Jennifer Anger, MD, MPH, presented “Recurrent UTIs in Women: Ask the Guideline” during the 30th Annual Perspectives in Urology: Point-Counterpoint, on March 10, 2023, at Humphreys Half Moon Inn, San Diego, California.

How to cite: Anger, Jennifer. “Recurrent UTIs in Women: Ask the Guideline.” March 10, 2023. Accessed Jul 2024.

Recurrent UTIs in Women: Ask the Guideline – Summary

Jennifer Anger, MD, MPH, discusses American Urological Association (AUA) guidelines regarding recurrent urinary tract infections (rUTIS) in women. She begins by discussing antimicrobial stewardship and the consideration of collateral damage, explaining antimicrobial resistance among uropathogens has increased dramatically in the past 20 years.

Dr. Anger characterizes the index patient for the 2019 rUTI guideline as an otherwise healthy adult female with an uncomplicated, culture-proven rUTI associated with acute-onset symptoms. She summarizes guideline highlights, including the recommendation that clinicians obtain a complete patient history and perform a pelvic examination in women presenting with rUTIs. Additionally, clinicians should obtain urinalysis, urine culture, and sensitivity with each symptomatic acute cystitis episode prior to initiating treatment for rUTIs.

Dr. Anger outlines first-line therapy (nitrofurantoin, TMP-SMX, and fosfomycin) and explains clinicians should use as short a duration of antibiotics as reasonable for rUTI patients with an acute cystitis episode. For patients with urine cultures resistant to oral antibiotics, clinicians may treat with culture-directed parenteral antibiotics for as short a course as reasonable.

Dr. Anger discusses use, dosing, and duration of prophylactic antibiotics and points out that clinicians may offer cranberry prophylaxis for rUTIs, but explains that studies are lacking in this area. Clinicians should repeat urine culture to guide further management when UTI symptoms persist following antimicrobial therapy.

In peri- and post-menopausal women with rUTIs, clinicians should consider vaginal estrogen therapy to reduce the risk of recurrence. Dr. Anger then highlights the 2022 UTI Guideline Update and explains randomized, controlled trials that contributed evidence to this amendment report.

About the 30th Annual Perspectives in Urology: Point Counterpoint conference: Presented by Program Chair and Grand Rounds in Urology Editor-in-Chief E. David Crawford, MD, this conference brought together leading experts in urology, medical oncology, and radiation oncology to discuss and debate the latest topics in genitourinary cancers, primarily prostate cancer and bladder cancer. This interactive conference offered topical lectures, pro/con debates, interesting-case presentations, interactive panel discussions, and interactive audience and faculty networking. 


Jennifer T. Anger, MD, MPH, (she/her) Professor of Urology; Vice Chair of Research; and The C. Lowell and JoEllen Parsons Endowed Chair in Urology, Gender Affirming Surgery, Urologic Reconstruction, and FPMRS with the University of California at San Diego Health System is a board-certified female pelvic medicine and reconstructive surgery expert who has dedicated her career to improving the quality of surgical care for patients with pelvic floor disorders. She is the only physician in San Diego who performs gender affirming pelvic or "bottom" surgery, including vaginoplasty (penile inversion, peritoneal and intestinal), vulvoplasty (zero or shallow depth), metoidioplasty, phalloplasty, and robotic hysterectomy with vaginectomy and non-binary options.