Recurrent Urinary Tract Infections

Women who have had three UTIs are likely to continue having them. Four out of five such women get another within 18 months of the last UTI. Many women have them even more often.

Treating Recurrence of UTI

Women who have frequent recurrences (three or more a year) should ask her doctor about one of the following treatment options

1) Take low doses of an antibiotic such as TMP/SMZ (bactrim) or nitrofurantoin daily for 6 months or longer. If taken at bedtime, the drug remains in the bladder longer and may be more effective.

2) Take a single dose of an antibiotic after sexual intercourse.

3) Take a short course (1 or 2 days) of antibiotics when symptoms appear.

Dipstick Test

Dipsticks that change color when an infection is present are now available without prescription. The strips detect nitrite, which is formed when bacteria change nitrate in the urine to nitrite. The test can detect about 90 percent of UTIs when used with the first morning urine specimen and may be useful for women who have recurrent infections. 

Avoiding Infection

Some additional steps that one can take on her own to avoid an infection: 
  • Drink plenty of water every day. Increasing the intake of fluids encourages frequent urination that flushes the bacteria from the bladder. Avoid fluids that irritate the bladder, such as alcohol, citrus juices, and caffeine.
  • Urinate when you feel the need; don’t resist the urge to urinate.
  • Wipe from front to back to prevent bacteria around the anus from entering the vagina or urethra.
  • Take showers instead of tub baths.
  • Cleanse the genital area before and after sexual intercourse.
  • Avoid using feminine hygiene sprays and scented douches, which may irritate the urethra.
  • Urinating immediately after sexual intercourse may help eliminate any bacteria that may have been introduced during intercourse. Refraining from urinating for a long period of time may allow bacteria time to multiply, so frequent urination may reduce the risk of cystitis in those who are prone to urinary tract infections.
  • It may be helpful to drink cranberry juice.

Diagnosis

To find out whether you have a UTI, your doctor will test a sample of urine for pus and bacteria. You will be asked to give a “clean catch” urine sample by washing the genital area and collecting a “midstream” sample of urine in a sterile container. This method of collecting urine helps prevent bacteria around the genital area from getting into the sample and confusing the test results. The sample is sent to a laboratory for analysis.
In the urinalysis test, the urine is examined for white and red blood cells and bacteria. Then the bacteria are grown in a culture and tested against different antibiotics to see which drug best destroys the bacteria. This last step is called a sensitivity test.

Some microbes, like Chlamydia and Mycoplasma, can be detected only with special bacterial cultures. These infections are suspected when a person has symptoms of a UTI and pus in the urine, but a standard culture fails to grow any bacteria.

When an infection does not clear up with treatment and is traced to the same strain of bacteria, the doctor will order a test that makes images of the urinary tract. One of these tests is an intravenous pyelogram (IVP), which gives x-ray images of the bladder, kidneys, and ureters. An opaque dye visible on x-ray film is injected into a vein, and a series of x-rays is taken. The film shows an outline of the urinary tract, revealing even small changes in the structure of the tract.

If you have recurrent infections, your doctor also may recommend an ultrasound exam, which gives pictures from the echo patterns of sound waves bounced back from internal organs. Another useful test is cystoscopy. A cystoscope is an instrument made of a hollow tube with several lenses and a light source, which allows the doctor to see inside the bladder from the urethra.