This review article defined women who had recurrent urinary tract infections (UTIs) as having either ≥ two episodes in the last six months or ≥ three episodes in the last 12 months. Using a number of databases, including the Cochrane Database and Medline, systematic review articles and randomised controlled trials were identified and reviewed to produce the article. It shows that a number of risk factors have been identified and that these differ between pre- and post-menopausal women. There may also be a genetic predisposition in affected patients e.g. histo-blood group non-secretors, altered interleukin-8 receptors. In evaluating patients for UTIs it stresses the importance of the presence of symptoms and to try and identify any underlying risk factors. It also highlights that the classical urine microscopy definition of a UTI (i.e. >10 colony forming units) may well be too high and that the European Association of Urology (EAU) guidelines of symptoms + >10³ cells/ml may be more appropriate. It also mentions the importance of having a clear urine sample two weeks post infection to ensure total clearance but acknowledges that this may lead to the treatment of asymptomatic bacteria, which is not beneficial for patients.

There are no guidelines for imaging in recurrent UTI patients. Preventative measures patients can try include lifestyle modifications e.g. using an alternative method of contraception if using a diaphragm and spermicides. After this there are various antibiotic regimens that can be considered:

1. Continuous
2. Post-coital prophylaxis
3. Patient-initiated therapy

All have proven efficacy. Oestrogen therapy has also been shown to be beneficial. Other potential preventative therapies however do not have strong supporting evidence i.e. cranberry juice or tablets, vitamin C and methenamine salts. Therapies such as D-Mannose, lactobacillus (probiotics) and vaccination are emerging as other possible treatments in the management of this symptomatic group of patients.

Recurrent urinary tract infections in women.
Aydin A, Ahmed K, Zaman I, et al.
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Ann Crump

Central Manchester Foundation NHS Trust

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