From the Guidelines
Approximately 75-80% of cystitis cases in women are related to sexual activity. Sexual intercourse can introduce bacteria from the vaginal area and perineum into the urethra, which can then travel to the bladder and cause infection 1. The female urethra is relatively short compared to the male urethra, making it easier for bacteria to reach the bladder. Key factors that contribute to the development of cystitis in women include:
- Sexual habits and hygiene, such as the use of diaphragms and/or spermicides 1
- Inadequate hydration and infrequent urination
- Poor hygiene practices, such as wiping patterns and the use of harsh cleansers
- The mechanical action of intercourse, which can push bacteria toward the bladder and cause irritation to the urethral opening
To reduce the risk of sex-related cystitis, women should:
- Urinate before and after sexual activity to flush out bacteria
- Stay well-hydrated to promote more frequent urination
- Practice good hygiene, including avoiding the use of spermicidal-containing contraceptives and harsh cleansers
- Consider using lubrication to minimize urethral irritation
- Avoid prolonged holding of urine and sequential anal and vaginal intercourse 1
If recurrent infections occur, a healthcare provider might recommend preventive antibiotics to be taken after intercourse or regular prophylactic antibiotics for those with frequent infections 1. It is essential to note that antibiotic prophylaxis should be approached judiciously due to the risk of antibiotic resistance and adverse effects. Self-care measures, such as ensuring adequate hydration and practicing good hygiene, should be advised before considering antibiotic prophylaxis for recurrent UTIs 1.
From the Research
Trigger Factors for Female Cystitis
- Sexual intercourse is reported as a trigger factor for recurrent cystitis by 35% of patients 2
- Other trigger factors include stress (34%) and diarrhoea/digestive symptoms (19%) 2
Risk Factors for Recurrent Urinary Tract Infections
- Younger or older age is associated with an increased risk of recurrent UTI 3
- Immunocompromised status and positive urine culture result at index UTI are also associated with an increased risk of recurrent UTI 3
- Diabetes mellitus and frequent prior-year outpatient and emergency department encounters are additional risk factors 3
Treatment and Management of Urinary Tract Infections
- Antimicrobial therapy is usually indicated for amelioration of symptoms in UTIs 4
- First-line treatment of acute uncomplicated UTI has traditionally involved a 3-day regimen of trimethoprim-sulfamethoxazole or TMP alone 4
- Alternative first-line agents include fluoroquinolones, nitrofurantoin, and fosfomycin 4
- A 5-day course of nitrofurantoin is equivalent clinically and microbiologically to a 3-day course of trimethoprim-sulfamethoxazole 5