medical Ethics Committee of University of South China (2023NHHL020) and adhered to the principles stated in the Declaration of Helsinki. The purpose, content, and significance of the research were fully explained to potential participants by the first author during the recruitment process. The interviews were confidential and conducted for a period of time that was not burdensome to the patient. Participation in this study was voluntary, and the participants had the right to withdraw at any time without facing any adverse consequences. Prior to conducting the interview, written informed consent was obtained from all participants.

3. Results

Finally, out of the 20 participants who were introduced or registered as interested in the study, 16 completed the interviews, and 4 were disqualified after rechecking their qualifications before organizing the interviews. The interview time was 20–45 min. Participants’ characteristics are listed in Table 2.

Table 2.

Recruitment location and subject characteristics (demographics, sexual behaviour, UU infection diagnosis, and symptoms) N = 16.

	N or Median [Range]
Recruitment site
The First Affiliated Hospital of University of South China	9
The Second Affiliated Hospital of University of South China	7
Age	33 [20–46]
Education level
Junior high school and below	7
High school or technical secondary school	5
University and above	4
monthly income
<4000 yuan	10
≥4000 yuan	6
Matrimony
married	13
unmarried	3
Number of times had BV diagnosed in the past	5 [1–26]
Number of sexual partners, 1 years	3 [1–13]

Figure 1 shows the final five central themes and subsidiary sub-themes of this study. Five central themes emerged: (a) physiological, (b) psychological, (c) social, (d) economic, and (e) clinical health care needs. Narratives that justified and helped confirm the traceability of the results were presented in Tables 3–7.

Figure 1.

Five themes emerged from narratives.

Table 3.

Narratives of theme 1: physiological impact.

Theme 1: Physiological impact
Vulvar discomfort	‘It’s mostly itchy, the vulva itches so bad it feels like ants are running around down there.’ (Participant 5, 33 years old) ‘It’s when I take a shower at night and rinse with the showerhead that it’s especially itchy. It also itches when I wipe my vulva with paper after peeing.’ (Participant 6, 37 years old) ‘Normally I don’t feel anything, except for a sudden itchy vulva around my period, and every time I get to that point, I know I’m not completely healed.’ (Participant 1, 33 years old)
Abnormal leucorrhea	‘I felt like I was always making a mess in the bathroom, especially with all the white stuff, you know, I felt like I had a layer of batter on my underwear, disgusting, thick layers. I had to keep changing my clothes.’ (Participant 7, 35 years old) ‘When you take off your clothes before going to bed, you can see the residual leukorrhea on your underwear is yellow in color.’ (Participant 3, 31 years old) ‘Sometimes it gets a little worse and the discharge can be pink, and this time, because it had been going on for three months, I ended up coming to the hospital.’ (Participant 4, 40 years old) ‘I don’t know if it is my psychological effect, usually I don’t feel anything, but I feel that after having sex with my partner, my private parts will emit a distinct, strong, and unpleasant smell…I mean, a fishy smell.’ (Participant 7, 35 years old). ‘It must have an impact on life, mainly when you go to the toilet, the smell is very big, especially in summer.’ (Participant 8, 20 years old)
Reproductive impact	‘My husband and I were planning to get pregnant, but this disease has never been cured and I’m worried about how it will affect the health of our child, so our plans have been put on hold.’ (Participant 9, 30 years old) ‘I heard that this may affect reproduction, and I am really worried.’ (Participant 2, 26 years old)
Other Physiological changes	‘In addition to the itching of the vulva, it also feels a little dry inside. This only occurs with recent infections.’(Participant 5, 33 years old) ‘But this time I came to the hospital because my bottom was itchy, felt a little swollen, and for some reason, I was losing a lot of pubic hair.’ (Participant 16, 33 years old) ‘I had some pain when I urinated and the doctor said I had a urinary tract infection.’ (Participant 3, 31 years old) ‘Sometimes when you are outside you will suddenly want to go to the bathroom all of a sudden, as soon as you have this feeling you have to look for a bathroom right away, you simply can’t hold it in …… and it hurts a little bit to pee, and I don’t know what’s going on.’ (Participant 11, 27 years old)’

Table 4.

