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Recurrent UTI

Definition: > 3 proven urinary tract infections within 12 months (positive msu or symptoms of cystitis associated with nitrite positive dipstick).

 

Women have a 50% lifetime risk of UTI and this increases with age. There is often no significant underlying identifiable cause.

 Indications for referral:

  • Emergency referral if features of systemic sepsis: pyrexia/confusion/tachycardia/tachypnoea/hypotension/severe nausea and vomiting.
  • Persistent haematuria after treatment of infection refer as per 2WW haematuria guidelines
  • Abnormal USS: refer to appropriate speciality depending on abnormality.
  • Women with rec UTI and definite suggestion of bladder outflow obstruction (Residual Volume  RV >100ml)
  • In those who have had the treatments suggested above, eg. low-dose abx, with normal USS and RV, but are still very symptomatic and distressed may be referred for review. However, it is likely that there is little else to offer.

 

Possible causes:

  • Increasing age with atrophic vaginitis post menopause
  • Intercourse
  • Pregnancy
  • Diabetes
  • Urinary tract abnormality (anatomical/functional/stones/indwelling catheter)
  • Residential care
  • Immunocompromise

 

Differential diagnoses:

  • STD
  • Chronic pelvic pain syndrome
  • Drug induced cystitis eg ketamine

 

Management prior to referral:

  • Send MSU prior to starting antibiotics and change according to sensitivities. Consider treatment for 1-2 weeks.
  • Request USS renal tract. If this is normal further investigation is not usually required.
  • Lifestyle advice: adequate fluid intake/regular cranberry/hygiene/void after intercourse
  • Topical oestrogens (intravaginal) in post-menopausal women
  • Antibiotic dose after intercourse if a predisposing factor
  • Prophylactic antibiotic course for six months. If breakthrough infection send msu, treat for 2 weeks and change antibiotics according to sensitivities.

 

 

References

 

NICE, CKS, Urinary Tract Infection (lower)  - men, October 2014

NICE, CKS, Urinary Tract Infection (lower) – women, July 2015

 

Contributors

Mr Christopher Blake, Consultant Urologist, RCHT

Dr Stephanie Jackson, GP Lead Urology

Reviewed: July 2018