Recurrent Urinary Tract Infections: Why They Happen and How They Should Be Treated

By Mr Neil Haldar, Consultant Urological Surgeon

Last reviewed: August 2026

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Key points

• A recurrent urinary tract infection is generally defined as two or more UTIs within six months, or three or more within twelve months.
• Recurrent UTI should be confirmed rather than assumed. Persistent urinary symptoms with repeatedly negative cultures may have another cause.
• Younger women, postmenopausal women and men develop recurrent infections for different reasons, so treatment should not be identical for everyone.
• Vaginal oestrogen is an important non-antibiotic treatment for postmenopausal women with recurrent UTI.
• Methenamine hippurate is now supported by NICE as an alternative to daily antibiotic prophylaxis in appropriate women with recurrent UTI.
• Cranberry products probably offer some benefit, but evidence varies between preparations. The best recent trial of D-mannose did not show a significant preventive benefit.
• Routine cystoscopy and extensive imaging are not necessary for every otherwise healthy woman with recurrent uncomplicated UTI. Investigation should be targeted according to age, symptoms, culture pattern and risk factors.
• Recurrent infections in men, visible blood in the urine, kidney infections, stones, incomplete bladder emptying and persistent symptoms despite negative cultures deserve specialist assessment.

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What is a recurrent urinary tract infection?

Urinary tract infections are extremely common, particularly in women. For some people, however, an occasional infection becomes a repeated cycle of burning, frequency, urgency, urine tests, antibiotics and another infection only weeks or months later.

Recurrent UTI is generally defined as:

• Two or more episodes within six months, or
• Three or more episodes within twelve months.

However, there is an important distinction between meeting the numerical definition and establishing that the episodes were genuinely bacterial infections.

In my practice, the single most important principle is this:

Recurrent UTI is a diagnosis that should be established, not simply inherited from a series of previous prescriptions.

Urinary frequency, urgency, discomfort and burning can all occur in conditions that have nothing to do with bacterial infection. Repeatedly treating these symptoms with antibiotics without confirming the diagnosis can delay the real diagnosis and contribute to antimicrobial resistance.

A significant proportion of patients referred to me with “recurrent UTIs” eventually turn out to have something else — such as genitourinary syndrome of the menopause, an overactive or incompletely emptying bladder, kidney or bladder stones, bladder pain syndrome or, less commonly but importantly, a bladder tumour.

The good news is that the way we prevent recurrent UTI has changed. Daily antibiotics are no longer the only realistic option, and several effective non-antibiotic strategies can often be tried first.

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Reinfection, relapse and persistent infection

Not every recurrent infection means the same thing.

Understanding the pattern is one of the first things I try to establish when reviewing previous urine culture results.

Reinfection

A reinfection is a new infection occurring after the previous episode has genuinely cleared. It may involve a different organism or sometimes the same bacterial species reintroduced after an infection-free interval.

This is the commonest pattern in otherwise healthy women.

It usually points towards susceptibility to infection rather than a major structural abnormality of the urinary tract.

Relapse

A relapse means the same organism appears again soon after apparently successful treatment, often within a couple of weeks.

This raises a different set of questions.

Could bacteria be persisting somewhere in the urinary tract?

Possible reservoirs include:

• A urinary stone
• Chronic bacterial prostatitis in a man
• A bladder diverticulum
• Incomplete bladder emptying
• Foreign material following surgery or instrumentation

Persistent frequency, urgency, poor flow or incomplete emptying may require a broader assessment of urinary symptoms and bladder function.

Persistent infection

Sometimes the original infection never properly clears.

This may occur because the organism is resistant to the antibiotic used, because the antibiotic does not penetrate the infected tissue adequately, or because an underlying structural problem is allowing bacteria to persist.

This is why previous urine cultures can be so useful.

A sequence of culture reports showing the organisms involved and their antibiotic sensitivities often tells me more than a single urine test performed during the consultation.

If possible, I therefore ask patients with recurrent infections to obtain copies of their previous microbiology results.