Narratives of theme 2: psychological impact.

Theme 2: Psychological impact
confusion and frustration	‘Do medications help? Why has my illness lasted so long?’ (Participant 1, 33 years old) ‘I don’t know why I got it. I wash my underwear separately. Why me?’ (Participant 7, 35 years old) ‘I’m really confused as to why I have this disease, I’ve always been clean…’ (Participant 15, 43 years old)
Worry and anxiety	‘This disease has never been cured and I’m worried about how it will affect my child’s health…’ (Participant 9, 30 years old) ‘I need to take time off from work, so I have to make up a lot of reasons why I don’t want other people to know I have this disease.’ (Participant 16, 33 years old) ‘I am afraid that this disease will be transmitted to my daughter.’ (Participant 6, 37 years old) ‘Sometimes I lose sleep over it…will it affect my future fertility?’ (Participant 7, 35 years old) ‘Perhaps this has less of a physical impact, but it does have a significant mental and emotional impact.’ (Participant 16, 33 years old)
Embarrassment and shame	‘Sometimes in public, my vulva will suddenly become very itchy, but I don’t dare to touch it in public, which is embarrassing and uncomfortable.’ (Participant 5, 33 years old) ‘So I would refuse my husband oral sex because it would be really embarrassing.’ (Participant 7, 35 years old) ‘Every time I went to the hospital for a douche, I felt my self-esteem suffer because it meant I would need to take off my pants in front of strangers and then be ashamed to let someone else touch a private part, even if they were a healthcare professional.’ (Participant 2, 26 years old)
Guilt and regret	‘He’s out there waiting for me now, this disease keeps coming back, I’ve been afraid to sleep with him, I feel so sorry for him, I’m actually more helpless, but this disease is never cured, I can’t do anything…’ (Participant 2, 26 years old) ‘My family takes good care of me, but it makes me feel guilty, and I really want to be cured right away, and it’s worth it to spend as much money as I can.’ (Participant 13, 28 years old)
Anger and pain	‘It annoyed me and came at me again and again, but there was nothing I could do about it.’(Participant 16, 33 years old) ‘So I sometimes don’t want to have sex with my husband… Sometimes the itching down there is just unbearable, unbearable!’ (Participant 10, 34 years old) ‘You say it’s out of sight, out of mind, but it’s a pain in the ass …… Oh, I’m so tired…. Look at how it’s been two or three months and all the meds, why isn’t it better yet!’ (Participant 11, 27 years old)
Self-concept change	‘I’m afraid I’ll lose my attraction to him because of it, and that makes me very insecure.’ (Participant 8, 20 years old) ‘I feel sad…Although my husband is gentle and always supportive, I’ve done everything I can and it still goes back and forth… Is it my health? Or is something not going well? I read online that this disease is very treatable, why is it different when it comes to me?’ (Participant 16, 33 years old)

Table 5.

Narratives of theme 3: social impact.

