Recurrent UTI in Women

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Managing Recurrent UTIs: Prevention and Treatment

Recurrent urinary tract infections (UTIs) can be a frustrating and painful ordeal for both women and men, although they most often occur in cis women. Numerous new approaches are emerging to treat chronic UTI’s beyond just antibiotics. Here you can learn about recurrent uti in women, including their causes, symptoms, and recurrent uti treatment options. With the help of the best-in-class urologists at Comprehensive Urology, take control of your urinary health with innovative treatments for recurrent urinary tract infections. Reach out today for an appointment to find out more about our ThermiVa Vaginal Rejuvenation treatment which may help you to reduce recurrent urinary tract infections. You can also find out more about our UTI vaccine trial. 


      • Causes, pathogenesis and risk factors of recurrent UTIs is essential for prevention.

      • Prevention methods include hydration & diet, hygiene, and behavioral changes

      • Treatment strategies involve antibiotics or prophylactic approaches with caution due to resistance concerns.

      • Learn about the new Urinary Tract Infection Vaccine Study at Comprehensive Urology in Beverly Hills, Los Angeles


    Table of Contents

    What is a recurrent uti in women?

    Recurrent UTI in women, or recurrent urinary tract infections, are infections that come back several times, even after a full course of antibiotics. Antibiotics are the standard of care because UTI’s are causes by bacteria. About half of all women will experience a UTI in their lifetime, and up to 50% of those who get a UTI will have a recurrent infection within the subsequent 6-month period. Men, on the other hand, have a significantly lower prevalence of UTIs, with an estimated lifetime prevalence of 13.7%.

    Treatment of a recurrent UTI in women and men begins by understanding the causes, pathogenesis, and risk factors.

    Causes and Pathogenesis of Urinary Tract Infections

    Recurrent UTIs are most often caused by the bacterium called Escherichia coli (E. coli). 75% of the time E. Coli causes UTI’s which can originate from rectal bacterial flora. How the infection happens, called pathogenesis, starts with E. Coli or another type of bacteria from the gut contaminating the vaginal area. However, the correlation between the intestinal, vaginal, and urinary microbiome in recurrent uti in women is still being studied. Since antibiotics are used to treat UTI’s and these same medications can decimate the healthy flora in the colon, it’s possible that long term, antibiotics may create an environment with less competition for E. Coli, contributing to future infections.

    Risk Factors of Recurrent UTI in Women

    There are several factors that can increase the risk of recurrent UTIs, including:

    • Sexual activity, as it can introduce bacteria into the urinary tract
    • The use of spermicides and diaphragms, which have been linked to an increased risk
    • Postmenopausal women, who may be at higher risk due to changes in the urinary tract and hormonal fluctuations during menopause.

    Genetics also play a role in recurrent UTIs, as having a mother or sister who has frequent urinary tract infections is considered a risk factor. Other lifestyle factors, such as reduced fluid intake, delayed urination, and wiping from back to front after defecation, can also contribute to the development of recurrent UTIs.

    It’s essential to be aware of the incidence and risk factors, and make appropriate lifestyle changes when possible to reduce the likelihood of recurrent infections. By understanding and addressing these risk factors, individuals can take a proactive approach to preventing recurrent UTIs.

    Symptoms and Diagnosis of Recurrent UTI in Women

    Recognizing the UTI symptoms of recurrent UTIs, which may be caused by a bladder infection, is crucial for early diagnosis and treatment. Symptoms may include:

    • frequent urgency to urinate
    • cloudy urine
    • blood in the urine
    • burning sensation during urination
    • urinary frequency
    • urinary urgency
    • back pain
    • nausea and vomiting
    • chills
    • fever
    • fatigue
    • mental changes or confusion, particularly in elderly individuals.

    To confirm a diagnosis of recurrent UTIs, healthcare professionals typically utilize urine culture and sensitivity tests. These tests help identify the cause of the organism and determine the most appropriate antibiotic treatment. A positive urine culture with a colony-forming unit count of greater than 102 per mL is considered diagnostic for UTIs in symptomatic patients.

