Alice,

I'm a sexually active college female in a monogamous relationship, where we use condoms and spermicide. What's bothering me is that I keep getting urinary tract infections, practically once a month. Every time I go into the health center at my school, they take a urine sample, and take a culture, since it's been reoccurring so often, but nothing else has become of that. I feel as if I drink cranberry juice religiously. Is there anything else I can do to stop this?

Dear Reader,

Urinary Tract Infections (UTIs) are so common that most women and some men get them at some point in their lives. For some women, UTIs are a recurring problem, leading to hours or days of discomfort and pain, countless courses of antibiotics, feelings of frustration, and negative feelings toward intercourse or penetration.

In your case, it's recommended that your diagnosis be confirmed by rigorous testing each time. For example, if you had a positive urine analysis result (i.e., many white blood cells, the presence of bacteria, possibly a large number of red blood cells), was a 48-hour culture then done to count the number of bacterial colonies, the type of bacteria involved, and which antibiotics the bacteria are sensitive to? You can ask someone at your school's health center about what specific tests have been done. Also, have your infections ever been treated with antibiotics?

If your diagnosis is being made solely on the basis of your symptoms, then what you have is likely not caused by a urinary tract infection. Irritation to spermicide and/or condoms is one possibility. Others include a vaginal infection that is irritating to the urethra, or an anatomical predisposition that causes the urethra to get compressed during intercourse. A pelvic exam, rarely done when diagnosing a UTI, can identify the presence of these two possible causes.

Since you wrote that you get a UTI on a monthly basis, perhaps your symptoms are cyclical and related to your period. Intercourse during menstruation often precipitates a UTI because blood is a medium where bacteria thrive.

Your health care provider can help you to find out if your UTIs are recurrent infections, meaning infections with the same organism that are inadequately treated, or re-infections after adequate treatment and a cure. One reason why otherwise healthy women get repeated infections is because previous infections can damage the internal lining of the bladder, called the mucosa, which may necessitate longer courses of antibiotic treatment. The mucosa is an essential barrier to the bacteria that normally enter the bladder. Treatment in this manner allows healing so that simpler measures will work more effectively the next time there's an infection.

At this point, it may make sense to see a urologist, who can figure out exactly what's going on with you. The urologist may perform a cystoscopy, to rule out interstitial cystitis, and/or put you on prophylactic or post-intercourse antibiotics or some other treatment. It's important to treat infections as soon as you have symptoms. Frequent UTIs are not normal and need to be rigorously evaluated. Being vigilant can be key to managing frequent infections.

In the meantime, while you take care of yourself medically, these prevention strategies help decrease the number of bacteria in the bladder and/or can boost immunity to those bacteria that do make it in:

  • Drinking six to eight glasses of water a day is thought to be helpful in flushing out the bacteria, as frequent passing of water by urination can help prevent bacteria from reaching infectious numbers in your bladder. (By the way, bladder irritants, such as caffeine, alcohol, and spicy foods, can aggravate symptoms, but won't cause an infection.)
  • Changing sexual positions so that a penis or finger is not rubbing or "knocking boots" directly against your urethral opening (pee hole). Sexual intercourse and/or penetration can push bacteria into the bladder.
  • Emptying your bladder before and after sex could help flush out bacteria, which can reduce your risk.
  • Learning about alternatives to spermicides, including condoms coated with non- spermicidal lube, other contraceptive options, and safer sex techniques, and discussing them with your partner and health care provider, are good ideas. Spermicides can alter the variety of bacterial flora in the vagina, killing off friendly bacteria and allowing pathogenic ones to flourish, causing an infection.
  • Boosting your immune system, by eating plenty of fruits and vegetables rich in antioxidants, vitamins, and fiber; exercising; refraining from or quitting smoking; and, getting enough sleep. Similar to how we are more prone to colds when we are run down, the same applies to UTIs.
  • Taking antibiotics after sex prescribed for you by your health care provider can be useful when other methods prove ineffective.

When you get a UTI, your body will try to acidify your urine to stop bacteria from growing, causing the burning feeling when you urinate. Continue drinking unsweetened cranberry juice, as cranberries contain an acid that lowers the pH of the urine, making it more acidic. Cranberry tablets (a.k.a. CranActin), available at many health food stores, also can be taken as an effective supplement/alternative.

Hope you feel better soon!

Alice!
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