Recurrent UTI and vaginitis

When it keeps coming back.

Three or four infections a year is a pattern rather than bad luck. The treatment for a pattern is a culture, a diagnosis and a prevention plan — not a fifth prescription over the phone.

How this is approached here

What a recurrence visit involves

  1. 01

    A culture before antibiotics

    Not after they fail. Repeated empiric treatment is the main route to a resistant organism.

  2. 02

    Testing that distinguishes bacterial vaginosis

    Candida and trichomonas, because all three present as discharge and the treatments differ entirely.

  3. 03

    Speciation for recurrent yeast

    Candida glabrata does not respond to fluconazole, which is why repeat courses keep not working.

  4. 04

    For post-menopausal recurrent UTI

    An assessment for genitourinary syndrome of menopause. Vaginal estrogen is the single most effective prevention, and is persistently under-used.

  5. 05

    A written prevention plan

    Post-coital prophylaxis, self-start treatment where appropriate, or methenamine where antibiotics are to be avoided.

  6. 06

    Referral to urology where there is a stone

    An anatomic cause, or a resistant organism needing a longer course.

Reasons to be seen rather than treated by phone

When this needs an appointment

Fever, flank pain or vomiting

That is a kidney infection, not a bladder one, and it is urgent.

Blood in the urine that persists

After the infection has cleared.

Three or more infections in a year

Or two in six months.

Symptoms that do not improve within

48 hours of starting an antibiotic.

Discharge that has been treated twice

For yeast without improving — it is frequently not yeast.

Pregnancy

At any point, with urinary symptoms. Asymptomatic bacteriuria is treated in pregnancy and not otherwise.

Recurrent infections: common questions

Why do I keep getting these?
The common reasons are an organism that was never correctly identified, an antibiotic that does not reach it, a species that is not susceptible to what was prescribed, and, after menopause, tissue changes that make recolonisation easy. Each has a different answer, which is why the culture comes first.
Does cranberry work?
The evidence is weak and inconsistent. It is unlikely to harm you. It is not a substitute for a prevention plan if you are having four infections a year, and we would rather tell you that than let you keep buying it.
Is vaginal estrogen safe?
Low-dose vaginal estrogen has minimal systemic absorption and is, for most women, appropriate even where systemic hormone therapy is not. We go through your own history before recommending it rather than quoting a label warning at you.
Can I get treatment without coming in?
For an established pattern we have already cultured and diagnosed, yes — self-start treatment is part of the plan. For a first or newly changed episode, no, because treating the wrong organism is how a simple problem becomes a recurrent one.

Know before you book.

Vireo opens in 2027. Until then the plan list, panel status and first-available wait for every office are published on this site and kept current. Questions can go to the practice office on (305) 555-0180.

See the locations