Recurrent UTI in Women: Diagnosis and Management

Recurrent urinary tract infection (UTI) is defined as two or more UTIs within 6 months or three or more within 1 year. The annual recurrence rate of UTI in women is approximately 14% to 25%. Risk factors for recurrent UTI include antimicrobial exposures, more frequent sexual activity, use of spermicidal agents or diaphragms, peri- or postmenopausal status, personal hygiene practices, urinary stasis from incomplete bladder emptying, pelvic organ prolapse, and voiding dysfunction. When women present with recurrent UTI symptoms, urinalysis and urine culture should be obtained. Management guidelines recommend empiric treatment with a first-line antibiotic based on prior culture results, then changing the antibiotic if the new culture shows resistance, or waiting for culture results before selecting an antibiotic. Longer duration of therapy does not reduce the risk of recurrent UTI. Asymptomatic bacteriuria should not be treated, except in patients who are pregnant or undergoing invasive urologic procedures. Prevention of recurrent UTI begins with behavioral modification and hygienic practices. The next step is prescription of antibiotic prophylaxis with shared decision-making. Nonantibiotic methods are also used to prevent recurrent UTI, and evidence of their effectiveness varies. These methods include use of cranberry products, Lactobacillus probiotics, vaginal estrogen, methenamine supplements.