Recurrent Urinary Tract Infections

Recurrent urinary tract infections (UTIs) are defined as two or more UTIs within a twelve month period. They are bacterial infections that typical involve the bladder. Classic symptoms include lower abdominal pain or ‘pressure’, urinary burning, urgency, and frequency. If the kidney is also involved, back pain and fever may be present as well. The majority of UTIs in women are uncomplicated and involve only the bladder. Complicated UTIs are those involve the kidney or occur in pregnancy, diabetics, transplant patients, frail elderly, in weakened immune systems, or with urinary tract structural or anatomic abnormalities.

Common risk factors include: sexual intercourse, diaphragm/spermicidal jelly containing nonoxynol-9, fecal soilage of the vagina/groin, constipation, tampon use, menopause, urinary catheter use, diabetes, urinary stones, incomplete bladder emptying, anatomic abnormalities such as obstruction or reflux, neurological diseases such as multiple sclerosis or spinal cord injury, incomplete antibiotic usage, bacterial resistance.

Other urogenital problems that may mimic symptoms of UTIs include: urinary stones, vaginal infections, urethral infections from sexually transmitted diseases (STDs), interstitial cystitis.

Medical workup may include: determining a pattern of infection (intercourse, menses), prior antibiotic usage/compliance, prior catheter use, gynecological history, physical exam, urine culture, x-rays or endoscopy of the bladder (cystoscopy) if warranted.

Potential treatment options include: Longer or different course of antibiotics, proper daily hygiene, post-intercourse voiding/showering or antibiotic use, alternative contraceptive use, panty liner instead of tampons, bladder retraining for inappropriate habits, low dose antibiotic suppression, self-start therapy, and correction of anatomic problems.

Follow-up may include: monitoring for symptom resolution, re-culturing urine if symptoms recur, identify other potential risk factors, perform x-rays or cystoscopy, re-evaluation every six months.

For further information on all topics of female pelvic health, please visit Dr. Karlovsky’s blog at, or his practice website at

Matthew E. Karlovsky, M.D.
Center for Urological Services, P.C.
4545 E. Chandler Blvd, Suite 300
Phoenix (Ahwatukee), AZ 85048
480-961-2325 fax