Background

Urinary tract infections (UTIs) are some of the most common infections seen in the primary care setting.  Without appropriate treatment, acute cystitis has the potential to advance to more serious infections such as pyelonephritis and urosepsis.  Because of this, treatment with standard antibiotics such as TMP-sulfa, nitrofurantoin, and ciprofloxacin should be strongly considered, especially in cases where a culture proves the infection positive for bacteria at >/= 100,000 CFU/mL.  However, other strategies can be considered in those with recurrent infections or symptomatic colonization with lower concentrations of bacteria, or as adjuvants to antibiotic treatment.

Mechanical and Anatomic Considerations

There are a number of anatomic and mechanical risk factors that increase the likelihood of colonization and infection of the urinary tract with pathogenic bacteria—most commonly, E. coli.  Risk factors of this type include the following:¹

·         condom use

·         spermicide use

·         diaphragm use

·         delayed urination

·         incomplete bladder emptying

·         atrophic vulvo-vaginal changes

·         lack of voiding after sex

·         cystocele in females

·         lack of circumcision in males

·         penetrative anal sex

·         prostatic hypertrophy

Simple, low risk interventions to reduce these risks include urination after intercourse, avoiding holding urine/waiting a long time to urinate after the urge arises, and, for women, wiping from front to back after urination (Natural Standard).²  Cystoceles often respond well to regular completion of Kegel exercises.  Vaginal estrogen can be considered in the postmenopausal woman with atrophic vulvo-vaginal changes and recurrent UTIs.