Theme 3: Social impact
Sexual life change	‘I don’t know how to tell my partner, because we are long-distance relationship, usually meet the opportunity is not much… But this disease always can not get well, I am not too convenient to have sex with him, one is afraid of the spread of inflammation, and secondly, I am worried that he smelled the kind of fishy smell emitted by my body…’ (Participant 9, 30 years old) ‘During this time, I would refuse my husband to perform oral sex on me due to the large amount of leukorrhea and the strange odor it gave off, even though he said he didn’t feel any different.’ (Participant 7, 35 years old) ‘Since the inside of the vagina only goes in a little at a time and not all the way … which exacerbates the pain. In short, every time we have sex it doesn’t go well.’ (Participant 13, 28 years old)
Intimate relationships damage	‘I don’t dare to tell my boyfriend the fact that I have UU, I’m afraid he’ll suspect me because it’s an STD and break up with me. Honestly, I don’t know how to explain it to him, so I simply don’t tell him…’ (Participants 8, 20 years old) ‘In the summer, he sometimes does not take a shower, and in the winter even more …… So I don’t want to be with him sometimes, I understand all these reasons, but I tell him he just doesn’t listen … I really can’t stand it anymore!’(Participant 10, 34 years old) ‘I suspect that it is my husband’s problem, I have been infected with this disease before, and then we went to take medicine together as a couple to cure it, and after that it was fine … This time after intercourse, I felt itchy vulva again, once I came for examination, I found out that I have infected this disease again, do you think it could be because he has someone outside?’ (Participant 15, 43 years old)
Social difficulty	‘I used to work out but haven’t gone in a while… You know, gyms with pools and public bathrooms.’ (Participant 9, 30 years old) ‘Can I still sleep with my daughter? I haven’t slept with her in a long time lately, we used to sleep together all the time since we found out we’ve been sleeping in separate beds, we’re both quite uncomfortable with it but it hasn’t been cured, so when do I have to wait until I can go?’ (Participant 6, 37 years old)
Daily Life Restriction	‘My vulva is always itchy for a while, when it’s not itchy it’s fine, when it’s itchy it’s very uncomfortable, sometimes it keeps me awake at night and I can’t sleep during the day, it’s very annoying!’ (Participant 11, 27 years old) ‘If I wear tight pants, I feel itchy down there, so I don’t wear skinny jeans anymore.’ (Participant 12, 38 years old)
Work efficiency decline	‘My physical discomfort causes me to be unable to concentrate on work.’(Participant 13, 28 years old) ‘Ever since I’ve had it, I’ve been feeling tired, I don’t know if it’s psychological rensons.’ (Participant 5, 33 years old)

Table 6.

Narrative of theme 4: economic impact.

Theme 4: Economic impact
Medical burden	‘I’ve had this for four or five years now, it gets better with medication and then a few months later it starts itching again …… Once I made three trips to the hospital in a row until the doctor said I was cured, but after a few months it started itching again and I went back to the hospital to get it checked out and found out it was infected again.’ (Participant 2, 26 years old) ‘I’ve had it before, I found out about it when I was in another city, got cured and then it came back after a couple of years.’ (Participant 5, 33 years old) ‘I bought two to three hundred dollars worth of medication to take, and I spent the money and didn’t get better.’ (Participant 11, 27 years old)
Implicit cost	‘Going to the hospital for follow-up appointments often clashes with my working hours, which affects my attendance and also affects my salary.’ (Participant 13, 28 years old) ‘Every time I come to the hospital from the county, I have to wake up after six o’clock to take the bus, get checked and wait for the results to get medicine. When I get home, it’s already dark and the whole day is gone. Sometimes the results can’t be obtained and I have to wait until the next day, which is a waste of time.’ (Participant 2, 26 years old)

Table 7.

Narrative of theme 5: clinical needs.

Theme 5: Clinical needs
Information needs	‘To be honest, I don’t know exactly what a UU is yet, is it a bug? Or microbes? Or inflammation?’ (Participant 7, 35 years old) ‘Do those medicines work? It’s not as good as it used to be, I was at the clinic in our village and they just gave me an anti-inflammatory shot and it was fine.’ (Participant 1, 33 years old) ‘…If it doesn’t itch anymore, that’s a good thing … There’s no need to go back for a special medical checkup.’ (Participant 2, 26 years old) ‘In addition to getting me on medication, I would like to learn more about recovering from illnesses, such as what to eat, how to handle underwear, and what to look for when interacting with people.’ (Participant 7, 35 years old)
Psychological needs	‘After talking to you today, I feel so much more relaxed and it just doesn’t seem to be as stressful. These are things I have been afraid to share with others, but it was okay to discuss this with you healthcare professionals.’ (Participant 2, 26 years old)
Support needs	‘Can I tape the safe sex part for my husband? I told him it wouldn’t work and that he would only believe it if you doctors and nurses told him.’ (Participant 10, 34 years old)