    Symptoms of Recurrent UTIs

    Recurrent UTIs can cause symptoms similar to painful bladder syndrome, such as frequent urgency to urinate, burning sensation during urination, and lower abdominal discomfort. However, painful bladder syndrome is a separate condition that requires a different approach to diagnosis and treatment. This highlights the importance of proper diagnosis and understanding the underlying causes of recurrent UTIs.

    While kidney or bladder stones are not directly mentioned in the context of recurrent UTIs, they can contribute to the development of urinary tract infections by obstructing the flow of urine and providing a surface for bacteria to adhere. Therefore, addressing any underlying anatomical issues can be a crucial step in the management of recurrent UTIs.

    Common symptoms of recurrent UTIs include:

    • Frequent urination: the need to urinate more frequently than is customary, which can be disruptive to daily activities and sleep patterns.
    • Burning sensation during urination (dysuria): a feeling of discomfort or pain when urinating. This symptom can be particularly distressing and may cause individuals to avoid urinating, which can exacerbate the infection.
    • Lower abdominal pain: discomfort in the lower region of the abdomen.

    It’s essential to recognize these symptoms and seek medical attention promptly to prevent complications.

    Diagnostic Tests

    The diagnosis of recurrent UTIs relies on accurate and timely testing. Urine culture and sensitivity tests are commonly used to diagnose recurrent UTIs and identify the causative organism. These tests are particularly important for patients who have been treated for cystitis in the past three months, as there is an increased risk of antibiotic resistance.

    In addition to urine culture and sensitivity tests, healthcare professionals may utilize urinalysis and ultrasonography to further evaluate patients with recurrent UTIs and rule out other underlying conditions. While these tests can provide valuable information, they may have limitations, and additional testing may be required in some cases.

    Ultimately, the accurate diagnosis of recurrent UTIs is crucial for determining the most appropriate treatment plan and preventing complications. Understanding the diagnostic process can empower patients to seek timely medical attention and advocate for their health.

    Non-Antibiotic Prevention Methods of Recurrent UTI in Women

    While antibiotics are commonly used to treat and prevent recurrent UTIs, there are various non-antibiotic methods that can also be effective. These methods include hydration, diet, and behavioral changes. By adopting these preventive measures, individuals can reduce their reliance on antibiotics and decrease the risk of antibiotic resistance.

    Understanding and implementing non-antibiotic prevention methods can be particularly beneficial for those who experience frequent recurrent UTIs or have concerns about the potential side effects of antibiotic treatment. In this section, we will explore hydration, diet, and behavioral changes as non-antibiotic prevention methods for recurrent UTIs.

    Hydration and Diet

    Maintaining proper hydration and consuming a balanced diet may help prevent recurrent UTIs. Some strategies to consider include:

    • Increasing fluid intake
    • Regularly monitoring urine osmolality
    • Ensuring adequate hydration
    • Following a balanced diet

    While the precise role of hydration in UTI prevention remains unclear, some studies have suggested that these practices can lead to improved hydration, reduced osmolality, and fewer UTIs over a four-month period.

    Dietary supplementation, such as Chinese herbal medicines and cranberry products, may also reduce the rate of recurrent UTIs. For example, cranberry juice and its concentrated form have been shown to significantly reduce the recurrence of symptomatic cystitis. It is recommended to consume between 150 to 750 mL of cranberry juice or its concentrated form daily for the prevention of recurrent UTIs.

    While hydration and diet may not entirely prevent recurrent UTIs, incorporating these strategies into one’s daily routine can help reduce the risk and support overall urinary health.

    Behavioral Changes

    In addition to hydration and diet, certain behavioral changes can help reduce the risk of recurrent UTIs. Here are some tips:

    • Adopt good hygiene habits, such as wiping from front to back after using the restroom, to prevent the introduction of bacteria into the urinary tract.
    • Urinate after sexual intercourse to flush out any bacteria that may have been introduced during the activity.
    • Avoid tight clothing, harsh soaps, and bubble baths to reduce irritation and the potential for bacterial growth.

