Recurrent urinary tract infection in the female

PURPOSE OF REVIEW: Recurrent urinary tract infection is a common problem and can affect women of all ages, particularly the elderly and pregnant women. Obstetricians and gynaecologists need to have up-to-date knowledge of the diagnosis, pathophysiology and management of this condition. RECENT FINDINGS: The diagnosis of urinary tract infection is made on the basis of symptoms and bacteriuria of more than 103 bacteria per ml. Host and bacterial virulence factors are important in the pathogenesis of recurrent urinary tract infections. General host factors predisposing to recurrent infection are genetic factors, ageing, the menopause, urogenital dysfunction, sexual behaviour, and previous pelvic surgery. Urinary tract infection is common in pregnancy, and recent studies have suggested an association with mental retardation and developmental delay. Women with recurrent urinary tract infection in pregnancy should be considered for long-term antibiotic prophylaxis. Intravaginal oestrogens and cranberry juice have been found to be effective for prevention, although more research is required. Women with recurrent urinary tract infection should have at least a 3-day course of trimethoprim or cotrimoxazole, or a 5-day course of beta-lactams or nitrofurantoin, with perhaps a 10-day course in the elderly. Women with frequent urinary tract infection (more than three episodes per year) should be offered prophylactic antibiotics, which can be patient-initiated, postcoital, or long-term low-dose therapy. In the future, vaccines against specific uropathogenic bacteria may be useful in urinary tract infection prophylaxis. SUMMARY: More research is required, by all medical disciplines, on various aspects of urinary tract infection.