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Why do some people keep getting UTIs?

The underlying reasons differ considerably between younger women, postmenopausal women, and men.

Recurrent UTI in younger women

In otherwise healthy premenopausal women, recurrent cystitis is usually a problem of bacterial access and individual susceptibility rather than a diseased bladder.

The female urethra is short and lies close to areas naturally colonised by bowel organisms, particularly Escherichia coli.

Recognised risk factors include:

• Frequent sexual intercourse
• A new sexual partner
• Spermicide-containing contraception
• Diaphragm use
• A family history of recurrent UTI
• Having experienced UTIs at a young age

There also appears to be a genuine biological and genetic component to susceptibility. Some people’s urinary tract lining allows uropathogenic bacteria to adhere more readily.

One point is worth making very clearly:

Recurrent UTI in a younger woman is not evidence of poor hygiene.

I frequently meet women who have spent years believing that their infections must be the result of something they are doing wrong. Usually they are not.

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Recurrent UTI after the menopause

After the menopause, the biology changes significantly.

Falling oestrogen levels affect the tissues of the vagina and urethra. The vaginal epithelium becomes thinner, vaginal pH changes and the protective lactobacilli that previously formed part of the normal vaginal microbiome diminish.

As a result, bowel organisms such as E. coli can colonise the area more easily.

Other factors also become more common with age, including:

• Pelvic organ prolapse
• Incomplete bladder emptying
• Reduced mobility
• Diabetes
• Constipation
• Previous pelvic surgery

This matters because one of the most useful treatments for recurrent UTI after the menopause is not an antibiotic at all — it is vaginal oestrogen.

I discuss this in more detail below.

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Recurrent UTI in men

Recurrent UTI in a man should be approached differently.

Because the male urethra is much longer, repeated infection without a contributing factor is less common. NICE recommends specialist assessment or advice for men with recurrent UTI.

Possible underlying causes include:

• An enlarged prostate causing obstruction
• Incomplete bladder emptying
• Chronic bacterial prostatitis
• Kidney or bladder stones
• Urethral stricture
• Bladder diverticulum
• Previous urinary tract surgery or instrumentation
• Diabetes

A man repeatedly receiving courses of antibiotics without anyone asking why the infections are occurring deserves a more structured assessment.

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Other factors that increase UTI risk

In either sex, recurrent infection is more likely in people with:

• Diabetes, particularly when poorly controlled
• Immunosuppression
• Urinary catheters
• Intermittent self-catheterisation
• Neurological bladder dysfunction
• Multiple sclerosis
• Spinal cord injury
• Parkinson’s disease
• Spina bifida
• Kidney or bladder stones
• Significant constipation
• Previous pelvic radiotherapy
• Urinary diversion
• Previous complex urinary tract surgery

These patients require a more individualised approach than someone with straightforward recurrent uncomplicated cystitis.

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Which bacteria cause recurrent UTIs?

The commonest organism by far is Escherichia coli.

Other organisms include:

• Klebsiella
• Proteus
• Enterococcus
• Staphylococcus saprophyticus
• Pseudomonas, particularly following catheterisation or instrumentation

The organism can sometimes provide an important clue.

Proteus

Proteus organisms can raise urinary pH and contribute to the development of infection-related stones.

Repeated Proteus infections therefore make me more suspicious of underlying stone disease and strengthen the case for imaging.

Resistant or unusual organisms

Repeated infection with resistant organisms, Pseudomonas or unusual bacteria — particularly in somebody without a catheter or recent hospital exposure — should prompt consideration of a structural or functional abnormality.

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Why can the same UTI appear to keep returning?

Our understanding of recurrent UTI has evolved.

Uropathogenic E. coli can sometimes interact with and invade the superficial cells lining the bladder. Experimental work has demonstrated intracellular bacterial communities and reservoirs that may help bacteria evade normal host defences.

Biofilms can also develop on:

• Catheters
• Stones
• Foreign material
• Some urinary tract abnormalities

These mechanisms may help explain why apparently similar infections can recur despite apparently appropriate treatment.