    These changes can help prevent urinary tract infections and prevent recurrent UTIs.

    For some individuals, self-initiated treatment may be an option, wherein those with previous UTIs who can recognize the symptoms can be effectively treated with self-initiated antibiotic therapy. Implementing these behavioral changes can help minimize the risk of recurrent UTIs and improve overall urinary health.

    By understanding and addressing the factors that contribute to recurrent UTIs, individuals can take a proactive approach to preventing these infections.

    Natural Remedies

    Natural remedies, such as cranberry products, probiotics, and d-mannose, have shown potential in preventing recurrent UTIs. However, the evidence for the effectiveness of these remedies remains inconclusive, and further research is needed to determine their true potential.

    Cranberry products, for example, are believed to reduce the recurrence of symptomatic cystitis, but studies have produced mixed results. Probiotics, which are live microorganisms that supplement the natural bacterial flora in humans, have been proposed as a potential UTI prevention method. Research is ongoing.

    D-mannose, a sugar found in certain fruits, has also demonstrated potential in preventing recurrent UTIs. In a randomized study, participants receiving d-mannose had a statistically significant lower risk of recurrent UTI than those who received no treatment, with an absolute risk reduction of 45%. However, as with other natural remedies, more research is needed to confirm the efficacy and safety of d-mannose in preventing recurrent UTIs.

    Antibiotic Treatment and Prophylaxis Recurrent UTIs

    Antibiotic Treatment and Prophylaxis

    Antibiotics play a crucial role in the treatment and prevention of recurrent UTIs, and they are often the first line of defense for these infections. However, the growing issue of antibiotic resistance poses a significant challenge to the long-term effectiveness of these medications. In this section, we will discuss the use of antibiotics for treating and preventing recurrent UTIs, as well as the concerns surrounding antibiotic resistance.

    It’s important to note that while antibiotics can be effective in treating and preventing recurrent UTIs, they should be used judiciously and only as prescribed by a healthcare professional. Overuse of antibiotics can contribute to the development of antibiotic resistance, making infections more difficult to treat in the future.

    Antibiotic Stewardship

    Overuse of antibiotics has lead to a rise of antibiotic resistance in infectious bacteria. Yet, it is essential to get treatment as Urinary tract infections can move up to the bladder and even the kidneys if left untreated. It ensure that you are getting the correct antibiotic, be sure to get a PCR test to specifically identify the type of bacteria causing the infection. By know which bacterium to treat, your urologist will choose the correct medication to effectively treat the UTI. Culture tests are much less accurate, which is why it’s important to ask for a PCR. PCR is the same procedure used to test the COVID-19 flu virus, however it can be used to test more than viruses, including bacterial and fungal infections.

    Treatment Strategies

    Antibiotics such as nitrofurantoin, trimethoprim-sulfamethoxazole, and fosfomycin are commonly used to treat recurrent UTIs. The choice of antibiotic depends on the type of bacteria causing the infection which is best determined by a PCR test before the patient takes a medication.

    For an initial recurrence of UTI, a three-day course of trimethoprim-sulfamethoxazole is advised. Patients who have been treated for cystitis in the last three months are at an increased risk of antibiotic resistance. Therefore, urine culture and susceptibility testing should be performed to guide antibiotic therapy. The duration of therapy for recurrent complicated UTIs is typically 10 to 14 days, but this may vary depending on the individual’s circumstances.

    It’s essential to follow the prescribed treatment plan and complete the full course of antibiotics, even if symptoms improve before the medication is finished. This helps ensure the infection is fully eradicated and reduces the risk of antibiotic resistance.

