Many women are all too familiar with urinary tract infections (UTIs) and bacterial vaginosis (BV). The symptoms can range from annoying to downright painful. Fortunately, a course of antibiotics often clears up the issue.
For some women, however, these infections keep coming back—again and again. Why do UTIs and BV recur, and what can you do to stop the cycle? Andrea Altomaro, CNM, a certified nurse midwife at Henry Ford Health, has answers.
What’s Considered ‘Recurrent’ UTIs or BV?
UTIs are common; more than half of all women will have at least one in their lives. But women with recurrent UTIs get more than the occasional infection. “Recurrent UTIs are defined as two UTIs within 6 months or three UTIs in a year,” explains Altomaro.
BV is a form of vaginitis (inflammation or infection of the vagina) that affects up to 29% of women at least once in their reproductive years. “If you have three documented cases of BV within a year, you may have recurrent BV.”
Why Do I Keep Getting UTIs?
UTIs occur when bacteria enter your urethra and travel up to your bladder. “Women have shorter urethras than men, so it’s easier for bacteria to find their way into the urinary system,” says Altomaro.
But why do some women seem to get UTIs frequently, even after treatment? Possible reasons include:
- Declining estrogen levels in perimenopause or after menopause, which cause thinner tissue in the genital area that is more prone to infection
- Holding your urine too long, which can allow germs to collect in your bladder
- Pelvic organ prolapse, where one or more of your pelvic organs drops out of place
- Sexual contact, because bacteria can spread to the urethra during skin-to-skin contact
- Urinary conditions, such as kidney stones or a urinary fistula (abnormal connection between two organs in your urinary system)
- Wiping back to front, which can spread germs from your stool to your urethra
Causes of Recurrent BV
Normally, your vagina has a pH balance that allows ‘good’ bacteria to keep ‘bad’ bacteria in check. If something disrupts this pH balance, the bad bacteria can take over and cause BV.
So why do some women get BV again and again? One of the reasons may be sexual contact. “BV can spread from person to person through sexual intercourse,” says Altomaro. “This may be more likely to happen if you have multiple or new sexual partners.”
You can also get recurrent BV from the same partner. “If you have one partner and you keep getting BV, your partner may have the bacteria and not know it,” Altomaro explains.
Other reasons for recurrent BV include:
- Douching, which can upset the vagina’s pH
- Not completing your antibiotic treatment from a previous BV infection, which can cause bacteria to become resistant to antibiotics
Do I Need Treatment for Recurrent UTIs and BV?
If you have symptoms of a UTI or BV, don’t ignore them—even if you’ve had them many times before. “An untreated UTI can spread to your kidneys and blood, causing a life-threatening infection,” says Altomaro.
BV is also a serious concern when left untreated. “BV makes you more likely to contract a sexually transmitted infection (STI) like chlamydia, which can cause long-term health complications,” says Altomaro. “In addition, BV can be dangerous during pregnancy, leading to premature birth and a low birth weight for your baby.”
Stopping the Cycle of UTIs and BV
The first step is treatment, usually with antibiotics. Then, your provider may recommend strategies to prevent future infections. For recurrent UTIs, these steps may help:
Avoid spermicides and diaphragms: These contraceptive methods may cause irritation and increase UTI risk in some women. “Condoms are an effective contraceptive option that isn’t linked to UTIs,” says Altomaro.
- Consider vaginal estrogen: Peri- and post-menopausal women may benefit from a vaginal estrogen cream, which can thicken the vaginal tissue and help prevent UTIs.
- Manage diabetes: If you have diabetes, see your healthcare provider regularly. “Diabetes increases the amount of sugar in your urine,” explains Altomaro. “This excess sugar can cause bacterial growth and UTIs.”
- Practice proper bathroom habits: “Urinate when you feel the urge, and drink plenty of water every day to flush out your bladder,” says Altomaro. “Always wipe front to back to prevent the spread of bacteria to your urinary system.”
- Urinate after sex: Emptying your bladder after sexual activity can help remove bacteria on the surface of your urethra. “Flushing that bacteria away may stop it from entering your urinary tract after sex,” Altomaro explains.
To prevent recurrent BV, you can:
- Avoid douching: “The vagina is self-cleaning, so douching is unnecessary and can be harmful,” Altomaro says.
- Limit sexual partners: Having fewer sexual partners lowers the risk of getting BV from sex.
- Wear a condom: Condoms prevent sexually transmitted infections (STIs) and BV. “Use condoms consistently with all sexual activity to avoid catching or spreading the infection,” Altomaro says.
The best treatment for recurrent infections starts with an open conversation with your provider. “Many women are embarrassed to talk about conditions that affect their urinary or reproductive organs,” says Altomaro. “Remember that your provider is here to help, and we care for these conditions every day. Our goal is to help you be as healthy as possible.”
Reviewed by Andrea Altomaro, CNM, a certified nurse midwife at Henry Ford Medical Center- Royal Oak.
