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Perineal Anatomy and Urine-Voiding Characteristics of Young Women with and without Recurrent Urinary Tract Infections

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Thomas M Hooton at University of Miami Miller School of Medicine
Thomas M Hooton
Ann E Stapleton at University of Washington Seattle
Ann E Stapleton
Pacita L. Roberts
Pacita L. Roberts
Pacita L. Roberts
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Carol Winter
Carol Winter
Carol Winter
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1600 Brief Reports CID 1999;29 (December)
States and Canada—1997 results from the SENTRY Antimicrobial
Surveillance Program. Diagn Microbiol Infect Dis 1998; 32:313–6.
3. National Committee for Clinical Laboratory Standards. Performance stan-
dards for antimicrobial susceptibility testing: 9thinfor mationalsupplement.
NCCLS document M100-S9. Villanova, PA: National Committee for Clin-
ical Laboratory Standards, 1999.
4. Ho PL, Que TL, Tsang DN, NG TK, Chow KH, Seto WH. Emergence of
fluoroquinolone resistance among multiply resistant strainsof Streptococcus
pneumoniae in Hong Kong. Antimicrob Agents Chemother 1999;43:
1310–3.
Table 1. Characteristics of young women with recurrent urinary tract infections and of
control subjects.
Characteristic
Patients
(n= 98)
Controls
(n= 107) P
Distance from urethra to anus, cm 4.8 50.6 (3.5–7.0) 5.0 50.7 (3.6–7.5) .03
Distance from posterior fourchette to anus, cm 2.6 50.5 (1.7–4.0) 2.8 50.5 (1.5–4.8) .04
Length of urethra, cm
a
3.6 50.4 (2.8–4.6) 3.5 50.4 (2.8–4.4) .27
Volume of post–void residual urine, mL
b
43 541 (0–140) 49 548 (0–190) .41
NOTE. Data are (range)mean 5SD
a
Patients, ; controls, .n = 80 n = 83
b
Patients, ; controls, .n = 82 n = 84
Perineal Anatomy and Urine-Voiding Characteristics
of Young Women with and without Recurrent
Urinary Tract Infections
We evaluated the association of specific perineal anatomic
factors and urine-voiding characteristics with recurrent urinary
tract infection (UTI) in young college women. Subjects were
eligible for inclusion if they were healthy nonpregnant women
aged 18–30 years with no known abnormalities of the urinary
tract. Case subjects had had >3 UTIs in the past 12 months
or >2 UTIs in the past 6 months, whereas control subjects had
had no UTI in the past year and no more than 1 UTI in any
previous year. Case subjects were identified through a monthly
computer search of patient-encounter forms, and medical re-
cords were reviewed for information on UTI diagnoses.Control
subjects were randomly selected each month from the pool of
age-eligible women who had attended the student health clinic
in the past 12 months.
Each subject was asked to come to the clinic with a com-
fortably full bladder and to urinate into a UroScan Uroflow-
meter (Dacomed, Minneapolis, MN). Then, with the subject in
Informed consent was obtained from the patients, and guidelines for hu-
man experimentation of the US Department of Health and Human Services
and those of the University of Washington were followed in the conduct of
the clinical research.
Grant support: National Institute of Diabetes and Digestive and Kidney
Diseases (nos. DK 47549 and DK 53369).
Reprints or correspondence: Dr. Thomas M. Hooton, Harborview Med-
ical Center, Box 359930, 325 Ninth Avenue, Seattle, WA 98104 (hooton@
u.washington.edu).
Clinical Infectious Diseases 1999;29:1600–1
q1999 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/1999/2906-0061$03.00
the lithotomy position, a small plastic ruler was used to measure
the anatomic distances given in table 1. Finally, within 5
minutes after urination, a 16-French foley catheter was inserted
into the urethra, the balloon was inflated, and the post–void
residual urine volume was measured. The catheter was marked
with a marking pen at the urethral orifice, and the distance
from the base of the balloon to the mark on the catheter was
taken as the urethral length.
