A recurrent UTI occurs within 4 weeks after previous infection. Symptoms that occur sooner than this are likely to be relapses due to the original pathogen. In such cases, it is important to perform urine cultures and re-treat for at least 2 weeks.

Recurrent UTI is usually caused by factors that allow increased bacterial adherence to urinary epithelium. Investigation for anatomical or functional urinary tract abnormalities are generally of low yield. In less than 1% of cases, a surgically correctable lesion is found.

Patients with recurrent UTI can be instructed on patient-initiated therapy. At the onset of typical UTI symptoms, patients simply begin a 3-day course of antibiotics. Patients with more than two episodes of cystitis per Year can be offered antibiotic prophylaxis. If the infections are temporally related to intercourse, a single dose of antibiotics should be taken within 2 hours after intercourse. If the infections are unrelated to intercourse, patients can be given continuous daily prophylaxis. Prophylaxis is 95% effective in reducing recurrences without causing an increase in bacterial resistance. Unfortunately, recurrences tend to happen when prophylaxis is stopped.

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