Recurrent urinary and vaginal infections

Overview

Burning, itching or discomfort in the genital area can come from the bladder or from the vagina. Although the complaints are similar, the causes and treatment are different — and treating “blindly” often leads to recurrences.

Urinary infections (cystitis)

Symptoms: burning on urination, frequent and urgent need to urinate, pain in the lower abdomen, sometimes urine with a smell or with blood.

When they are considered recurrent: at least 2 episodes in 6 months or 3 episodes in a year. In this case, episodes should be documented with a urine culture — taken preferably before the antibiotic.

The choice of antibiotic depends on the symptoms, previous cultures, pregnancy and local resistance.

Bacteria in the urine without symptoms (asymptomatic bacteriuria) are usually not treated — except in pregnancy and before certain urological procedures.

Preventing recurrences

• drinking enough fluids, especially in women who drink little
• in women after menopause, vaginal estrogen can significantly reduce recurrences
• antibiotic prophylaxis or other methods are decided individually by the doctor — they are not for self-treatment

Vaginal symptoms

Itching, burning, an unpleasant odor or a change in discharge can come from:

• candidiasis (yeast infection) — itching, white curd-like discharge
• bacterial vaginosis — a disturbance of the balance of normal bacteria, with gray discharge and a fishy odor
• trichomoniasis and other sexually transmitted infections
• non-infectious causes (irritation, allergy, hormonal changes)

Appearance and odor do not always determine the cause. The assessment may include a gynecological examination, microscopy or specific tests.

Bacterial vaginosis and candidiasis are different conditions: antibiotics and antifungal preparations are not interchangeable. Wrong use can make the situation worse.

• Avoid vaginal douching (internal washes) — they disrupt the normal flora.
• Do not repeatedly use vaginal suppositories or creams without a diagnosis.

The partner

• Trichomoniasis and some sexually transmitted infections require treatment of the partner.
• Ordinary candidiasis does not routinely require treatment of the partner.
• For recurrent bacterial vaginosis, the ACOG guidance (2025) supports considering simultaneous treatment of a regular male partner, in appropriate cases. The decision is made with the doctor.

When to see a doctor

Consult when episodes recur — to confirm the cause with tests and to draw up a prevention plan, instead of treating each episode separately.