A total of 213 women were enrolled. There were no statis-
tically significant differences in demographics, except that con-
trol subjects were more likely to be white (87% vs. 74%; P =
). The mean distances from urethra to anus and from pos-
.02
terior fourchette to anus were significantly shorter in case sub-
jects (table 1). These differences were similar in each of the
racial groups. The distance from urethra to anus was signifi-
cantly associated with weight ( ), height ( ), and
P!.001 P=.002
body mass index ( ), but case subjects and control sub-
P!.001
jects did not differ significantly in terms of these variables.
Case subjects were more likely than control subjects to have
a distance from urethra to anus of !4.5 cm (the 25th percentile
figure for control subjects) (OR, 2.4; 95% CI, 1.2–4.8; P =
). Moreover, of the 109 women who reported no spermicide
.013
use in the past year, 15 (38%) of 40 case subjects versus 7 (10%)
of 69 control subjects had a distance from urethra to anus of
!4.5 cm (OR, 5.7; 95% CI, 2.0–16.6, after adjustment for the
frequency of coitus in the past month; ). This asso-P=.0013
ciation was not seen in the 96 spermicide users (OR, 0.9; 95%
CI, 0.3–2.6; ).P=.90
Urethral length, post–void residual urine volume, and urine-
flow characteristics (peak and average flow rate, time to peak
flow, voiding time, and total volume urinated), on the other
hand, were not associated with risk of recurrent UTI.
The results of our study suggest that the distance uropath-
by guest on December 5, 2016http://cid.oxfordjournals.org/Downloaded from
CID 1999;29 (December) Brief Reports 1601
ogens must travel from the fecal reservoir to the urethra may
be related to the risk of recurrent UTI in some women. Al-
though such anatomic differences are of relatively little con-
sequence in women who have other risk factors for UTI, such
as frequent coitus or use of spermicides, which facilitate both
colonization of the vagina with uropathogens [1] and subse-
quent UTI [2], it is possible that anatomic differences play a
greater role in the pathogenesis of UTI in women who do not
have these or other exogenous risk factors.
Thomas M. Hooton,
1
Ann E. Stapleton,
1
Pacita L. Roberts,
1
Carol W inter,
1
Delia Scholes,
2
Tamara Bavendam,
1
and Walter E. St am m
1
1
University of Washington School of Medicine and
2
Group Health
Cooperative of Puget Sound, Seattle, Washington
References
1. Hooton TM, Roberts PL, Stamm WE. Effects of recent sexual activity and
use of a diaphragm on the vaginal microflora. Clin Infect Dis 1994;19:
274–8.
2. Hooton TM, Scholes D, Hughes JP, et al. A prospective study of risk factors
for symptomatic urinary tract infection in young women. N Engl J Med
1996;335:468–74.
by guest on December 5, 2016http://cid.oxfordjournals.org/Downloaded from
... We have also recently identified that high body mass index (BMI) was inversely associated with cystitis (Jansaker et al., 2022), which could be explained by previous findings identifying that the distance uropathogens must travel from the fecal reservoir to the urethra was related to cystitis (Gyftopoulos et al., 2019, Hooton et al., 1999 and BMI (Hooton et al., 1999). The relationship between BMI and various other infections has been established (Dobner and Kaser, 2018, Kaspersen et al., 2015, Phung et al., 2013, but only a few smaller studies have investigated BMI in relation to pyelonephritis and the results were inconsistent (Nassaji et al., 2015, Semins et al., 2012. ...
... We have also recently identified that high body mass index (BMI) was inversely associated with cystitis (Jansaker et al., 2022), which could be explained by previous findings identifying that the distance uropathogens must travel from the fecal reservoir to the urethra was related to cystitis (Gyftopoulos et al., 2019, Hooton et al., 1999 and BMI (Hooton et al., 1999). The relationship between BMI and various other infections has been established (Dobner and Kaser, 2018, Kaspersen et al., 2015, Phung et al., 2013, but only a few smaller studies have investigated BMI in relation to pyelonephritis and the results were inconsistent (Nassaji et al., 2015, Semins et al., 2012. ...
