Recurrent Urinary Tract Infection (UTI)

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What is recurrent UTI? When you have urinary tract infection for three or more times in a year or two infections within six months period, each following complete resolution of the previous one, it is referred to as recurrent urinary tract infection.

What causes recurrent UTI?

Recurrent UTI occurs due to bacterial re-infection or persistence of the previous bacteria which caused the previous UTI. Bacterial re-infection means the current UTI is caused by a different bacteria or the same type of bacterial after the previous infection has been cleared, has shown by negative culture after treatment with specific antibiotics which the bacteria was sensitive to.

Bacterial persistence on the other hand means that the same bacteria remains in the urinary tract and is cultured two weeks after the treatment with the specific antibiotics which the bacteria was sensitive to.

What are the types of recurrent urinary tract infection?

Recurrent urinary tract infection may be complicated or uncomplicated.

What constitutes uncomplicated recurrent UTI?

Recurrent UTI in healthy humans with no functional or structural abnormalities along the urinary tract is referred to as uncomplicated UTI.

What constitutes complicated UTI?

Recurrent UTI in humans with functional or structural abnormalities is said to be complicated. Also, when pyelonephritis (kidney infection) becomes recurrent, it is considered as being of complicated origin.

Functional and structural factors resulting in complicated UTI

  1. Frequent sexual intercourse
  2. Prolonged urethral catheterization 
  3. Urinary incontinence (involuntary loss of urine)
  4. Vesicoureteric reflux (movement of urine from the bladder to the ureters)
  5. High residual urine volume (high quantity of urine in the bladder after passing urine)
  6. Urinary fistula (abnormal leaking channel for urine)
  7. Surgery (injury to urinary tract during surgery)
  8. Obstruction to urine flow out of the bladder (due to stricture or enlarged prostate)
  9. Pregnancy, ureteric or kidney stone 
  10. Diabetes – high sugar content of urine encourages bacterial growth  
  11. HIV / AIDS – compromised body immunity leads to inability of the body to fight infection

How is recurrent UTI diagnosed?

You may have symptoms such as painful urination, urinating more frequently than before, inability to hold urine until a convenient time or place, blood in urine, waking up more frequently in the night to pass urine, loin or lower abdominal pain.

Investigation such as urine culture and sensitivity is necessary to identify the organism causing recurrent UTI as well as the antibiotic most suitable for its treatment.

Others like uroflowmetry (a study of movement of urine in the urinary tract), post-void residual volume (i.e. the volume of urine in the bladder after urinating), cystoscopy (procedure for viewing inside of the bladder with an instrument, ultrasound and CT scan may be necessary to rule out complicated causes of recurrent UTI such as kidney, ureteric or bladder stone, duplicated ureters.

What are organisms responsible for urinary tract infection?

  1. Escherichia coli
  2. Staphylococcus saprophyticus
  3. Proteus mirabilis  
  4. Klebsiella pneumoniae  

How is recurrent UTI treated?

  1. Underline problems, if any as identified during the investigations, are treated.
  2. Antibiotics are given according to the sensitivity of the particular organism causing the urinary tract infection
  3. When urinary tract infections occur once or twice a year, treatment with antibiotics with each episode is recommended. This involves three to five day course of antibiotics
  4. When there are three or more episodes of urinary tract infections in a year, treatment options include:
  1. Continuous antibiotics treatment - This involves low dose antibiotics given daily or on alternate days for six months.
  2. Treatment after every sexual intercourse - This is effective when recurrent UTI is related to sexual activity. This involves a single dose of the common antibiotics used for treatment of urinary tract infection after sexual intercourse.

How can recurrent UTI be prevented?

  1. Drink plenty fluids (water and other liquids) so that you can pass urine frequently as this helps in flushing bacteria out of the urinary tract.
  2. Avoid holding urine in the bladder for too long as this encourages bacterial growth and multiplication.
  3. Women should endeavour to clean their genital before and after sex.
  4. Pass urine immediately after having sex to wash away any bacteria that has found its way into the urinary tract during sexual intercourse.
  5. Avoid multiple sexual partners so as to reduce the risk of urinary tract infection as well as sexually transmitted infection.
  6. Women should avoid the use of spermicide as contraceptive, as well as vaginal douching, as this may irritate the vagina and urethra and makes it easy for bacteria to get into the urinary tract and cause infection.
  7. Use of vaginal oestrogen creams or vaginal rings by post-menopausal women encourages the presence of the bacteria that normally reside in the vagina which help to defend the body against foreign bacteria. 
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