Chronic UTIs — what causes repeat infections and what to do about them

Getting one UTI is annoying. Getting them over and over is exhausting. About 20–30% of women who have a first UTI will get another within months, and that’s when you need a different plan than “take antibiotics and wait.”

This page gives clear, useful steps: how doctors figure out if your UTIs are truly chronic, what tests matter, treatment options, and prevention strategies you can try today.

How chronic UTIs are diagnosed

Doctors usually call UTIs “recurrent” if you have two or more in six months or three or more in a year. They won’t just guess — expect a urine culture. A culture tells exactly which bacteria are causing the infection and which antibiotics will work. If you’ve been treated based on symptoms alone, ask for a culture next time.

If infections keep coming despite targeted antibiotics, your doctor may order further tests: a bladder ultrasound, a CT scan, or a cystoscopy to check for stones, anatomical issues, or other problems. For postmenopausal women, low vaginal estrogen is a common hidden cause and is easy to treat.

Treatment choices and smart antibiotic use

Short courses of targeted antibiotics are the mainstay, but the key is using the right drug for the bug. That’s why culture results matter. Some common options include nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin — choices depend on the bug and local resistance patterns. Fluoroquinolones like levofloxacin can work, but they have more side effects and are usually reserved when other options fail. See our Levoquin guide for details on risks and proper use.

Doctors sometimes offer two other approaches: a low-dose antibiotic taken daily for months, or a postcoital single-dose antibiotic if your UTIs follow sex. Both can help, but they should be prescribed by a clinician who monitors side effects and resistance.

For non-bacterial causes (like interstitial cystitis) antibiotics don’t help. If cultures are repeatedly negative, ask about other bladder conditions.

Preventive steps that actually help

Some tips are science-backed, others are low-risk habits worth trying. Practical steps that reduce recurrence: stay hydrated, pee after sex, avoid spermicides, use plain water only for hygiene (no douches), and switch to breathable underwear. For women past menopause, topical vaginal estrogen often cuts UTI recurrences significantly.

Cranberry products may help some people — choose a product with enough active ingredient and treat it as a mild preventive, not a cure. Probiotics (Lactobacillus) show modest benefits for some women. Discuss both with your clinician.

Finally, keep a simple log: dates, symptoms, sexual activity, and antibiotics used. That record helps your doctor spot patterns and choose better tests or treatments. If recurrent UTIs are disrupting sleep, work, or mood, push for a referral to a urologist or urogynecologist. You don’t have to live with constant infections — there are clear steps to find the cause and reduce how often they come back.