... Body height also seem to be slightly associated with cystitis (Jansaker et al., 2022). Body height has not been as strongly associated with the distance uropathogens must travel from the fecal reservoir to the urethra (Hooton et al., 1999). However, it is more plausible that the distance uropathogens need to travel from the bladder to the pelvic of the kidney to cause pyelonephritis (i.e., through the ureter) could be associated with body height, which has been suggested in anatomical studies (Mansouri et al., 2019). ...
The relationship between body mass index, body height, parity, and pyelonephritis – a nationwide population-based cohort study of over one million parous women (1997–2018)
Article
Full-text available
  • Oct 2022
  • INT J INFECT DIS
Objective To explore the association between various physiological factors and pyelonephritis in parous women. Methods Swedish nationwide registers were used to identify 1 073 467 parous women aged 15–50 years. The study period was 1997–2018 or until first incidence of pyelonephritis, death or emigration. Cox proportional hazard methods were used to determine hazard ratios (HR) and 95% confidence intervals (CI) of pyelonephritis in relation to BMI and body height, adjusted for age, parity, and individual-level sociodemographic variables. Results 21 625 women (2.0%) were diagnosed with pyelonephritis during follow-up. In the fully adjusted model, low BMI (<18.5) was associated with pyelonephritis (HR 1.13, 95% CI 1.06–1.21). Parity and certain sociodemographic characteristics were also independently associated with pyelonephritis. Body height below 161 cm was associated with pyelonephritis (HR 1.12, 95% CI 1.09–1.16) in all but the fully adjusted model. Conclusion Low BMI and short body height seem to be associated with uncomplicated pyelonephritis. More research is needed to verify these findings and identify the possible mechanisms.
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... Retrospective studies have demonstrated that E. coli strains causing UTI may, although appropriately treated and not found in repeated urine cultures can cause a new UTI up to 3 years later. The majority of recurrences are thought to be reinfection, while a minority (5-10%) is relapsed (4,5,6). The strong propensity of UTIs to recur, often within a few weeks or months after an initial acute infection, may contribute to additional problems, including renal scarring and an increased risk for developing bladder cancer (7,8,9). ...
... Also in Iraq high incidence of bacterial infection was for E. coli 80% (3). Uropathogenic Escherichia coli express adhesive fibers known as type 1 pili that mediate binding to and invasion of luminal facet cells of the urinary tract (4,6,8). This intracellular niche is conducive to UPEC replication and formation of IBCs with biofilm-like properties (12). ...
Phenotypic detection of some virulence factors of uropathogenic Escherichia coli isolated from recurrent urinary tract infection patients
Article
  • Nov 2022
Urinary tract infections (UTIs) are health growing problem in patients attending some hospitals in worldwide, to shed light on this subject, present study was done to detect some virulence factors of E. coli isolated from patients with recurrent urinary tract infection (RUTI) This study included 130 patients with RUTI, and 50 healthy persons as a control of both genders (aged 6-70 years) attending Al-Zahra Teaching Hospital in Al-Kut/Wassite governorate and Al-Harery Teaching Hospital of specialized surgeries/Baghdad during beginning of September 2009 to end of April 2011. Intracellular bacterial communities (ICBC) (namely E.coli) was isolated from (68/130) 53% from patients with RUTI. These bacteria showed differences in response to antibiotics which was used for treatment, Ciprofloxin, Amikacin and Gentamicin provide good efficacy against E.coli isolated from patients with recurrent UTI. Results of phenotipical studies on virulence factors of E.coli the revealed that 50% of RUTI isolates produced P-fimbria, 10.3% with S-fimbria, 36.8% have Dr-fimbria, 78% have type 1 fimbria and 22.1% of them produced aerobactin and all isolates gave negative results for hemolysin production.