They do not, however, mean that every recurrent UTI represents a “hidden infection”. The culture pattern, symptoms and anatomy still need to be considered together.

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Symptoms of a urinary tract infection

A lower UTI or cystitis commonly causes:

• Burning or stinging when passing urine
• Increased urinary frequency
• Urgency
• Suprapubic discomfort
• Cloudy urine
• Offensive-smelling urine
• Occasionally visible blood in the urine

Some symptoms require more urgent assessment.

When a UTI needs urgent medical attention

Seek same-day medical assessment if urinary symptoms are accompanied by:

• Fever
• Rigors or shaking chills
• Pain in the loin or flank
• Nausea or vomiting
• Significant weakness or deterioration
• Confusion, particularly in an older person
• Rapid heart rate or low blood pressure
• Feeling profoundly unwell

These features may indicate a kidney infection (pyelonephritis) or a systemic infection.

Urosepsis is a medical emergency.

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Blood in the urine should not automatically be blamed on infection

Blood can occur during a genuine urinary infection.

What matters is what happens afterwards.

Visible blood in the urine that persists or recurs after the infection has been successfully treated should not simply be attributed to a UTI.

NICE recommends suspected-cancer-pathway referral for people aged 45 and over with visible haematuria that persists or recurs following successful treatment of a urinary infection.

I have written separately about blood in the urine and how it should be investigated.

I also run a Rapid Access Haematuria Service for patients requiring structured investigation.

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Conditions commonly mistaken for recurrent UTI

This is one of the most important parts of recurrent UTI assessment.

Several conditions produce symptoms remarkably similar to cystitis.

Genitourinary syndrome of the menopause

Oestrogen deficiency can cause:

• Urinary frequency
• Urgency
• Burning
• Vaginal dryness
• Vaginal soreness
• Pain during intercourse

It frequently coexists with genuine recurrent UTI, which is one reason vaginal oestrogen can be so helpful after the menopause.

Overactive bladder

An overactive bladder can cause severe urgency and frequency without infection.

Patients with persistent urgency, frequency, nocturia or incomplete emptying may benefit from a structured LUTS and urinary symptoms assessment.

Bladder pain syndrome

Bladder pain syndrome — sometimes called interstitial cystitis — may cause pain related to bladder filling, urinary frequency and urgency with repeatedly negative cultures.

Antibiotics do not treat it.

Sexually transmitted infection

Some sexually transmitted infections can cause dysuria and urinary white cells without conventional bacterial growth.

Chlamydia is an important example, particularly in younger sexually active patients.

Urinary stones

Kidney and bladder stones may cause pain, blood in the urine, recurrent infection or persistent urinary abnormalities.

Bladder cancer and carcinoma in situ

This is the diagnosis I am particularly concerned not to miss.

Bladder cancer usually presents with haematuria, but carcinoma in situ can sometimes cause marked urinary frequency, urgency and discomfort.

Persistent irritative urinary symptoms with negative cultures — particularly in someone with a smoking history or other risk factors — should therefore not simply be labelled as repeated infection.

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What does sterile pyuria mean?

Sterile pyuria means white blood cells are found in the urine, but routine culture does not grow the expected bacteria.

Possible explanations include:

• Recent antibiotic treatment
• Sexually transmitted infection
• Urinary stones
• Bladder pathology
• Tuberculosis of the urinary tract in appropriate risk groups
• Interstitial nephritis
• Bladder pain syndrome
• Occasionally infection not demonstrated by conventional culture

It is a finding to understand, not dismiss.

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How should recurrent UTI be investigated?

My approach is built around three questions:

1. Is this genuinely recurrent bacterial infection?
2. Is there a reservoir, obstruction or structural explanation?
3. Is there a modifiable factor increasing susceptibility?

Not everyone needs every possible urological test.

Current European guidance specifically advises against extensive routine investigation with cystoscopy and imaging in younger women with uncomplicated recurrent cystitis and no risk factors, because the diagnostic yield is low.

The investigation should therefore fit the patient.

