Effective prevention for recurrent uncomplicated urinary tract infections (UTIs) must include the integration of clear evidence-based patient education. Because a lot of online content can be misleading, clinicians need to emphasize safe self-care practices, discourage the use of harmful products, and provide vetted educational resources. An ongoing dialogue between clinicians and patients can empower patients to manage their own health and can reinforce best preventive practices.

I usually provide gender-specific patient education because women and men have different risk factors for UTIs. For women with recurrent uncomplicated UTIs, I will go over important prevention strategies, such as urinating after sexual intercourse. The female urethra is short, and sexual activity can push one’s own bacteria into the bladder. So, a UTI from sexual intercourse is not an infection from a female patient’s partner; it is from her own genitourinary flora. Urinating right after sexual activity can certainly make a difference.

However, I do want to make sure that I am not blaming or shaming patients. The concept that having recurrent UTIs is their fault needs to be addressed from the beginning. Many women use antiseptic wipes in the vulva area, shower before and after sexual activity, douche, and/or wear special underwear to try to help prevent UTIs because they think that they happen because of a hygiene-related issue, when they really do not. It is an issue with an imbalance with their own natural flora. However, it is actually really important not to strip the natural flora in the vulva area. Part of patient education on UTI prevention is about balanced hygiene to maintain the Lactobacillus in the vulva by not overwashing the area, not using any soap in the vulva area, definitely not douching, making sure that there is frequent urination, and hydration. Further, the use of vaginal estrogen for women low in estrogen with UTIs or genitourinary syndrome of menopause is now much more acceptable because there are no longer boxed warnings from the US Food and Drug Administration (FDA) for them.

For male patients who develop UTIs without underlying urinary tract abnormalities or other complicating factors, I also discuss practical prevention strategies. Hydration is also really important for UTI prevention in men, and they should also urinate after sexual activity, particularly men who are having sexual intercourse with men. Good genital hygiene and avoiding practices that may reintroduce bacteria into the urinary tract can help reduce UTI risk for both partners.

In older adults, asymptomatic bacteriuria is incredibly common. Many people living in nursing homes and older individuals in general have a high prevalence of asymptomatic bacteriuria, affecting approximately 25% to 50% of women and 15% to 40% of men. There is no indication to treat asymptomatic bacteriuria; it is a laboratory finding. I tell patients that if they have a positive culture but are feeling fine, they should challenge someone who is trying to prescribe them antibiotics.

Educating both men and women about the signs and symptoms of UTIs, including helping them understand what is and is not a real UTI, is important. The education piece is difficult, however, because not many patients will dedicate 5 hours, for example, to taking a class on preventing UTIs. Moreover, a lot of the information that can be found online can be harmful. Some of the self-help products that are marketed for UTI prevention, such as vaginal washes, can also be harmful, which is why I try to address all of it. I give patients more information, including links to podcasts and handouts. The Urology Care Foundation (UCF), which is affiliated with the American Urological Association (AUA), has great patient handouts on recurrent uncomplicated UTIs.

It is important to keep the conversation and education with patients about UTIs ongoing because prevention is an ongoing process. And who is better to help these patients than themselves?