Recurrent urinary tract infections in otherwise healthy adult women. Rational strategies for work-up and management

Recurrent urinary tract infections (UTIs) are common, but clinicians unfamiliar with the natural history or pathogenesis may order unnecessarily expensive tests and provide unsubstantiated advice to their patients. A large body of literature indicates that recurrent UTIs do not progress to permanent kidney damage or end-stage renal disease. The vast number of UTIs are due to the interplay between minor weaknesses in host defenses and bacterial virulence factors. Sexual intercourse and diaphragm/spermicide use are the two behavioral factors most consistently associated with UTIs. Basic history, physical exam, and urinalysis are able to identify the few patients likely to benefit from invasive urologic workups, which usually have a very low yield when ordered routinely. Effective management options include daily or post-coital antimicrobial prophylaxis, or patient-initiated treatment. Patients can be reassured of an excellent prognosis. There is no evidence validating proscription of personal preferences, such as soda pop, tight clothing, or direction of perineal cleansing after defecation.