    Prophylactic Approaches

    For individuals who experience frequent recurrent UTIs, prophylactic antibiotics may be considered as a preventive measure. These low-dose antibiotics can help reduce the likelihood of recurrent infections, but their use should be carefully monitored to avoid contributing to antibiotic resistance. Postcoital prophylaxis, which involves administering antibiotics within two hours of sexual intercourse, can also be an effective preventive measure for some individuals.

    For those who can recognize the symptoms of a UTI, self-initiated antibiotic therapy may be a viable option, allowing for prompt treatment at the onset of symptoms. When selecting a prophylactic approach, it’s important to consider factors such as the individual’s medical history, the risk of antibiotic resistance, and the potential side effects of the medication. Consulting with a healthcare professional can help guide the selection of the most appropriate prophylactic strategy for each individual.

    Managing Complicated Recurrent UTI in Women

    Complicated UTIs can present with more severe symptoms and complications compared to uncomplicated UTIs. These infections may be associated with:

    • Urinary obstruction
    • Instrumentation
    • Diabetes
    • Renal abscesses

    Identifying and treating complicated UTIs is crucial to prevent further complications and ensure appropriate management.

    In this section, we will discuss the identification and treatment of complicated UTIs, as well as the potential risk factors and complications associated with these infections.

    Identifying Complicated UTIs

    Individuals with complicated urinary tract infections (UTIs) can have serious symptoms. These include bacteremia, sepsis, multiple organ system failure, and acute renal failure. To identify these infections, healthcare professionals may utilize various diagnostic tests, such as urinalysis, urine culture, ultrasonography, and quantitative urine culture.

    Certain factors can increase the risk of complications associated with UTIs, such as urinary tract obstruction, recent urinary tract instrumentation, and underlying medical conditions like diabetes mellitus. It’s important to identify and address these risk factors in order to effectively manage complicated UTIs and prevent further complications.

    If complications are suspected or symptoms persist despite antibiotic treatment, it’s essential to consult a healthcare professional for further evaluation and management. This may include referral to a specialist, such as a urologist, infectious disease expert, or renal medicine specialist.

    Recurrent UTI Treatment Options

    The treatment of complicated UTIs typically involves a combination of antibiotics, relieving urinary obstruction, and referral to a specialist if necessary. Antibiotics used to treat complicated UTIs are based on the type of bacteria causing the infection and may include cephalosporins, fluoroquinolones, and aminoglycosides.

    Relieving urinary obstruction is a crucial component of treating complicated UTIs, as it can help reduce the risk of recurrent infections. This may involve the use of a catheter to drain the bladder or surgical removal of any blockages. In some cases, consultation with a specialist may be necessary to determine the most appropriate treatment plan and address any underlying conditions or complications.

    It’s important to follow the prescribed treatment plan and consult a healthcare professional if symptoms do not improve or complications develop. Timely and appropriate treatment of complicated UTIs is essential for preventing further complications and ensuring the best possible outcome.

    Emerging Therapies and Research

    As the prevalence of recurrent UTIs and antibiotic resistance continues to rise, researchers are exploring new therapies and treatment options in the field of recurrent UTI prevention and management. These emerging therapies, such as cranberry prophylaxis and the development of new antibiotics like gepotidacin, Tebipenem, and sulopenem, have the potential to revolutionize the way we approach and treat recurrent UTIs.

    Immunostimulants and Vaccines

    Experimental vaccines and immunostimulants have shown promise in preventing UTIs, but their efficacy is limited. Developing effective vaccines for UTIs has been a challenge. This is attributed to:

    • The lack of natural protective immunity in humans post infection
    • Failure to evoke bladder antibodies
    • Vast variety of pathogens
    • The need to avoid triggering pathological immune response to gut colonization bacteria.

    Despite these challenges, multiple vaccines and immunostimulants have been trialed in mice, rats, and non-human primates, showing promising results. One such immunostimulant, OM-89, is an oral bacterial lysate immunostimulant currently utilized to treat recurrent UTIs.