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... Морфологические исследования T.M. Hooton и соавт., а также K. Gyftopoulos и соавт. показали, что наружное отверстие уретры у пациенток, страдающих посткоитальным циститом, действительно позиционировано относительно близко к влагалищу по сравнению со здоровыми женщинами [7,8]. При этом в исследовании K. Gyftopoulos и соавт. ...
Surgical correction of vestibulo-vaginal frictional dislocation of urethra in postcoital cystitis
Article
  • Sep 2023
Aim . To improve the results of surgical treatment of patients with recurrent postcoital cystitis. Material and methods . From 2005 to 2023, extravaginal transposition of the urethra according to the method developed by us (patent No. RU2408296C1 from 10.01.2011) and its modification (patent No. RU2686948C1 from 18.06.2018) was performed in 502 women aged from 18 to 61 years (average age 29.6 ± 7.2 year) at the Urology Department of the I.I. Mechnikov Northern State Medical University. The main part of patients was operated at the Center of Urology of the City Multidisciplinary Hospital No. 2 (St. Petersburg). Results . Out of 502 women we operated on, 370 (73.7 %) were examined in the distant postoperative period. A satisfactory result was observed in 338 (91.4 %) of them. The operation proved to be ineffective in 32 (8.6 %) women. Repeated transposition of the urethra was performed in 17 patients (3.4 %). С onclusion . The indication for extravaginal urethral transposition is the association of sexual intercourse with episodes of cystitis exacerbations. The high efficacy of this operation for the prevention and treatment of postcoital cystitis is achieved through the correct selection of women as well as compliance with all technical features of the proposed surgical intervention.
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... However, postmenopausal women experiencing rUTI demonstrated a significantly elevated PVR and diminished urine flow rate compared to age-matched controls [30,31]. However, in young, healthy, nonpregnant women, no difference in PVR was noted between rUTI patients and controls [32]. According to most current guidelines, an elevated PVR is considered an independent risk factor for recurrent urinary tract infections (rUTI) in women; therefore, PVR should be measured before the management of UTI in women [33]. ...
Effectiveness of Platelet-Rich Plasma Injections as Prophylaxis for Recurrent Urinary Tract Infection in Women
Article
Full-text available
  • Jun 2023
Purpose: To investigate the therapeutic efficacy of intravesical platelet-rich plasma (PRP) injections as prophylaxis for adult women with recurrent urinary tract infection (rUTI). Methods: This proof-of-concept study enrolled 63 women with rUTI in PRP treatment and control groups after achieving control of the most recent urinary tract infection (UTI) episode. The treatment group included 34 women who received 4 monthly intravesical PRP injections. The control group was made up of 30 women who received continuous antibiotic treatment for 3 months. After the completion of PRP or antibiotic treatment, outpatient follow-up was continued for up to 12 months. Treatment was considered successful if ≤2 UTI episodes occurred during a period of 12 months or ≤1 UTI episode within 6 months; otherwise, the outcome was considered a treatment failure. The frequency of symptomatic UTI episodes before and after PRP treatment was compared with that of the controls. Regression analysis was used to determine the association between potential predictors for a failed treatment outcome. Results: At the study endpoint, 33 PRP and 25 control group patients were available for analysis. After four PRP injections, the frequency of rUTI episodes per month was significantly decreased compared with baseline (0.46 ± 0.27 vs. 0.28 ± 0.30, p = 0.047). The PRP treatment success rate was 51.5% (17 of 33) for the PRP group versus 48% (12 of 25) for the control group. The PRP treatment success group had significantly higher voided volume, lower post-void residual volume, and higher voiding efficiency than the PRP treatment failure group. A higher baseline voiding efficacy ≥0.71 was significantly associated with a successful outcome (OR 16.56; p = 0.049). Conclusions: The study results revealed that repeat intravesical PRP injections decreased the recurrence rate of UTI within 1 year in women with rUTI. The treatment success rate with intravesical PRP injections for rUTI was about 51.5%, whereas for women with prolonged antibiotic treatment, it was 48.0%. A baseline VE ≥ 0.71 was associated with a better treatment outcome with PRP injections.