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Urine culture

For someone with recurrent infections, obtaining a mid-stream urine specimen for culture before starting antibiotics, whenever practicable, is extremely useful.

It establishes:

• Whether bacteria are present
• Which organism is responsible
• Which antibiotics it is sensitive or resistant to
• Whether repeated episodes involve a similar microbiological pattern

Symptoms and urine dipsticks alone are not always enough.

Dipsticks are useful, but nitrite can be negative with some organisms, and bacterial counts below traditional laboratory thresholds can sometimes still be relevant in a patient with convincing symptoms.

Conversely, bacteria may be present in urine without causing the patient’s symptoms.

Context matters.

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Blood tests

Depending on the clinical circumstances, I may arrange:

• Kidney function
• Full blood count where appropriate
• HbA1c to screen for or assess diabetes

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Bladder emptying

A post-void bladder scan measures how much urine remains after passing urine.

It is quick and non-invasive.

Incomplete emptying is an easily overlooked reason for recurrent infection and is particularly relevant in:

• Men with prostate enlargement
• Women with significant prolapse
• People with neurological disease
• Patients following pelvic or urinary tract surgery

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Imaging

Imaging is not required for every otherwise healthy woman with straightforward recurrent cystitis.

I have a lower threshold for ultrasound or other imaging where there is:

• Visible haematuria
• Recurrent kidney infection
• Stone disease or suspected stone disease
• Repeated Proteus infection
• Abnormal renal function
• Incomplete bladder emptying
• Previous urinary tract surgery
• An unusual microbiological pattern
• An atypical clinical history

CT may be required where stones, upper urinary tract abnormalities or haematuria need more detailed assessment.

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Cystoscopy

Flexible cystoscopy allows inspection of the inside of the bladder using a thin, flexible telescope.

It is not routinely necessary in every woman with uncomplicated recurrent UTI.

I consider cystoscopy where there is, for example:

• Persistent or recurrent haematuria
• Persistent sterile pyuria
• Concern about bladder cancer or carcinoma in situ
• Suspected bladder diverticulum
• Suspected fistula
• Abnormal imaging
• Previous relevant urinary tract surgery
• Persistent atypical symptoms
• A recurrent infection pattern that remains unexplained

In men, specialist investigation is usually appropriate, but the exact combination of cystoscopy, imaging and assessment of bladder emptying depends on the clinical picture rather than being automatic.

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Asymptomatic bacteriuria: when bacteria should not be treated

One counterintuitive aspect of urinary infection is that finding bacteria does not always mean antibiotics are needed.

Asymptomatic bacteriuria means bacteria are present in the urine, but the person has no urinary symptoms.

This becomes increasingly common with age and is also common in people with long-term urinary catheters.

In most circumstances, it should not be treated.

Treating asymptomatic bacteriuria does not generally prevent future symptomatic infection and increases antibiotic exposure and resistance.

Important exceptions include:

• Pregnancy
• Before certain urological procedures in which the urinary tract lining will be breached

This is particularly important in older people.

A positive urine culture in an older person who is confused does not automatically prove that the confusion is due to a UTI. Other causes of acute deterioration still need to be considered.

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Treating an acute UTI

Treatment should ideally reflect:

• Current NICE or local antimicrobial guidance
• Previous culture results
• Renal function
• Drug allergies
• Local resistance patterns
• Whether the infection is confined to the bladder
• Whether the patient is male or female
• Whether the prostate or upper urinary tract may be involved

For uncomplicated lower UTI in non-pregnant women, NICE recommends nitrofurantoin or trimethoprim as first-choice options where resistance risk is low, with agents such as pivmecillinam or fosfomycin used as alternatives in appropriate circumstances.

Treatment courses are usually longer in men.

Nitrofurantoin is not suitable for pyelonephritis and should not be relied upon where prostatitis is suspected because it does not achieve adequate therapeutic concentrations in prostatic tissue.

Kidney function also matters when prescribing nitrofurantoin.

