Recurrent urinary tract infections in women. Pathogenesis and management

Greater understanding of the pathogenesis of recurrent urinary tract infection (UTI) in women has led to highly successful management techniques. The primary care physician plays a vital role in evaluation and long-term management of these patients. Careful collection and culture of the urine must be performed to document and classify infections. Almost all recurrent UTIs are reinfections from bacteria in the fecal flora. Such infections can be managed successfully by low-dose prophylaxis, self-start intermittent therapy, or postintercourse therapy. Patients with infections at close intervals, particularly when caused repeatedly by the same strain, may have a focus of bacterial persistence within the urinary tract. Careful radiologic and urologic evaluation of these patients is mandatory, and localization and removal or correction of the underlying abnormality can result in a cure.