What are the risk factors for recurrent urinary tract infections (UTIs)?

• In premenopausal women, the risk factors are new or multiple sexual partners, having a UTI before age 15, sexual intercourse three or more times per week, spermicide use
• In postmenopausal women, the risk factors are urinary retention and estrogen deficiency.

We now know that the following DO NOT increase the risk of UTI  obesity, hot tub use, frequent tampon use, wearing cotton underwear, wiping back-to-front after a bowel movement, douching, or increased hydration.

Imaging (like an ultrasound) or cystoscopy (looking up the urethra and into the bladder with a scope) is rarely necessary in healthy women with recurrent UTIs, unless she has risk factors for complicated infection.

We now treat UTIs with an antibiotic course of 1-5 days, depending on the antibiotic.

If you have recurrent UTIs, consider talking to your doctor about either continuous (meaning every day) antibiotics or taking an antibiotic after sexual intercourse to help decrease recurrent rate of UTIs. Voiding after intercourse may be helpful.

If you are postmenopausal, daily estrogen vaginal cream place on the labia may reduce the risk of future UTIs.

Data is conflicting if daily cranberry tablets are helpful in preventing UTIs in premenopausal women.

If you have any of the following, this may warrant further evaluation

• blood in the urine (either by sight or by urinalysis),
• history of urinary tract malignancy,
• history of urinary tract surgery,
• history of kidney stones,
• urine bacteria that is multidrug-resistant,
• persistent symptoms or bacteria in the urine despite 2 weeks of culture-directed antibiotics,
• stool in the urine or air with urination,
• repeat episodes of kidney infections,
• any difficulty with voiding.
  

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