For someone with recurrent UTI, culture-directed treatment becomes increasingly important because prior antibiotic exposure increases the risk of resistant organisms.

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How can recurrent UTIs be prevented?

This is where management has changed most.

The aim is to use the least burdensome strategy that works and, where possible, reduce unnecessary exposure to continuous antibiotics.

I generally work through prevention in stages.

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1. Drink enough — but more is not always better

Increasing fluid intake is one of the simplest interventions with randomised trial evidence behind it.

A trial in premenopausal women with recurrent cystitis who habitually drank less than 1.5 litres of fluid per day found that adding about 1.5 litres of water daily substantially reduced recurrent infections over twelve months.

The qualification is important.

This evidence applies particularly to women who previously drank relatively little.

If somebody is already drinking two to three litres every day, forcing themselves to drink even more is unlikely to solve the problem and may worsen frequency and urgency.

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2. Address obvious triggers

Simple measures worth considering include:

• Avoiding spermicide-containing contraception where possible
• Considering an alternative to a diaphragm if infections are recurrent
• Emptying the bladder without rushing
• Treating significant constipation
• Addressing incomplete bladder emptying
• Urinating after intercourse if infections are consistently intercourse-related

Some traditional advice about wiping direction, baths, clothing and hygiene has a much weaker evidence base than patients are sometimes led to believe.

I would not want somebody with recurrent UTI to conclude that they have caused the problem by failing to wash or wipe correctly.

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3. Vaginal oestrogen after the menopause

For postmenopausal women, this is one of the highest-value interventions.

Local vaginal oestrogen helps reverse the changes produced by oestrogen deficiency and promotes restoration of a healthier vaginal environment.

It is available in several forms, including:

• Cream
• Vaginal tablet or pessary
• Vaginal ring

NICE recommends considering vaginal oestrogen for recurrent UTI when behavioural and personal hygiene measures alone have not been effective.

This is local treatment, not systemic HRT given specifically to prevent UTI.

Systemic absorption with low-dose vaginal preparations is generally low, but treatment should still be individualised.

Women with a history of hormone-sensitive breast cancer should discuss the decision with the appropriate clinician. In women taking aromatase inhibitors in particular, I would involve the breast oncology team.

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4. Cranberry

Cranberry has been debated for decades.

It contains proanthocyanidins, which may interfere with bacterial adherence to urinary tract cells.

The updated Cochrane review published in 2023 found evidence that cranberry products reduce the risk of symptomatic, culture-verified UTIs in some groups, including women with recurrent UTIs.

The difficulty is that cranberry juices, tablets and extracts differ considerably in formulation and dose.

I therefore regard cranberry as a reasonable low-risk option, but not something I would promise will prevent infection.

High-sugar cranberry drinks are undesirable for many people, and anyone taking warfarin should check before regularly using cranberry products.

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5. Does D-mannose prevent recurrent UTI?

D-mannose became extremely popular because laboratory mechanisms appeared plausible and early small studies were encouraging.

The best evidence has subsequently been less convincing.

A large UK double-blind randomised placebo-controlled trial involving 598 women across 99 primary-care practices, published in JAMA Internal Medicine in 2024, found no statistically significant reduction in further medically attended UTIs with daily D-mannose compared with placebo.

Approximately 51% of women taking D-mannose experienced another medically attended UTI compared with about 56% receiving placebo.

The investigators concluded that D-mannose should not be recommended for prevention in this primary-care population.

European guidance consequently describes the overall evidence as weak and contradictory.

If somebody tells me D-mannose has clearly helped them and they tolerate it, I do not necessarily insist that they stop.

But I would not currently recommend starting D-mannose over interventions with stronger evidence.

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6. Methenamine hippurate

Methenamine hippurate represents one of the most important developments in recurrent UTI prevention.

It is not a conventional antibiotic.

In sufficiently acidic urine, methenamine generates formaldehyde, which has an antiseptic effect against bacteria.

The UK ALTAR trial compared methenamine hippurate with daily low-dose antibiotic prophylaxis in women with recurrent UTI.

