Recurrent uncomplicated urinary tract infections: definitions and risk factors.

Recurrent uncomplicated urinary tract infections (UTI) have a high impact on patients' quality of life and high direct and indirect costs for public health. Therefore, optimal management should be of high priority. Current international guidelines were reviewed, and a systematic literature search was performed in Medline, Cochrane, and Embase. Several risks factors have been identified and used in everyday clinical practice to plan the correct strategy for recurrence prevention. Among all factors, the most important are: sexual intercourse, spermicide use, having a new sex partner, having a mother with a history of UTI, having had UTI during childhood, and asymptomatic bacteriuria treatment. Moreover, other risk factors such as reduced fluid intake, habitual and post-coital delayed urination, wiping from back to front after defecation, douching and wearing occlusive underwear, as well as irregular bowel function should be taken into account. Recurrent UTI show a high impact on clinical practice. Risk factors are generally related to both virulence of pathogens and patient's behavior or condition. A recently developed nomogram can assist in identifying women at high risk of symptomatic recurrence that can be suitable candidates for a prophylactic strategy.