Female UTI


Definition: > 3 proven urinary tract infections within 12 months (positive msu or symptoms of cystitis associated with nitrite positive dipstick).

Women have a 50% lifetime risk of UTI and this increases with age. There is often no significant underlying identifiable cause.

Indications for referral:

  • Emergency admissionif features of systemic sepsis: pyrexia/confusion/tachycardia/tachypnoea/hypotension/severe nausea and vomiting.
  • 2ww Urology if  Persistent haematuria after treatment of infection



C&B referral

  • Abnormal USS: refer to appropriate speciality depending on abnormality.
  • Women with rec UTI and definite suggestion of bladder outflow obstruction (Residual Volume  RV >100ml)
  • Recurrent upper UTIs
  • Pregnant – consider A&G
  • In those who have had the treatments suggested below, eg. low-dose abx, with normal USS and RV, but are still very symptomatic and distressed may be referred for review. Consider via A&G However, it is likely that there is little else to offer.


Possible causes:

  • Increasing age with atrophic vaginitis post menopause
  • Prolapse
  • Intercourse
  • Pregnancy
  • Diabetes
  • Urinary tract abnormality (anatomical/functional/stones/indwelling catheter)
  • Residential care
  • Immunocompromise


Differential diagnoses:

  • STD
  • Chronic pelvic pain syndrome
  • Drug induced cystitis eg ketamine


Management prior to referral:


Antibiotic prophylaxis

Consider if above measures ineffective/ inappropriate

Discuss risks long term antibiotic use including resistance

Taking into account antibiotic sensitivities on recent MSUs

If pregnant please consider which A/bio are safe at different stages of pregnancy

  • Consider single dose prophylaxis if identifiable trigger such as post sexual intercourse
    • Trimethoprim 200mg stat dose or Nitrofurantoin (if eGFR >45 ml/min) 100mg stat dose
  • Daily Prophylactic antibiotic course for six months if no identifiable triggers
    • Trimethoprim 100mg nocte or Nitrofurantoin (if eGFR >45ml/min) 50-100mg nocte

Advise If breakthrough infection – needs medical rev, send msu, treat with different antibiotic to prophylaxis antibiotic


 Patient information




NICE NG112, Urinary tract infection, October 2018

NICE, CKS, Suspected recurrent Urinary Tract Infection in women, June 2021



Mr Christopher Blake, Consultant Urologist, RCHT

Dr B Wesson, GP & Kernow RMS Urology Guideline lead

Review date: March 2022

Next review due March 2023