Recurrent urinary tract infection in women
Section snippets
Background
A recurrent urinary tract infection (UTI) is a symptomatic UTI that follows clinical resolution of an earlier UTI generally, but not necessarily, after treatment. Recurrent UTIs are common among young healthy women even though they generally have anatomically and physiologically normal urinary tracts. Mabeck found that nearly one-half of the women whose uncomplicated UTIs resolved spontaneously developed a recurrent UTI within the first year [1]. In a recent study of college women with their
Pathogenesis
Most uncomplicated UTIs in women cannot be explained by underlying functional or anatomic abnormalities of the urinary tract, but instead appear to result from the interaction of infecting E. coli strains with the woman's epithelial cells. In the healthy person, most uropathogens originate in the person's rectal flora and enter the bladder via the urethra with an interim phase of periurethral and distal urethral colonization. Many host genetic, biologic, and behavioral factors, several of which
Healthy premenopausal women
Sexual intercourse, diaphragm-spermicide use, and a history of recurrent UTI have been recently shown to be strong and independent risk factors for UTI [41]. Even spermicide-coated condom use results in an increased risk of UTI [42], [43]. Recent antimicrobial use, which has been shown to adversely effect vaginal flora in animals and humans [44], also is strongly associated with increased risk of UTI [45]. Risk factors specific for recurrent UTI, however, have received relatively little study.
Treatment
Knowledge of the antimicrobial susceptibility profile of uropathogens causing uncomplicated UTIs in the community, if known, should guide therapeutic decisions for the treatment of acute uncomplicated cystitis. E. coli strains isolated from patients with uncomplicated cystitis are usually susceptible to one or more of the commonly used oral agents, although ampicillin and sulfonamides generally should not be used for empiric therapy because approximately one-third or more of isolates
Prevention strategies
Sexually active women and those who use spermicides, particularly when used in conjunction with diaphragms, who have frequent recurrent UTI should be counseled about the possible association between their infections and their contraceptive method. Abstinence or a decrease or elimination of the usage of spermicide-containing products would be expected to reduce the risk of UTI. Cranberry products are widely used for prevention of UTI but their efficacy has yet to be clearly demonstrated. It is
Urologic evaluation
The majority of women with recurrent uncomplicated cystitis has no anatomical or functional abnormality of the urinary tract and, therefore, does not need an evaluation of their urinary tract. Studies of the value of excretory urography and of cystoscopy in women with recurrent UTI have demonstrated that significant abnormalities which influence subsequent management of UTIs are very uncommon [95], [96], [97], [98]. Thus, routine evaluation of recurrent cystitis patients with excretory
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