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Recurrent UTI's in women

Updated: Jul 2

Recurrent urinary tract infections (UTI's) are a common problem among women, with up to 50% experiencing at least one episode in their lifetime. Recurrent UTIs are defined as two or more infections in six months or three or more infections in one year. This review aims to provide a comprehensive overview of recurrent UTIs in women and evidence-based management.

Causes of Recurrent UTIs:

The most common cause of recurrent UTI's is reinfection by the same bacterial strain. Other risk factors for recurrent UTI's include sexual activity, use of certain contraceptives, menopause, pregnancy, urinary tract abnormalities, and immune system deficiencies.

Diagnosis of Recurrent UTI's:

The diagnosis of recurrent UTI's is made by the presence of typical symptoms such as dysuria, urinary frequency, urgency, and lower abdominal pain, coupled with a positive urine culture with significant bacteriuria. If a woman has recurrent UTI's, she should undergo a thorough evaluation, which includes a urinalysis, urine culture, and imaging studies to rule out urinary tract abnormalities.

Urine Culture being performed
Culture Medium - isolating the organism responsible for causing a UTI

Management of Recurrent UTIs:

  • Non-Pharmacological Management:

Non-pharmacological interventions for preventing recurrent UTI's include adequate hydration, regular urination, wiping front to back after urination, avoiding irritants such as spermicides and feminine hygiene sprays, and avoiding prolonged use of urinary catheters.

  • Pharmacological Management:

Antibiotic prophylaxis is the primary pharmacological intervention for the prevention of recurrent UTI's. Nitrofurantoin, trimethoprim-sulfamethoxazole, and fosfomycin are the most commonly used antibiotics for prophylaxis.

Treatment of Acute Episodes:

The management of acute episodes of recurrent UTI's is similar to that of an initial UTI. Treatment typically involves a short course of antibiotics for three to five days.

Postcoital prophylaxis:

Postcoital prophylaxis is a pharmacological intervention for women with recurrent UTI's triggered by sexual activity. Women take a single dose of an antibiotic immediately after sexual intercourse to prevent infection.


Immunoprophylaxis with oral or intravaginal administration of lactobacillus has shown promising results in preventing recurrent UTI's.


Recurrent UTI's are a common problem among women, and a thorough evaluation is necessary to identify the underlying risk factors. Non-pharmacological interventions should be considered first, and antibiotic prophylaxis can be used in selected women. The choice of antibiotic should be based on local resistance patterns, and postcoital prophylaxis can be considered for women with UTI's triggered by sexual activity. Further research is needed to determine the optimal duration of prophylaxis, the role of immunoprophylaxis, and other non-antibiotic strategies for the prevention of recurrent UTI's in women.

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