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... However, retention is not always related to UTI or UTI evolution. [7] Second, in women with a long history of UTI or very frequent episodes of UTI, there could be a higher propensity for planktonic bacteria to anchor at new bladder wall sites beyond the trigone. However, there are some women who have had UTIs for many years or decades, but only have chronic trigonitis on cystoscopy. ...
Does Bacterial Motility Influence the Extent of Bladder Wall Involvement in Women With Recurrent Urinary Tract Infections?
Article
  • Jan 2023
Purpose Because bacterial motility has been implicated as a potential virulence factor, we compared the motile and nonmotile properties of bacteria isolated from urine cultures in women with recurrent urinary tract infections (RUTI) to test if such motility properties are linked to the extent of bladder wall infection on cystoscopy. Materials and Methods After IRB approval, a retrospective review of women with antibiotic-recalcitrant symptomatic RUTI (≥3 Urinary tract infections/year) who underwent electrofulguration (EF) for cystitis was conducted. Pre-operative office cystoscopy staged cystitis as stage 1: trigone (trigonitis), stage 2: stage 1 and bladder base, stage 3: stage 2 and one or both lateral walls, and stage 4: the whole bladder (pancystitis). Positive urine cultures before EF for the type of bacteria (motile vs. non-motile) were compared among stages. Results From 2006 to 2020, 139 women with RUTI met the study criteria. The median age was 67 with 95% Caucasian. Those with stage 4 cystitis were older ( P = 0.0009) and less sexually active ( P = 0.038). Patients with a higher stage were associated with a higher number of motile organisms ( P = 0.0056), with an increased presence of non-E. Coli motile organisms ( P < 0.0001) such as Proteus ( P = 0.0024), Pseudomonas ( P = 0.0062), Enterobacter ( P = 0.020) and Citrobacter ( P = 0.0067). Conclusion The comparison of bacterial motility in women with RUTI at four different stages of bladder surface involvement identified unique characteristics and bacterial strains associated with each stage. RUTI women with higher stages of cystitis had more unique types of motile urinary bacterial strains, possibly suggesting a role in the spread of cystitis beyond the trigone.
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... One hypothesis to explain this disparity is that anatomical differences, such as the shorter distance between the anus and the urethral opening in females or a longer urethra in males, influence UTI prevalence in humans. The major challenge is that hypotheses based on anatomical differences lack supporting evidence because they are nearly impossible to test experimentally 23,24 . Arguing against anatomical differences as the primary reason underlying the sex disparity in UTI, this pronounced increase in susceptibility in women is most striking in adolescents and adults under the age of 50 (Fig. 1). ...
The impact of biological sex on diseases of the urinary tract
Article
Full-text available
  • Jul 2022
Biological sex, being female or male, broadly influences diverse immune phenotypes, including immune responses to diseases at mucosal surfaces. Sex hormones, sex chromosomes, sexual dimorphism, and gender differences all contribute to how an organism will respond to diseases of the urinary tract, such as bladder infection or cancer. Although the incidence of urinary tract infection is strongly sex biased, rates of infection change over a lifetime in women and men, suggesting that accompanying changes in the levels of sex hormones may play a role in the response to infection. Bladder cancer is also sex biased in that 75% of newly diagnosed patients are men. Bladder cancer development is shaped by contributions from both sex hormones and sex chromosomes, demonstrating that the influence of sex on disease can be complex. With a better understanding of how sex influences disease and immunity, we can envision sex-specific therapies to better treat diseases of the urinary tract and potentially diseases of other mucosal tissues.
