Thread by @jfitzgeraldMD

Ladies, let me reassure you--unless you are purposely wiping back to front, your hygiene isn't the problem.

A 🧵 on recurrent UTIs.

1/ Is it really a UTI? The best way to know if you have a UTI is to get a urine CULTURE. This is NOT the same thing as when your pee is dipped in the office or the ER! A culture actually tells you what kind of bacteria it is, and what antibiotics will kill it.

2/There are a lot of reasons for it to burn when you pee that are NOT a UTI. STDs, soaps (baby wipes count) sometimes yeast infections or BV, bladder inflammation, urethral cysts, and if you're breastfeeding or menopausal, dryness from not having estrogen around.

3/BTW, the definition of recurrent UTIs is two positive CULTURES (NOT office dips) in 6 months or three in one year--WITH SYMPTOMS. So insist on a culture. If the cultures keep being negative, see a specialist to figure out whats really going on.

4/While we're on that topic, do NOT get a urine culture for no reason. Many women will find bacteria in their urine that is not causing problems--this is called ASYMPTOMATIC bacteruria. It happens more in older women, but can happen to anyone. Leave your microbiome alone!

5/But let's say you do have symptoms (burning, frequency, urgency) and culture proven UTIs, what can you do? It depends a bit on your age and sexual activity. But let's talk about the things that most of us have heard about.

6/Cranberry juice--does NOT work. Step away from the Ocean Spray. There is very weak evidence that potentially concentrated cranberry PILLS can help, but in general, save your money.

7/Drinking more water--science says this helps only if you are a young woman who has UTIs associated with having sex. Otherwise, just stay hydrated.

8/While we are on the topic of sex, absolutely sex (especially with somebody new) can cause UTIs. Peeing afterwards is fine--but it also hasn't been shown to help very much, so don't blame yourself if you get a UTI if you're religiously post-sex peeing. It's not that helpful.

9/Why are you getting UTIs from your new sex partner? Because your microbiomes are foreign to each other. This commonly happens in young women and should get better over time. Obviously make sure it isn't an STD like gonorrhea or chlamydia.

10/Also re: new sex partners, check your condoms for spermicides (VERY BURN-Y), alcohol based lubricants (also 🔥) and if you have a latex allergy (🔥🔥🔥). This is a good time to let everyone still reading know that your urethra, where you pee from, is protected by vagina skin.

11/The health of your vagina skin has a LOT to do with the health of your bladder. Not only does vaginal skin physically protect the urethra from bacterial invaders, but the microbiome of the vagina keeps bad bacteria (like the ones that come from the rectum) in check.

12/Estrogen plays a huge role in keeping the vaginal microbiome in check, because it keeps the pH of the vagina low (around 4), and keeps the vagina plush with good blood flow, which improves lubrication and the skin covers the urethra better.

13/This is why, in menopausal women, one of the best things we can do for recurrent UTIs is to give them a dab of vaginal estrogen cream. This is safe to use in virtually all women, even most breast-cancer survivors.

14/ Other things that can help: if the UTIs happen with sex, you may need an antibiotic tab afterwards (usually max 2 pills per day, even if you're having sex more than that 😅). Some women may need to take a low-dose antibiotic for several months.

15/Theres some data that a medication called methenamine can help (it makes your pee acidic and hostile to bacteria). Also some over the counter supplements called D-Mannose, but these aren't that great. Neither are probiotics. They can't hurt, but probably save your money.

16/Another thing I haven't mentioned yet is if the TRUE UTIs aren't coming from an obvious problem like sex, being post-menopausal, etc. a CT scan or ultrasound to look for a kidney stone or a walled-off kidney infection is needed. Also, looking in the bladder with a tiny camera.

17/With regard to antibiotics: your doctor should choose an antibiotic that is the most tailored to your particular infection for the least amount of time that jives with your allergies. I feel comfortable saying that there is almost no situation where this should be Cipro.

18/So, to conclude, real urine cultures are your friend. If the lab results and your symptoms aren't matching up, see a specialist to go down the road of more unusual causes of UTI symptoms. And step away from the baby wipes-- your hygiene is fine! 🧻

#uti #urogyn #fpmrs #IC #bladdersmatter #bladderhealthmonth
#sexualhealth #womenshealth #WomenSupportingWomen