Urinary tract infections in women are divided into two main categories: upper urinary tract infections (pyelonephritis) which usually manifest with fever, chills and pain in the loin and lower urinary tract infections (cystitis, urethritis) which cause dysuria problems (burning, stinging or pain during urination), urge to urinate, frequency and hematuria, but without fever.

The term uncomplicated recurrent UTIs refers to women of reproductive age with a normal urinary system and no underlying health problems who present with frequent cystitis. We use the term recurrent when there are more than 3 episodes in the previous 12 months or more than 2 episodes in the last 6 months. We must emphasize that this is not about persistence or incomplete treatment of an infection, but about re-infection with a different strain of microbe (usually different strains of colibacter E. coli).

The term “recurrent UTIs” should not be used in the case of men, as they have a different anatomy in the genitourinary system and by definition every UTI should be considered complicated and investigated for its etiology. In addition, complicated recurrent UTIs occur in patients with underlying anatomical or functional disorders of the urinary tract.

Risk factors

There are the following risk factors for recurrent UTIs, but in many cases we cannot identify a specific cause.
• The patient’s behavior and habits (sexual behavior, use of vaginal diaphragms, spermicides, etc.).
• Possible genetic predisposition, as it has been observed that there is an increased frequency of UTIs if there was a member in the immediate environment who suffered from recurrent UTIs.
• Atrophy of the vaginal epithelium due to estrogen deficiency in postmenopausal women.
• Mechanical and functional factors related to bladder emptying (urinary incontinence, presence of cystic hernia, residual urine after urination, etc.).

Treatment

Treatment of cystitis in patients who experience recurrences is with antimicrobial therapy based on an antibiogram. Symptoms usually subside immediately after taking antimicrobials. It is important for this simple infection, which in a significant percentage (46%) resolves automatically and without specific treatment, to use the antibiotic with the shortest possible spectrum and to administer it for the shortest possible duration, so as not to disturb the microbial flora. The treatment of choice, if the antibiogram shows sensitivity, is the administration of nitrofurantoin for 5-7 days. Alternatively, single administration of fosfomycin is preferred.

In particular, broad-spectrum antimicrobials such as amoxicillin-clavulanate and quinolones should be avoided. Also, prolonging the duration of treatment in recurrent infections should be avoided, as the phenomenon is not attributed to persistence of the infection but to re-infection. Using antimicrobials for a longer period of time will disrupt the flora, thus preparing the next episode with a more resistant strain of microbe.

Relapse prevention

You should make sure you drink enough fluids (> 2 liters per day) and urinate immediately when you feel the urge. You should take time to empty your bladder completely when urinating. It is best to avoid the use of soap and topical antiseptics in the perineal area, as it further disrupts the microbial flora.

To prevent recurrences, prophylactic antimicrobial treatment (chemoprophylaxis), i.e. a small dose of antibiotic every night for 3 or 6 months, can be given. If episodes typically occur after intercourse, chemoprophylaxis may be administered shortly before or after intercourse.

For more information:

https://www.hygeia.gr/services/clinic/pathologikes-loimoxiologikes-klinikes/g-pathologiki-loimoxiologiki-kliniki/