Recurrent Urinary Tract Infection

Urinary tract infections (UTI) are commonly seen in females. It was estimated that 60% of women will have an episode of acute bacterial cystitis in their lifetime. Women with UTI commonly presents with symptoms of urinary urgency, frequency, burning or stinging sensation when passing urine and pain. Some patients may develop more complicated symptoms such as fever, back or loin pain, nausea and vomiting indicating potential ascending infection into the kidneys.

 Diagnosis of recurrent UTI is made when you have 3 or more UTI episodes with proven bacteria presence in the urine cultures within 12 months.

Who are at risk?

Young/pre-menopausal women:

  • Sexual intercourse

  • Spermicide use

  • New sexual partner

  • History of childhood UTI

  • Urinary tract malformations

  • Vesico-ureteric reflux

 Post-menopausal/elderly:

  • Urinary incontinence

  • Vulva vaginal atrophy

  • Lower urinary tract obstruction e.g. pelvic organ prolapse, stones

  • Urinary retention 

  • Bladder pathology e.g. cancer, foreign body

  • Long term catheterisation

How do we manage recurrent UTI?

Recurrent UTI is managed the same way as acute UTI with oral antibiotics. However, it will be essential to obtain the urine culture and sensitivity before starting on oral antibiotics.

A pelvic and renal ultrasound scan may be indicated to rule out structural urinary tract abnormalities or pelvic pathology contributing to the symptoms.

Cystoscopy may be warranted to exclude bladder or urethral lesions

How can we prevent further UTI?

Several non-pharmacological measures have been described

  • Drink plenty of fluid to prevent dehydration

  • Wiping from front to back in toilet may avoid introducing bugs from perineum into urethra

  • Voiding after intercourse promotes flushing of bacteria from lower urinary tract

  • Avoid douching or wearing occlusive underwear

Medical therapy to prevent recurrent UTI

Over the counter products
Hiprex, cranberry tablets/juice

Topical vaginal oestrogen therapy
e.g. Ovestin or vagifem for postmenopausal women

Oral antibiotics
Oral antibiotics can be used in several ways to reduce the frequency of UTI. It is recommended that you discuss the options with your doctor before starting on antibiotics.

  • Low dose once daily oral antibiotics for 3 to 6 months or longer but risk of developing antibiotic resistance if used for long-term

  • Antibiotics after intercourse can be considered in women have UTI episodes associated with intercourse. A short course of antibiotics can be taken after intercourse with lesser side effects

  • Self-treatment with a short course of antibiotics after the first signs of a UTI. However, it is recommended to have your urine tested to confirm UTI before starting on treatment

Bladder instillation (iAluril)
To replenish bladder protection layer from repeated UTI.