Recurrent Urinary Tract Infection
I get urine infection very often; do I have recurrent Urinary tract infection (rUTI)?
rUTI refers to getting at least 2 infections in six months or at least 3 infections in one year.
The episode of UTI must be confirmed with positive urine culture.
Is this common?
rUTI is one of the most common conditions affecting mainly women.
It is estimated that around 50–60% of women will develop UTIs in their lifetimes and Escherichia coli is the most common organism that causes UTI.
Is rUTI related to sex?
Yes. Sexual intercourse and the use of spermicide can be the cause of rUTI especially in young and pre-menopausal women.
What are the other causes of rUTI?
| Young and pre-menopausal women | Post-menopausal and elderly women |
|
Sexual intercourse Use of spermicide A new sexual partner A mother with a history of UTI History of UTI during childhood Blood group antigen secretory status |
History of UTI before menopause Urinary incontinence Atrophic vaginitis due to oestrogen deficiency Increased post-void urine volume Blood group antigen secretory status |
Adapted from European Association of Urology (EAU) guidelines
Am I genetically at risk of getting rUTI?
Yes, it is possible. The different blood groups secretor substances may influence the availability of these receptors on the urothelial cells (cells on the surface of the bladder) thereby affecting bacterial adherence and the susceptibility to UTI.
The frequencies of secretor status in different ABO blood groups are 70.1% in group A, 67.8% in group B, 67.9% in group AB, and 88.3% in group O.
Hence blood group B and AB individuals are at risk of getting recurrent UTI.
What should I expect at my first visit to a Urologist?
Your Urologist will first take a history, perform physical examination and do a series of tests to establish the diagnosis of rUTI. These may include:
- Midstream urine analysis
- Urine Culture and Sensitivity analysis of the bacteria involved
- Bedside ultrasound examination of the kidneys and bladder
- Uroflowmetry and post void residual urine
Depending on your symptoms, further tests such as CT scan or Cystoscopy might be offered by the Urologist.
The purpose of these tests is to exclude any organic causes to the recurrent nature of the UTI. These include stones, downstream obstruction such as prostate enlargement or by prolapsed organs (women) and most importantly to rule out underlying cancers that could account for the symptoms.
What is the prevention for rUTI?
- Lifestyle and behavioral modification
- Probiotics, cranberry and D mannose prevention
- Antibiotics prevention
- Immunoactive prophylaxis or oral vaccines
Prevention is better than cure!
Lifestyle and behavioral modification
- Drink plenty of fluids
- To urinate regularly
- Not holding urine for a long time . This allows bacteria to multiply within the urinary tract, resulting in UTI.
- Pass urine after sexual intercourse
- Avoid spermicidal contraceptives if possible, diaphragms and vaginal douching with shower cream, soap or lotions. This will irritate the vagina and urethra area and facilitate the entry and colonisation of bacteria. They could alter vaginal flora and cause UTI.
- To wipe from front to back, which will reduce the spread of E. coli from the perigenital area to the urethra.
- Vaginal estrogen creams or rings may also reduce the risk of UTI in postmenopausal women
Probiotics, cranberry and D mannose prevention
Taking regular probiotics, cranberry supplements and D mannose has been shown to have positive effects towards rUTIs.
Do remember not all Lactobacillus strains are effective for vaginal flora restoration and rUTI prevention.
The highest efficacy was shown with L. rhamnosus GR-1, L. reuteri B-54, L. reuteri RC-14, L. casei shirota, and L. crispatus CTV-05.
Antibiotics prevention
- Self-start regime – If you are familiar with the symptoms and it has been proven with a urine culture before, the urologist may advise you to self-start antibiotic treatment whenever you are experiencing the start of the UTI symptoms.
- Post sexual intercourse self-start – If the UTI happens mostly after sexual intercourse, your Urologist may advise you to self start a 3-day prophylactic course of antibiotics after sexual intercourse.
- Long term low dose antibiotic regime – Your urologist may advise you to take a 3 to 6 month daily course of low dose antibiotics to prevent recurring UTI. This is usually advised when all conservative measurements fail.
Immunoactive prophylaxis or oral vaccines
The 2 most common used oral vaccines in the market are OM-89 and MV 140.
Several meta-analyses and systematic reviews based on Randominsed controlled trials have shown that oral immunotherapy is effective and safe method for the prevention of rUTIs compared to placebo at short-term follow up to 12months.
OM-89 or Uro-Vaxom® has been shown effective in preventing E coli rUTI in women compared to placebo. It is an oral capsule to be taken once a day for 3 months with or without subsequent booster dose.
On the other hand, MV 140 or Uromune™, a Sublingal spray to be taken twice a day for 3 months is effective in preventing 4 different types of bacteria causing rUTI ( Ecoli, Klebsiella pneumoniae, Proteus vulgaris and Enterococcus Faecalis).
These 2 oral vaccines have been recommended in European Association of Urology (EAU) in its guidelines. In Singapore, these vaccines are brought in through HSA’s Special Access Route.
Please visit your Urologist today to find out more.
Contributed by:
Dr Shirley Bang
Urologist
Advanced Urology Associates
Appointments: +65 6738 1838
Email: enquiry@urology.com.sg
https://urology.com.sg/
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