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... [7], к другим факторам риска в равной степени могут быть отнесены раннее начало эпизодов ИМП и наличие ИМП в анамнезе у матери. Риск развития рецидивных ИМП у женщин перименопаузального периода связан главным образом с наличием дефицита эстрогенов, приводящего к сдвигу в составе микробиоты и ряду дисфункциональных нарушений (недержание мочи, пролапс гениталий и/или наличие остаточной мочи после мочеиспускания) [8]. ...
Results of a clinical study of the drug efficacy and safety for intravesical administration based on bacteriophages in therapy in patients with chronic recurrent cystitis
Article
Full-text available
  • Dec 2021
Background. Urinary tract infections remain one of the urgent problems in the aspect of qualified medical care. The causative agents of nosocomial infections are becoming more and more resistant to the drugs used, while the rate of new drugs synthesis is lower than the rate of development of antibiotic resistance. Routine and empirical prevention of recurrent urinary tract infections is often ineffective. Aim. To study the efficacy and safety of intravesical application of the drug based on bacteriophages in therapy in patients with chronic recurrent cystitis. Materials and methods. A clinical study was carried out to study the efficacy and safety of the drug for intravesical administration based on bacteriophages in therapy in patients with chronic recurrent cystitis. The study included 75 patients who were divided into 3 groups in a 1: 1: 1 ratio. In the main group, the drug for intravesical administration based on bacteriophages, as well as rectal suppositories with bacteriophages were used; in the control group only a drug for intravesical administration based on bacteriophages or rectal suppositories with bacteriophages. On visits 1-4, all patients underwent a clinical blood test, general urine analysis, bacteriological urine analysis, as well as urine analysis by the polymerase chain reaction method. The analysis of the patients condition in groups was carried out according to the dynamics of main clinical symptoms changes, data from validated scales for assessing pelvic pain and urgency/frequency of urination and assessment of symptoms of acute cystitis (Acute Cystitis Symptom Score ACSS), as well as the dynamics of changes in objective parameters of laboratory studies and possible changes in sensitivity uropathogens to antibacterial drugs. Results. The average age of the patients included in the study was 50.6 years. In all 3 groups, bacteriological examination of urine showed a predominant growth of Escherichia coli (3104 CFU/ml). In the course of the study, there was a good tolerance to therapy, a decrease in clinical symptoms, as well as a significant decrease in the total score according to the pelvic pain scale and urgency/frequency of urination and the ACSS scale in all patients. Conclusion. The emergence of a large number of microorganisms resistant to various antibiotics and their rapid spread in the environment has led to an increase in scientific interest in bacteriophage therapy as an alternative method of treatment. The overall subjective effectiveness of the therapy in our study was more than 80%, safety - 100%. Further research will allow for a personalized approach to the treatment of infectious diseases of the urinary system.
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Elucidating the effect of body mass index, height, and parity on uncomplicated cystitis: a nationwide population-based cohort study
Article
Full-text available
  • Feb 2022
In this nationwide cohort of one million fertile women, BMI, height, and parity only had minor but statistically significant effects on the risk of uncomplicated cystitis. The results indicate that underweight women and certain sociodemographic groups might have higher risks, which could have underlying explanations that need further studying.
