Understanding Chronic Urinary Tract Infections and Sex

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One of the frustrating things about a urinary tract infection (UTI) is the way it interferes with sex. It is one thing when it happens every once in a while; it's another when it becomes an ongoing, chronic condition.

A UTI can affect anyone and involve either the lower urinary tract (comprised of the bladder and urethra), the upper urinary tract (the kidneys and ureters), or both. Women are more prone to getting UTIs than men—up to 30 times more likely, in fact—with lower tract infections accounting for the majority of sexual difficulties.

Factors that place a person at risk of developing a chronic UTI include:

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Symptoms

A UTI can often be recognized by symptoms involving the lower urinary tract, including:

UTIs and Painful Intercourse

A UTI can also cause painful intercourse, also known as dyspareunia. This is more likely to occur in women who experience chronic UTIs, especially those who are postmenopausal.

Causes

Bacteria such as E.coli can easily enter the urinary tract through the urethra, which is situated close to the genital area in both men and women. It can then travel up the urethra and into the bladder where infection can develop. If the kidneys are involved, it becomes a serious condition called pyelonephritis, which requires immediate attention.

Honeymoon cystitis is a term used to describe a UTI that a person gets after having sex with a new partner. It is most common in sexually active younger women. It is believed that women get UTIs more frequently because their urethra is shorter, making it easier for bacteria to enter into the bladder.

A chronic UTI is different from an acute UTI in that it either doesn't respond to traditional treatment or recurs frequently.

Prevention

To better reduce your risk of getting a UTI, there are several things you can do:

  • Wash your hands before and after sex, and try not to touch your genitals after you touch your or your partner's anus. The rectum, anus, and groin have a high density of bacteria that can easily be transferred to the urethra.
  • Urinate as often as needed, especially after sex, as this can help clear bacteria from the urinary tract. Drink plenty of water to flush bacteria out of the system. Women should wipe from front to back after urinating.
  • Wash your foreskin before and after sex if you are uncircumcised, and use condoms regularly.
  • Reduce your number of sex partners.
  • Drinking cranberry juice daily is sometimes recommended for persons with a chronic UTI.
  • Low-dose antibiotics are sometimes given as a daily preventive routine (although overuse can increase UTI risk by altering the bacterial flora of the vagina). In some cases, they are recommended only after you have sex.

Diaphragms and Spermicides

Speak with your healthcare provider if you use a diaphragm or spermicide for contraception and are getting frequent bouts of UTI. A diaphragm can make it harder to empty your bladder completely (leaving bacteria behind to cause an infection).

Spermicide can alter the natural bacterial makeup of the vagina, allowing foreign bacteria to flourish more readily. Alternate methods for contraception may need to be considered.

Precautions After Menopause

While most studies investigating chronic UTIs have focused on younger age groups, there is now compelling evidence that shows a strong relationship between sexual intercourse and UTIs in postmenopausal women.

It is, therefore, just as important for older women to take the same preventive measures as younger ones, irrespective of how often you have sex or how many sexual partners you have.

UTIs and Sexually Transmitted Diseases

A number of sexually transmitted infections (STIs) are known to cause UTIs, including trichomoniasis and chlamydia. Oftentimes a person will assume that the UTI is bacterial in nature (and treat it as such) and fail to identify the underlying STI.

It is, therefore, vital to consider your risk of STIs when any infection of the genitals or urinary tract is involved. This is especially true if you have multiple sex partners or have gotten a UTI after having sex with a new partner.

Current pediatric guidelines recommend that doctors take a comprehensive sexual history of any adolescent with urinary tract complaints and routinely test them for STIs.

Sexually active men under the age of 35 who don't use condoms can experience a condition called epididymitis. It is an infection of the epididymis, the coiled tube to the back of the testicles, that can be caused either by bacteria or an STI, most often gonorrhea or chlamydia. Treatment varies based on the cause and severity.

Safer sex practices, which include the consistent use of condoms, are always the best plan for reducing the risk of these and other STIs.

When to Call a Healthcare Provider

Urinary tract infections require treatment with antibiotics. Even if a UTI is relatively mild, your healthcare provider will likely recommend a one- to three-day course of antibiotics.

If a UTI is causing dyspareunia, it is typically due to frequent or recurrent UTIs that require more extensive treatment. In some cases, a daily, low-dose antibiotic may be prescribed for six months or longer. In postmenopausal women, estrogen replacement therapy may be advised.

If a kidney infection (pyelonephritis) develops, you need to seek prompt medical attention. If left untreated, pyelonephritis can lead to kidney failure and sepsis.

When to Seek Urgent Care

Seek immediate medical attention if you have signs and symptoms of pyelonephritis, including:

  • Back or side (flank) pain
  • High fever
  • Chills
  • Vomiting

Frequently Asked Questions

  • Is it safe to have sex with UTI?

    Sex is generally not advised until the UTI has completely cleared as it can further irritate already inflamed tissues and introduce new bacteria into the urinary tract. If this occurs, it can lead to a second UTI and an even longer recovery time.

  • When can I have sex after UTI?

    Many healthcare providers will tell you to wait two weeks after the symptoms have fully cleared before having sexual intercourse. If you do have sex, urinate before and after sex to flush bacteria from the urinary tract, and avoid sexual positions that place direct pressure against the urethra.

  • How long after sex can you develop UTI?

    Studies have shown that people who get a UTI from sex tend to do so within 24 hours of sexual intercourse. Escherichia coli (E,coli), the bacteria most commonly linked to UTIs, typically reside in the bowels. When introduced into the urinary tract, E. coli will adhere to the walls of the urethra and begin to proliferate almost immediately.

  • How soon can you have sex after starting antibiotics for UTI?

    You should experience an improvement within 24 to 48 hours of starting antibiotics. However, it's important to remember that the resolution of UTI symptoms doesn't mean that the bacteria is gone. To ensure clearance, you need to take the antibiotics as prescribed and to completion. Failure to do so can lead to antibiotic resistance.

  • How can I prevent a UTI from sex?

    UTIs can affect anyone, but there are a few simple things you can do to reduce your odds of getting a UTI from sex:

    • Avoid harsh feminine products that promote inflammation and increase the risk of UTIs.
    • Use condoms during anal sex to avoid infection in the insertive partner.
    • Avoid switching from anal sex to vaginal sex without first putting on a new condom (or stopping to wash the penis with soap and water).
    • Urinate immediately before and after sex.
    • To avoid a second UTI, wait two weeks after a UTI clears before having sex.
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