Diagnosis and management of recurrent urinary tract infections in non-pregnant women

Summary pointsRecurrent acute cystitis, or recurrent urinary tract infection (UTI), is common in women, and most primary care providers will encounter this clinical entity many times in their practice. Women who have two or more infections in six months or three or more in one year meet the traditional definition of recurrent UTI that has been used for studies on prophylaxis, risk factors, and self initiated management.1 2 3 4 5 6 However, from a clinical perspective, any second episode of UTI warrants consideration as a recurrence and requires an informed approach to diagnosis and management. Most of these recurrences are considered to be reinfections rather than relapse or failure of initial therapy, although reinfection with the same strain can occur. Modifiable risk factors are few, and retrospective case-control observational studies indicate that genetic predisposition may play a role.7 8 This review will focus on the causes of recurrent UTI, when and how to investigate women who present with this problem, and how to manage and prevent recurrent infections. The recommendations are limited to non-pregnant adult women without comorbidities apart from diabetes. It is important to distinguish between this population …