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Management of uncomplicated recurrent urinary tract infections
Article
  • Nov 2021
Objectives: To discuss optimal management of recurrent urinary tract infections (UTIs) in women. About every second woman experiences at least one UTI in her lifetime, of those 30% experience another UTI, and 3% further recurrences. Especially young healthy women without underlying anatomical deficiencies suffer from recurrent UTIs (rUTI), which are associated with significant morbidity and reduction in quality of life. Methods: This is a narrative review, investigating publications dealing with recurrent UTI in women. Risk factors and options for management are discussed. Results: The increased susceptibility of women to rUTI is based on the female anatomy in addition to behavioural, genetic, and urological factors. However, why some women are more likely than others to develop and maintain rUTI remains to be clarified. Invasive characteristics of certain uropathogenic Escherichia coli that are able to form extra- and intracellular biofilms and may therefore cause delayed release of bacteria into the bladder, may play a role in this setting. Treatment recommendations for an acute episode of rUTI do not differ from those for isolated episodes. Given the nature of rUTI, different prophylactic approaches also play an important role. Women with rUTI should first be counselled to use non-antibiotic strategies including behavioural changes, anti-adhesive treatments, antiseptics, and immunomodulation, before antibiotic prophylaxis is considered. In addition to the traditional treatment and prophylactic therapies, new experimental strategies are emerging and show promising effects, such as faecal microbiota transfer (FMT), a treatment option that transfers microorganisms and metabolites of a healthy donor's faecal matter to patients using oral capsules, enemas, or endoscopy. Initial findings suggest that FMT might be a promising treatment approach to interrupt the cycle of rUTI. Furthermore, bacteriophages, infecting and replicating in bacteria, have been clinically trialled for UTIs. Conclusion: Due to the limitation of available data, novel treatment options require further clinical research to objectify the potential in treating bacterial infections, particularly UTIs.
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A Prospective Study of Risk Factors for Symptomatic Urinary Tract Infection in Young Women
Article
Full-text available
  • Aug 1996
Although acute urinary tract infections are common in young women, the associated risk factors have not been defined prospectively. We recruited sexually active young women who were starting a new method of contraception at a university health center or a health maintenance organization (HMO) and monitored them for six months for symptomatic urinary tract infections. Daily diaries and serial interviews were used to collect data on potential risk factors. Among 796 women, the incidence of urinary tract infections per person-year was 0.7 in the university cohort (mean age, 23 years; n = 348) and 0.5 in the HMO cohort (mean age, 29; n = 448). In both cohorts, there were strong dose-response relations between the risk of infection and both recent use of a diaphragm with spermicide (respective relative risks for one, three, and five days of use in the past week, 1.42, 2.83, and 5.68 in the university cohort, P<0.001; and 1.29, 2.14, and 3.54 in the HMO cohort, P=0.04) and recent sexual intercourse (respective relative risks for one, three, and five days with intercourse in the past week, 1.37, 2.56, and 4.81 in the university cohort, P<0.001; and 1.24, 1.91, and 2.96 in the HMO cohort, P=0.002). The risk of acute infection was also associated with a history of recurrent infection (relative risk, 5.58 in the university group and 2.10 in the HMO group) but not with cervical-cap use, ABO-blood-group nonsecretor phenotype, or delayed postcoital voiding. Among sexually active young women the incidence of symptomatic urinary tract infection is high, and the risk is strongly and independently associated with recent sexual intercourse, recent use of a diaphragm with spermicide, and a history of recurrent urinary tract infections.
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Effects of Recent Sexual Activity and Use of a Diaphragm on the Vaginal Microflora
Article
  • Aug 1994
We prospectively studied 40 women over a median period of 28 weeks to ascertain the effects on vaginal microflora of sexual intercourse alone compared with sexual intercourse associated with use of a diaphragm with a spermicide (diaphragm/spermicide). Compared with no sexual intercourse, sexual intercourse with use of a diaphragm/spermicide in the preceding 3 days was strongly associated with increases in rates of vaginal colonization with uropathogenic flora, including Escherichia coli (P < .0001), other gram-negative uropathogens (P = .0045), group D streptococci (P = .014), and group B streptococci (P = .0015). Except for E. coli colonization, no such increases in rates of vaginal colonization were seen at visits preceded by sexual intercourse without use of a diaphragm/spermicide. Compared with no sexual intercourse, sexual intercourse with use of a diaphragm/spermicide in the preceding 3 days also was associated with a marked increase in rates of candidal colonization (P < .0001) and with a decrease in rates of lactobacillus colonization (P < .0001). We conclude that bacterial and fungal microflora in the vagina are strongly influenced by recent use of a diaphragm/spermicide and minimally affected by sexual intercourse alone.
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