3.1. Physiological impact

When participants were asked about the traits of their bodies that were most affected by UU infections, many cited the presence of vaginal itching or burning sensations, a symptom that was easily perceived and far-reaching. Almost all participants cited problems with leukorrhea, which was the main reason why the female population sought medical attention. Changes in the color and amount of leukorrhea were most frequently mentioned. The color of leukorrhea might be yellowish or pinkish, which attracted participants’ attention. It also produced a large amount of leukorrhea, which made participants feel uncomfortable. It was also reported that an unbearable odor was emitted during infection. For most participants, this odor was always present when they developed an infection; however, for some participants, it was only noticeable or worse during or after sexual intercourse. In addition to the changes mentioned above, some participants reported other physical changes, such as vaginal dryness, abnormal loss of pubic hair, and urinary tract infections.

3.2. Psychological impact

Most participants reported that they suffered from certain negative emotions, including confusion and frustration, worry and anxiety, embarrassment and shame, guilt and regret, anger and pain. Some participants believed that UU infection hurt their self-esteem and self-confidence, which affected their self-concept and generated self-doubt.

3.3. Social impact

Undoubtedly, UU infection had a huge impact on the sexual lives of both participants and their partners. Most participants usually stopped all sexual activity until they were fully cured by treatment to prevent the disease from worsening and spreading. Alternatively, they chose to avoid certain sexual positions to prevent their sexual partner from noticing their symptoms and becoming embarrassed, which could affect the sexual experience of the couple. Some participants suggested that the discomfort and pain caused by the infection made them uncomfortable during sex, prevented them from relaxing or enjoying sex, and undermined their self-esteem and confidence. It also affected the level of intimacy between the participants and their partner. In more serious cases, this created mistrust in the sexual partner and affected the couple’s relationship. Participants’ fear of others noticing their illness or accidentally passing it on to others also affected their socialization and daily life, whether with acquaintances or strangers. The discomfort caused by the infection made participants feel tired, uncomfortable, and powerless in their daily lives, affecting their work efficiency and quality of life. These infections not only affected the individual participants of reproductive age in their daily plans but also affected the patient’s entire family.

3.4. Economic impact

Owing to the recurring nature of UU, regular check-ups and treatment were required, which increased the cost of healthcare and time for participants and created an additional burden on their lives. In addition, hidden expenses, such as increased time and indirect costs, greatly increased participants’ social pressure.

3.5. Clinical needs

Through interviews with participants, it was found that participants of reproductive age generally lacked knowledge related to UU and had no specific understanding of the characteristics, transmission, prevention, and treatment of the disease. Even participants who had been infected multiple times generally experienced this problem. In addition, they reported a lack of corresponding psychological intervention and social support.

4. Discussion

This study revealed the multifaceted impacts of symptomatic UU infection on women of childbearing age, encompassing physiological, psychological, social, and economic dimensions. These impacts constituted a self-perpetuating cycle detrimental to health and social functioning. Concurrently, the investigation identified patients’ clinical healthcare needs, informing future clinical efforts to address these patients’ specific and unmet needs [30].

Physiologically, infection with UU in the reproductive tract can cause a series of physical discomforts, including abnormal vaginal discharge, itching of the external genitalia; in severe cases, other clinical symptoms may also occur [31]. Existing research generally shows that almost all women have experienced symptoms of abnormal secretions, and these symptoms often worsen during or after sexual intercourse [32]. Unlike other reproductive tract infections, UU infection has insidious characteristics, with about 70%–90% of UU-infected patients having no obvious clinical symptoms and being easily overlooked, making it difficult to detect the infection early [33]. In this study, most patients with symptomatic UU infection often presented with clinical symptoms such as vaginitis and urethritis. If left untreated, UU infection may progress to serious diseases such as infertility, ectopic pregnancy, premature birth, stillbirth, and neonatal pneumonia [34]. In addition, the physiological changes caused by UU infection may lead to a series of psychological, social, and economic chain reactions, consequently posing a significant threat to the physiological health of women of childbearing age [35]. At present, early detection and treatment are considered the most cost-effective strategies to improve the sexual and reproductive health of the population, which suggests that medical staff need to enhance disease screening and implement precise diagnosis and treatment for symptomatic UU-infected patients [36].

