From the Guidelines
Recurrent post-coital UTIs can be effectively managed with a combination of lifestyle modifications, prophylactic antibiotics, and non-antibiotic alternatives, as recommended by the most recent guidelines 1.
Causes of Recurrent Post-Coital UTIs
The causes of recurrent post-coital UTIs include:
- Bacterial reinfection from a source outside of the urinary tract or from bacterial persistence 1
- Sexual habits and hygiene, such as the use of diaphragms and/or spermatocides 1
- Anatomical abnormalities, such as cystoceles, bladder or urethral diverticula, fistulae, indwelling catheters, urinary tract obstruction, and underlying conditions such as voiding dysfunction, pregnancy, diabetes, and immunosuppression 1
Treatment and Prevention Strategies
The treatment and prevention strategies for recurrent post-coital UTIs include:
- Urinating immediately after sexual intercourse to flush bacteria from the urethra
- Staying well-hydrated throughout the day
- Considering taking cranberry supplements to help prevent bacterial adhesion to the urinary tract
- Prophylactic antibiotic regimens, such as a single dose of nitrofurantoin (100mg) or trimethoprim-sulfamethoxazole (one single-strength tablet) taken within 2 hours after intercourse 1
- Non-antibiotic alternatives, such as methenamine hippurate and/or lactobacillus containing probiotics 1
- Vaginal estrogen therapy for postmenopausal women 1
- Increased water intake to reduce the risk of UTIs 1
Key Recommendations
The most recent guidelines recommend a tailored approach to prevention and treatment, taking into account the individual patient's needs and risk factors 1.
- Continuous or postcoital antimicrobial prophylaxis may be recommended for women with recurrent UTIs, with a focus on balancing the need for prevention against the risk of adverse drug events, antimicrobial resistance, and microbiome disruption 1
- Cranberry products containing proanthocyanidin levels of 36 mg may be recommended to reduce the risk of recurrent UTIs in women 1
- Vaginal estrogen therapy may be recommended for postmenopausal women to reduce the risk of recurrent UTIs 1
- Increased water intake may be recommended to reduce the risk of UTIs, with a goal of additional 1.5L of water per day 1
From the FDA Drug Label
To reduce the development of drug-resistant bacteria and maintain the effectiveness of sulfamethoxazole and trimethoprim tablets and other antibacterial drugs, sulfamethoxazole and trimethoprim tablets should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to empiric selection of therapy Urinary Tract Infections For the treatment of urinary tract infections due to susceptible strains of the following organisms: Escherichia coli, Klebsiella species, Enterobacter species, Morganella morganii, Proteus mirabilis and Proteus vulgaris It is recommended that initial episodes of uncomplicated urinary tract infections be treated with a single effective antibacterial agent rather than the combination
The causes of recurrent post-coital urinary tract infections (UTIs) are not directly addressed in the provided drug label. The treatment for urinary tract infections (UTIs) includes sulfamethoxazole and trimethoprim tablets for infections due to susceptible strains of certain organisms, such as Escherichia coli and Klebsiella species. However, the label does not specifically address recurrent post-coital UTIs. No conclusion can be drawn regarding the treatment of recurrent post-coital UTIs based on this information 2.
From the Research
Causes of Recurrent Post-Coital UTIs
- Recurrent UTIs are common among young, healthy women, even with anatomically and physiologically normal urinary tracts 3
- Sexual intercourse is a major risk factor for recurrent UTIs in women 4, 5
- Other risk factors for recurrent UTIs include impairment of the body's immune system and virulence factors 6
Treatments for Recurrent Post-Coital UTIs
- Postcoital antimicrobial prophylaxis is a highly effective approach to managing recurrent UTIs in young women 4
- Continuous prophylaxis, pre- and post-coital voiding, and self-starting are commonly accepted options for prophylaxis 6
- Long-term, low-dose prophylactic antimicrobials taken at bedtime or postcoital prophylaxis for women in whom episodes of infection are associated with sexual intercourse are recommended 3
- Antibiotics such as trimethoprim-sulfamethoxazole, fluoroquinolones, fosfomycin trometamol, or beta-lactams may be used for prophylaxis 3, 7
- Non-antimicrobial options such as vaccines, cranberry supplements, and intra-vesical instillation of hyaluronic acid and chondroitin sulphate are being explored, but their effectiveness is limited or conflicting 7, 6, 5
Prevention Strategies
- Behavioural factors such as adequate hydration, care with sexual hygiene, reducing body mass index (BMI), and post-void residual (PVR) volume may help prevent recurrent UTIs 6
- Immediate antibiotic treatment of UTI symptoms and postcoital prophylactic antibiotic treatment may also be effective in preventing recurrent UTIs 4, 5