Methenamine was found to be non-inferior to daily antibiotic prophylaxis for preventing recurrent infections during the treatment period.

NICE subsequently updated its recurrent UTI guidance in December 2024.

For appropriate women who are not pregnant, NICE now recommends considering methenamine hippurate as an alternative to daily antibiotic prophylaxis when recurrent UTI has not been adequately improved by measures such as behavioural changes, vaginal oestrogen where appropriate or single-dose antibiotic prophylaxis.

This is a significant change in practice.

An important practical point

Urinary alkalinising products containing substances such as potassium citrate or sodium citrate can make methenamine less effective and should not be taken alongside it without medical advice.

NICE advises reviewing methenamine treatment within six months and then at least annually.

It is not appropriate for everybody, particularly where recurrent upper urinary tract infection or a complicated urinary system is involved, and these situations require specialist advice.

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7. Post-coital antibiotic prophylaxis

Some women’s infections are strikingly linked to sexual intercourse.

When there is a reliable trigger, a single antibiotic dose associated with that trigger may be preferable to taking an antibiotic every day.

This can dramatically reduce total antibiotic exposure.

Select the appropriate agent using previous culture results, allergies, and resistance patterns.

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8. Self-start treatment

For selected patients with:

• A very consistent symptom pattern
• Well-documented previous cultures
• A clear management plan
• Good understanding of when medical review is required

Keeping a short course of appropriate antibiotics at home can be useful.

Where possible, I prefer the patient to provide a urine specimen before taking the first antibiotic dose.

Failure to improve, or the development of fever, loin pain, vomiting, or systemic illness, should prompt medical assessment rather than simply starting repeated courses at home.

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9. Continuous low-dose antibiotic prophylaxis

Continuous antibiotic prophylaxis remains effective.

It is appropriate for some patients when non-antibiotic strategies and targeted prophylaxis have not been sufficient.

Commonly used agents include low-dose:

• Nitrofurantoin
• Trimethoprim
• Cefalexin

The choice depends on culture results and individual circumstances.

The downside is cumulative antibiotic exposure, with the potential for:

• Antimicrobial resistance
• Adverse effects
• Alteration of the normal microbiome

Long-term nitrofurantoin also requires appropriate monitoring because uncommon but potentially important pulmonary and hepatic toxicity can occur.

Continuous antibiotics therefore remain valuable, but they should no longer automatically be the first or only preventive option considered.

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10. MV140 / Uromune — the UTI vaccine

MV140, commonly known as Uromune, is a sublingual bacterial immunotherapy containing inactivated organisms associated with urinary infection.

A placebo-controlled trial reported encouraging results, with substantially more women remaining infection-free after MV140 than after placebo.

There is also growing observational experience.

However, it is important to put this into context.

MV140 remains an unlicensed treatment in the UK and is supplied through named-patient arrangements rather than as a routinely licensed NHS treatment.

Current European guidance remains cautious about immunomodulatory prophylaxis.

I regard it as an interesting and potentially useful developing option, but it sits outside the standard first-line recurrent UTI pathway. If it is considered, patients should understand both its promising evidence and its regulatory status.

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11. Bladder instillations

Intravesical treatments containing hyaluronic acid, sometimes combined with chondroitin sulphate, aim to restore the bladder’s protective glycosaminoglycan layer.

Evidence shows benefit in selected patients, but the evidence base is smaller than for several of the strategies described above.

Treatment also involves repeated catheterisation to place the solution directly into the bladder.

I therefore reserve it for selected patients, particularly where:

• Less invasive preventive measures have failed
• There are difficult recurrent symptoms
• There is an overlap with bladder pain symptoms

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When should recurrent UTI be referred to a urologist?