Psychologically, symptomatic infections of UU in the reproductive tract can lead to significant negative emotional distress in women of childbearing age. In this study, all participants mentioned an increase in psychological stress, anxiety, shame, and social withdrawal behavior after infection, which is consistent with the conclusions of current research on the psychological impact of other reproductive tract infections on patients [37,38]. The World Health Organization’s report also pointed out that such patients generally have problems with increased shame and decreased self-esteem [39]. These negative emotions not only delay the recovery process of the disease, but also have a serious negative impact on the patient’s quality of life and clinical treatment effectiveness [40]. Meanwhile, this study further found that infection can, to some extent, trigger changes in patients’ self-concept, which is similar to the qualitative research findings of East et al. on women who contracted sexually transmitted diseases from their male partners [41,42]. The study found that infection can cause women to lose confidence in their ability to maintain healthy heterosexual relationships, increasing their vulnerability in current and future relationships13. In addition, changes in self-concept may further exacerbate negative emotions, affect patients’ social function and daily communication, reduce their confidence and compliance with treatment, and thus have adverse effects on daily life and rehabilitation process. With the transformation of the current medical model, paying attention to the psychological state of patients has become an important component of clinical treatment [43]. A complete treatment plan should not only achieve physical cure of the disease, but also strive to restore the patient’s mental health. Therefore, when implementing treatment and nursing interventions for infected patients, in addition to focusing on the improvement of physiological symptoms, it is also necessary to provide intervention and guidance regarding their self-concept, help patients rebuild a positive self-concept, and promote their comprehensive physical and mental recovery [44].

The economic impact of UU infection presents multidimensional characteristics, including both directly calculable medical expenses and difficult-to-quantify indirect costs. Current treatment costs show significant individual variation, with wide-ranging per-treatment expenses depending on condition severity, treatment plan, and regional differences [45]. Notably, because UU lacks the rigid cell wall found in other bacteria, it exhibits inherent resistance to beta-lactam antibiotics [46]. Concurrently, the non-standard and widespread use of antibiotics may lead UU to develop multi-drug resistance [47]. This further increases treatment failure rates and the need for repeat treatments, significantly escalating additional medical costs. A UK study of 120,519 female patients with uncomplicated urinary tract infections revealed a deeper economic burden: Within 28 days, UTI patients incurred medical resource costs averaging £160.06 (compared to £37.63 in a matched control group). This difference became even more significant during the 12-month follow-up period (£1206.77 vs. £460.97), reflecting long-term medical needs that extend far beyond acute-phase treatment [45]. Beyond direct medical expenses, UU infection incurs often underestimated yet equally destructive indirect costs. These include lost work productivity, personnel time costs, and productivity declines stemming from repeated medical visits. A Taiwanese study on rotavirus infection illustrates this impact: Child hospitalizations caused caregivers to take an average of 1.18–1.82 days off work, resulting in wage losses of $246.67 [48]. The economic burden mechanism of UU infection on women of childbearing age is similar. However, due to its recurrent and chronic nature, these indirect costs are likely more persistent. Because of the tendency for recurrent infections, a single persistent case may accumulate over 50 h lost throughout the entire treatment cycle. This translates into dual pressures for women of childbearing age: income loss and hindered career development. Clinical medical staff can reduce the economic losses of treating UU by optimizing the diagnosis and treatment process, strengthening patient education, promoting interdisciplinary collaboration, and exploring cost-effective treatment plans, achieving efficient, economical, and humane diagnosis and treatment goals.

