Recurrent Acute Cystitis

Recurrent (several episodes per year) symptomatic urinary tract infections in sexually active women has vastly different connotations than urinary tract infections in children. Urinary tract infections in children always demand evaluation. See the pediatric section.

Conversely, recurrent urinary tract infections in sexually active women without flank pain suggestive of kidney inflammation, without obvious bleeding, and normally with no other voiding dysfunction usually do not need evaluation.

This type of problem in sexually active women is exceedingly common and has nothing to do with inadequate fluid ingestion nor anything to do with hygiene, clothes, swimming pools, etc. If this problem were exacerbated by these factors, then the incidence of infections in women would be much higher than it is.

Recurrent urinary tract infections in sexually active women usually do not need evaluation with x-rays or cystoscopy, nor is there any scientific basis for the use of the archaic procedure of urethral dilatation.

Most women can be simply treated when presenting with this condition with a 48-72 hour course of an inexpensive antibiotic. If a woman should get more than 3-4 infections in a year, she may benefit from a course of long-term, low-dose antibiotics or urinary disinfectants. These women may need to take one pill at bedtime after treatment of their symptomatic urinary tract infection for prophylaxis for a period of months to years. If they should be susceptible to yeast vaginitis, a long-term urinary disinfectant may be more appropriate, as this type of medication has little chance of bringing about vaginitis. Taking these medications nightly rather than in the morning or only at times of intercourse seems to minimize the risk of breakthrough infections. Long-term, low-dose antibiotic prophylaxis does not cause immune or resistance problems.