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Recurrent Urinary Tract Infection
Recurrent urinary tract infections are defined as two episodes of acute bacterial cystitis within the last six months or three episodes within the last twelve months. This condition is more common in females, and it is estimated that over 50% of women will experience at least one urinary tract infection in their lifetime. Women with cystoceles, pelvic organ prolapse, and vesicoureteric reflux, as well as older men with outflow obstruction due to neurogenic bladder are predisposed to recurrent urinary tract infections. Risk factors include spermicide use, atrophic vaginitis, new or multiple sexual partners, chronic diarrhea, inadequate fluid intake, and urinary incontinence.
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Recurrent Urinary Tract Infection Diagnosis
Diagnosis of recurrent urinary tract infections requires a complete patient history and physical, as well as documentation of urine cultures and sensitivity tests. Women should undergo a pelvic examination to search for signs of cystoceles, vaginitis, vaginal atrophy, and pelvic organ prolapse while men should be evaluated for prostatitis. Symptoms of the current urinary tract infection should be examined to differentiate between simple and complicated cystitis. Patients with acute simple cystitis will present with urinary frequency, dysuria, and suprapubic pain. Patients with acute complicated cystitis may experience fever, chills, rigors, and general malaise. Another important distinction in diagnosis is whether current urinary tract infection is a relapse or reinfection. It is classified as a recurrence if the patient is reinfected with a new bacterial organism more than two weeks after the first infection. The patient has a relapse when, within two weeks from the first episode, the patient develops symptoms from the same bacterial organism due to incomplete treatment of the first episode.
Recurrent Urinary Tract Infection Podcasts
Listen to leading physicians discuss recurrent urinary tract infection on the BackTable Urology Podcast. Get tips, tricks, and expert guidance from your peers and level up your practice.
We talk with Dr. Yahir Santiago-Lastra, director of the Women's Pelvic Medicine Center at UC San Diego Health about the management of cystitis and pelvic pain syndromes. She shares her insights on genitourinary syndrome of menopause, pain evaulation and treatment, and procedural options including botox and sacral neuromodulation.
Recurrent Urinary Tract Infection Treatment
Urine cultures and sensitivity tests aid in determining the antimicrobial therapy to treat the recurrent urinary tract infection. First line therapies include oral antibiotics, such as Nitrofurantoin, Trimethoprim-sulfamethoxazole, or Fosfomycin. Second line therapies include Cephalexin, Cefaclor, and Norfloxacin. Pregnant women diagnosed with recurrent urinary tract infection should be treated with antibiotic prophylaxis. Management of recurrent urinary tract infections relies on maximizing personal hygiene factors and prevention measures. Patients should avoid the use of spermicides or skin irritants in the genital area. Additionally, patients should avoid long intervals between urinations, avoid bladder irritating foods and drinks, and take precautions after sexual intercourse.
 Al-Badr, A., & Al-Shaikh, G. (2013, August). Recurrent urinary tract infections management in women: A Review. Sultan Qaboos University medical journal. Retrieved February 24, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3749018/
 Aggarwal, N. (2021, December 3). Recurrent urinary tract infections. StatPearls. Retrieved February 24, 2022, from https://www.statpearls.com/ArticleLibrary/viewarticle/28284
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