In addition, symptoms such as itching, abnormal secretions, and painful intercourse caused by UU infection can directly significantly reduce the quality of sexual experience. Furthermore, the mandatory abstinence requirement during treatment deprives partners of emotional connection, potentially triggering a vicious cycle of emotional alienation that affects women’s sexual confidence, frequency, and satisfaction [49]. Due to the sexually transmitted nature of UU infection, it can also provoke deep-seated crises in intimate relationships [50]. This stems from trust issues caused by disease stigmatization, even if the infection originated from contact with a past partner [40]. Social stigma is widespread, greatly affecting women’s social and sexual lives. Unlike other studies, this research found that most patients did not question their partner’s loyalty due to infection [50]. Instead, they expressed self-denial, personal anxiety, and concerns about future fertility [51,52]. UU infections also increase women’s healthcare burden and social pressure, disrupt daily routines, and significantly impact both women and their families. Sameer et al. conducted a cross-sectional study of 464 married women in the community, finding that symptomatic reproductive tract infections significantly reduce women’s quality of life [22]. Consequently, clinicians should increase focus on patients’ sexual health and intimate relationships. This includes providing sexual health counseling to alleviate concerns, guiding couples in emotional communication to reduce alienation and trust issues [53], and actively promoting social education to diminish stigma and foster a supportive environment for patients [54].

We further investigated and analyzed the clinical health care needs of the relevant population and found that the biggest problem faced by women with reproductive tract UU infection is a lack of knowledge and even misperceptions of some of this knowledge, even in patients who have been infected for many years. This is similar to the results of a cross-sectional survey conducted in India by McManus et al. who measured the knowledge of female sexually transmitted infections/AIDs and found that more than one-third of the women did not have accurate knowledge of the signs and symptoms of Sexual Transmitted Infections, so they stressed the importance of gender-based sex education [55]. The lack of patient knowledge reflects the inadequacy of current clinical healthcare. Although there are drug interventions for these diseases, there is a lack of specific healthcare interventions and targeted evidence-based management guidelines [53,56]. This suggests that medical staff should gradually develop evidence-based management guidelines for UU infection in the future, while strengthening training for medical staff, building a patient health education system, and establishing a full cycle healthcare service model to improve the problem of insufficient clinical healthcare.

Overall, for the majority of the participants in this study, UU infection in the genital tract had a negative impact on their physiology, psychology, society, and economy, which spreads from individuals to the whole family and is long-term and far-reaching.

4.1. Limitation

This study had certain limitations. Since this is a small-sample study and lacks large-scale external verification, the research results may have a certain degree of regionality. Owing to the qualitative nature of this study, our main objective was to describe participants’ experiences, and their findings could not be generalized. In the future, multicenter and large-sample studies should be conducted to enhance the universality and reliability of the research results.

5. Conclusion

Infection experiences in the genital tract of women of reproductive age and their impact on life vary from person to person. Although some women report that UU has little impact on their lives, for the majority, UU has a moderate to severe impact on their lives, including negative effects on physiology, psychology, society, and economy. Infection affects the daily comfort of women of reproductive age, increases their psychological pressure and economic burden, influences their daily life and social activities, and may even lead to the breakdown of relationships, including marriage. At present, the relevant population generally lacks knowledge, education, psychological assistance, and social support, which suggests that clinical personnel should further strengthen their attention to these issues and construct relevant intervention plans. These results have expanded the existing knowledge about women’s experiences with UU in the genital tract. It has been found that there is currently a common lack of knowledge among women of reproductive age. However, there is a lack of research on the current clinical diagnosis and treatment guidelines for relevant patients. Future research needs to strengthen the exploration of UU to formulate standardized intervention programs and processes and promote the improvement of the health and well-being of relevant populations. The findings directly contribute to optimizing the gynecological diagnosis and treatment process, improving the doctor-patient communication mechanism, and providing empirical evidence based on patient experiences for the development of clinical guideline and the refinement of public health policies related to UU infection.

Funding Statement

This work was supported by the National Natural Science Foundation of China (No. 82272383 and 32070189), Hunan Natural Science Foundation(2024JJ5341 and 2024JJ5349), Hunan Provincial Health High-Level Talent Scientific Research Project (20230499) and Key Guidance Project of Hunan Provincial Health Commission(C202304127239), Hunan Province Graduate Research Innovation Project (CX20240088).

Ethics approval and consent to participate

The study protocol was reviewed and approved by the Medical Ethics Committee of University of South China(2023NHHL020). Participants provided informed consent to participate.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data are available upon request. Data are available by contacting Zhongyu Li by E-mail: lzhy1023@hotmail.com.