• More than 2 infections in 6 month, or 3 within a year
• caused by bacterial re-infection (different organism), or by bacterial persistence (same organism)
• Can also occur if a UTI has been inadequately treated
• Recurrent UTIs should always be thoroughly investigated for an alternative cause such as urinary tract stones or malignancy

Management

Conservative measures

• Increase fluid intake
• optimise blood sugars if diabetic
• post menopausal women - vaginal oestrogens
• avoid constipation
• good hygiene
• voiding before and after sexual intercourse
• Avoid spermicides
• D-mannose, cranberry juice

Medications

• Self start antibiotics
• Post coital prophylactic antibiotics - if this is a consistent trigger
• long term low dose prophylactic antibiotics - can be stopped after 3-6 months to see whether the bacteria have been fully eradicated