Recurrent UTI in young women

• related: UTI

Recurrent UTIs are a common problem in otherwise healthy young adult females, however there is no evidence that they lead to other health problems such as hypertension in the absence of underlying anatomic abnormalities.

Behavioral interventions such as postcoital voiding and increased intake of cranberry juice may help to decrease the risk of UTIs in some women. Antibiotic prophylaxis can be considered in women who have had more than two UTIs in six months or more than three UTIs in a year. Prophylaxis can be used either continuously for up to several years or solely after intercourse in women whose UTIs occur only after sexual activity. Fluoroquinolones, sulfamethoxazole-trimethoprim, and nitrofurantoin are the most commonly used agents. An additional option is providing female patients with antibiotics in advance, and allowing the patient to self-diagnose and treat her UTIs.

This patient has recurrent urinary tract infections (UTIs), defined as >2 infections in 6 months or >3 infections in 1 year; recurrence typically occurs due to reinfection of the same organism (eg, Escherichia coli).  Behavioral strategies that may prevent UTI recurrences include early postcoital voiding and avoidance of spermicides and diaphragms.

However, the most effective strategy for recurrent UTI prevention is with either daily or postcoital antibiotic prophylaxis.  Postcoital prophylaxis is preferred in women with UTIs temporally related to intercourse; efficacy is similar to daily prophylaxis.  Recommended prophylactic antibiotics include trimethoprim-sulfamethoxazole, nitrofurantoin, cephalexin, and ciprofloxacin.  However, resistance of uropathogenic E coli to trimethoprim-sulfamethoxazole is increasing and may limit its usefulness as an antibiotic prophylaxis.