Recurrent Urinary Tract Infection in Women

Especially before the age of 50, the incidence of urinary tract infection (UTI) is approximately 30 times higher in women than in men due to various anatomical and structural factors. The probability of urinary tract infection with prostate diseases in middle age and old age is almost equal in both sexes.

This infection, which is mostly bacterial and seen at various times of life, peaks in sexually active women aged 20-40. Half of all women are diagnosed with cystitis, which requires antibiotic treatment at least once in their lifetime. This is normal. However, this situation recurs frequently in some women and brings serious negativities in the comfort of life.

The definition of 'recurrent urinary tract infection' means UTI at least three times a year or at least twice in the last 6 months. Other reasons must be excluded for this definition, which applies to women who are anatomically and physiologically normal.

For example, congenital (congenital) anomalies of the kidney or kidney stone disease should be excluded by at least ultrasonography. Invasive diagnostic tests such as cystoscopy, urodynamics and cystography are not recommended in the first place.

What are the risk factors?

• Sexual intercourse,
• Frequent or new sexual partner,
• Birth control methods such as spermicide or diaphragm,
• Childhood urinary tract infections,
• History of urinary tract infections in the mother,
• Some blood group antigens,
• Urinary incontinence,
• Cystocele (bladder prolapse),
• Vaginal dryness developing after menopause,
• Elderly patients with cathaters or diapers and low self-care.

What is our treatment approach?

Our approach in recurrent urinary tract infections is primarily to minimize the risk with some lifestyle changes and recommendations. Antibiotic prophylaxis is also considered in patients who do not benefit from these.

Suggestions

• Balanced and adequate fluid intake,
• Attention should be paid to vaginal hygiene,
• Unnecessary vaginal cleaning should be avoided (In particular, agents such as shower gel and soap applied intravaginally increase the frequency of urinary tract infection instead of protecting it. Because by destroying the protective bacteria in the vaginal flora, we make room for pathogenic bacteria),
• Not using birth control methods such as spermicide and diaphragm,
• Postcoital voiding (urinating after sexual intercourse),
• Blueberries,
• Use of agents containing D-mannose,
• Oral vaccines such as Uro-vaxom and Urovac,
• Estrogen containing vaginal preparations in case of vaginal dryness and atrophy.

Antibiotherapy

Antibiotherapy is the next step in persistent urinary tract infection with behavioral changes and other measures. There are two types of antibiotic therapy models. They are called continuous low dose prophylaxis and postcoital prophylaxis (antibiotic use after sexual intercourse) approach. Antibiotics such as nitrofurantoin, fosfomycin and trimethoprim-sulfomethoxazole are generally preferred in recurrent UTI prophylaxis.

As a result, women who think they have recurrent urinary tract infections should apply to a urologist both for the accuracy of the diagnosis and for the treatment approach. In addition, other diseases that may cause similar symptoms (vaginitis, stone disease, tumor) should also be excluded in this application. The appropriate method of treatment may be different for each patient. Your doctor will make the most appropriate decision based on your history and personal characteristics.

I wish you healthy days.

Associate Professor. Arif Demirbaş