    Comprehensive Urology is on the cutting edge of recurrent urinary tract infections treatment studies with a vaccine trial currently happen in Beverly Hills, California. Contact us today to join the study.

    Competitive Inoculation

    Another emerging therapy for preventing recurrent UTIs and bladder infections is competitive inoculation, which involves the colonization of the urinary tract with less-pathogenic strains of bacteria in order to prevent infection. This treatment approach has the potential to be particularly beneficial for individuals who are vulnerable due to external factors, such as prolonged catheter use, and those with inadequate bladder evacuation.

    E. coli strain 83972, for example, does not demonstrate virulence factors related to symptomatic UTIs and has been shown to reduce the average number of UTIs in experimental groups. However, colonization with this strain is not established in those who have complete bladder emptying, and a symptomatic UTI has been observed in the absence of functional virulence factors.

    The development of competitive inoculation strategies offers an innovative approach to preventing recurrent UTIs, but further research is needed to determine the efficacy and safety of this treatment method.

    Recurrent UTI in Women FAQs

    In this section, we will address some frequently asked questions about recurrent UTIs. These questions and answers are based on the knowledge base and blog post content, providing clear and concise information to help readers better understand this common and frustrating condition.

    By addressing these frequently asked questions, we hope to provide readers with a comprehensive understanding of recurrent UTIs, their causes, prevention strategies, and treatment options. Empowered with this knowledge, individuals can take an active role in managing their urinary health and reducing the impact of recurrent UTIs on their daily lives.

    What causes recurrent UTIs in females?

    Recurrent UTIs in females are often caused by E. coli bacteria, which originate from the rectal bacterial flora. Sexual activity can also introduce bacteria into the urinary tract, increasing the risk of recurrent UTIs.

    Other factors, such as spermicide use and menopause, can contribute to the development of recurrent UTIs in females.

    Can recurrent UTIs be a sign of cancer?

    While recurrent UTIs are not typically a sign of cancer, persistent symptoms or complications may warrant further investigation to rule out other underlying conditions. In some cases, recurrent UTIs can be indicative of cancer, particularly bladder cancer.

    It is essential to consult a healthcare professional if symptoms persist despite treatment or if you have concerns about your urinary health.

    What will a urologist do for recurrent UTIs?

    A urologist can treat recurrent UTIs by prescribing a long-term course of antibiotics or recommending an antibiotic after sexual activity.

    What feels like a UTI but isn't a UTI?

    Interstitial cystitis (IC) or bladder pain syndrome (BPS) can cause long-term bladder pain that may feel like a urinary tract infection, but is not. IC/BPS is characterized by discomfort and pressure in the bladder area lasting for more than six weeks without an identifiable infection.

    What causes recurrent UTIs in females?

    Recurrent UTIs in females are most commonly caused by E. coli bacteria, as well as through sexual activity, spermicide use, and menopause.

    Can recurrent UTIs be a sign of cancer?

    Recurrent UTIs may not usually be an indication of cancer, but if symptoms persist or complications arise, it is important to investigate further to rule out other potential underlying causes.

    It is important to take any persistent symptoms seriously and to seek medical advice if necessary. Early diagnosis and treatment can help reduce the risk of complications and ensure that any underlying causes are identified and treated.


    In conclusion, recurrent UTIs are a common and often frustrating condition for those who experience them. Understanding the causes, symptoms, and various prevention methods is crucial for effectively managing and reducing the impact of recurrent UTIs on one’s daily life. By adopting preventive measures, such as maintaining proper hydration, practicing good hygiene, and implementing behavioral changes, individuals can reduce their reliance on antibiotics and decrease the risk of antibiotic resistance.

    Armed with the knowledge presented in this blog post, you can take control of your urinary health and reduce the likelihood of recurrent infections. Remember, it’s essential to consult a healthcare professional if symptoms persist or complications develop, as early diagnosis and appropriate treatment are crucial for preventing further complications and ensuring the best possible outcome. Learn about recurrent UTIs near me today.