Primary prevention

The mainstay of UTI prevention is avoidance of known risk factors. The CDC advises urinating after sexual activity; staying hydrated; taking showers instead of baths; minimize douching, sprays, or powders in the genital area; and teaching girls when potty training to wipe from front to back.[38]

Secondary prevention

Prevention of UTI includes reduction of modifiable risk factors, nonantimicrobial measures and antimicrobial prophylaxis.[1]

In patients with recurrent UTI (rUTI), the risk of UTI can be reduced with low-dose antimicrobial prophylaxis, single-dose antimicrobial therapy before or after sexual intercourse, or self-initiated therapy. In postmenopausal women, the incidence of recurrence may be decreased with topical vaginal estrogen cream.

There is little conclusive evidence to support hydration and urination soon after sexual intercourse for the prevention of UTIs.[23] However, many health experts advise patients with a history of rUTI to employ urination both prior to and within 15 minutes after sexual intercourse as a preventive measure.[1][122][123]

There has been conflicting evidence to support cranberry for the prevention of UTIs.[1][124][125][126]​​ However, one Cochrane review updated in 2023 supports the use of cranberry products to reduce the risk of symptomatic, culture‐verified UTIs in women with rUTIs.[117]​

Another meta-analysis found that cranberry was associated with a protective effect.[114]

One contributing factor to the controversial clinical results obtained with cranberry is the often lacking precise determination and authentication of the bioactive proanthocyanidin (PAC) of the A type content.[127] Cranberry supplements (containing 36 mg PAC per daily dose) prevented postoperative urinary tract infections in women undergoing benign gynecologic surgery involving urinary catheterization.[128] Other studies have shown a reduction in UTI burden with daily cranberry juice intake in women with a recent history of UTI.[129] 

If patients are interested in a nonantibiotic option for the prevention of UTI, they should be informed that 36 mg of PAC is the recommended effective dose for UTI prevention; however, doses may vary between brands and the label should always be consulted.

Recent studies have shown that methenamine hippurate, an oral antiseptic agent, is proving to be effective as a possible nonantibiotic option for prophylaxis in rUTI.[130] A systematic review suggested that it may be an effective and well-tolerated antibiotic-sparing option for UTI prophylaxis.[131] The EAU recommends that it may be an option to reduce rUTIs in women without abnormalities of the urinary tract.[1]

Use of this content is subject to our disclaimer