RECURRENT URINARY TRACT INFECTIONS:

RECURRENT URINARY TRACT INFECTIONS:

Dear Sumner:

I would appreciate if you would evaluate a 22 year old woman for me. Since her marriage last April, Sue has had one bladder infection after another. Her husband feels like it’s his entire fault (which, indirectly, it probably is!), and is ready to move into another room! I have treated each infection with 7 day courses of antibiotics, but the infections keep recurring. I realize that these infections are related to sexual activity, but my dilemma is coming up with a simple way of “breaking the cycle” of the recurrent infections. Sue (and her husband!) will be eternally grateful for your help!

Dear Mary:

You are absolutely correct that most urinary tract infections (UTI’s) in women follow sexual activity, usually occurring about 24 to 48 hours thereafter. The organisms, which are normally present in the urethral-vaginal area, get massaged up into the bladder during intercourse. I suggested to Sue that she void right after sexual activity, in hopes of “flushing out” the organisms before they multiply and cause the local tissue reaction with its associated irritative symptoms. We talked about the fact that the normal, non-inflamed urethral-vaginal tissue has a “built-in local defense mechanism.” With the recurring infections, this tissue becomes inflamed, rendering it more susceptible to the offending organisms. I am hoping that if Sue remains infection free for a prolonged period, there will be re-establishment of healthy tissue, making it more difficult for these organisms to colonize. If the simple post-coital flushing technique fails to achieve this goal, then Sue will take post-coital medication: e.g. one tablet of nitrofurantoin or trimethoprim sulfa, for a few months (along with post-coital voiding).

It is obviously very important to obtain an accurate sexual history. During my early years of training, I saw a teenager of 15 with a problem of recurrent urinary tract infections. Haltingly I inquired... ”Do you…you know…ever have sex with anyone?” Her reply was a combination of denial by both verbal and body language. I very rapidly learned that unambiguous questions are more likely to result in direct answers. For example, when I recently asked a coed at a local University who was having recurrent UTI’s: “Do these infections occur 24 to 48 hours after sex?” she replied: “Dr. Marshall, that’s hard to say since it’s unusual that 24 hours goes by without my having sex.”