Specialist urological assessment is particularly appropriate for:

• Men with recurrent UTI
• Recurrent lower UTI where the underlying cause is unknown
• Persistent or recurrent visible blood in the urine
• Recurrent kidney infection or pyelonephritis
• Repeated infection with fever or loin pain
• Known or suspected kidney or bladder stones
• Repeated Proteus infections
• Resistant or unusual organisms
• Persistent urinary symptoms despite negative cultures
• Incomplete bladder emptying
• Neurological disease affecting bladder function
• Recurrent infection following pelvic or urological surgery
• Failure of an appropriately implemented prevention strategy
• Anyone in whom the diagnosis of recurrent bacterial UTI remains uncertain

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How I approach recurrent UTI in clinic

My starting point is that recurrent UTI should be understood rather than simply treated repeatedly.

During a consultation, I am usually trying to reconstruct the pattern:

• What were the symptoms during each episode?
• Were urine cultures actually positive?
• Which organisms were isolated?
• Were they the same or different?
• Which antibiotics were used?
• Did symptoms completely disappear between infections?
• Is there a relationship with intercourse?
• Is the patient postmenopausal?
• Is the bladder emptying properly?
• Is there haematuria?
• Is there stone disease?
• Could another bladder condition be mimicking infection?

Where appropriate, I will examine the patient, measure the post-void residual urine volume and arrange targeted investigations.

I do not believe that every woman with recurrent uncomplicated cystitis needs automatic cystoscopy and CT scanning.

Equally, I do not believe that somebody with haematuria, repeated kidney infections, abnormal organisms, incomplete emptying or repeatedly negative cultures should simply receive another antibiotic prescription without investigation.

Once the diagnosis is established, prevention is individualised according to:

• Age and hormonal status
• Trigger pattern
• Previous organisms
• Antibiotic sensitivities
• Bladder function
• Other medical conditions
• Previous treatment
• The patient’s preference regarding long-term antibiotics

Often a combination of relatively simple measures works better than searching for one single solution.

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Specialist assessment for recurrent UTI

If you are experiencing repeated urinary infections, symptoms that return soon after antibiotics, recurrent infections after intercourse, persistent urinary symptoms despite negative cultures, or infections that have never been properly investigated, a structured urological assessment can help establish what is actually happening.

I provide specialist assessment through my Recurrent UTI Clinic for men and women with repeated urinary infections.

The aim is not simply to prescribe another antibiotic. It is to:

• Confirm whether infections are genuinely recurring
• Review previous urine cultures
• Look for underlying causes where appropriate
• Assess bladder emptying
• Identify hormonal or other modifiable factors
• Develop a personalised prevention strategy
• Reduce unnecessary antibiotic exposure where possible

I see private patients across Buckinghamshire, Berkshire and London. You can view my clinic locations here.

Book a consultation

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Frequently asked questions

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References and further reading

1. National Institute for Health and Care Excellence. Urinary tract infection (recurrent): antimicrobial prescribing. NICE guideline NG112.
2. European Association of Urology. EAU Guidelines on Urological Infections.
3. Harding C, Chadwick T, Homer T, et al. Methenamine hippurate compared with antibiotic prophylaxis to prevent recurrent urinary tract infections in women: the ALTAR non-inferiority RCT. NIHR Health Technology Assessment. 2022;26(23).
4. Hayward G, Mort S, Hay AD, et al. D-Mannose for Prevention of Recurrent Urinary Tract Infection Among Women: A Randomized Clinical Trial. JAMA Internal Medicine. 2024;184(6):619–628.
5. Williams G, et al. Cranberries for preventing urinary tract infections. Cochrane Database of Systematic Reviews. 2023.
6. Hooton TM, et al. Effect of Increased Daily Water Intake in Premenopausal Women With Recurrent Urinary Tract Infections. JAMA Internal Medicine. 2018;178(11):1509–1515.
7. Lorenzo-Gómez MF, et al. Sublingual MV140 for Prevention of Recurrent Urinary Tract Infections. NEJM Evidence. 2022.
8. National Institute for Health and Care Excellence. Urinary tract infection (lower): antimicrobial prescribing. NICE guideline NG109.

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This article is intended for general information and does not replace individual medical advice. If you have urinary symptoms with fever, loin or flank pain, vomiting, confusion or severe systemic illness, seek urgent medical assessment.