ARTICLE

Article

Abstract

We conducted a case-control study to explore the role of health behavior and sexual and medical history on urinary tract infection (UTI) risk among otherwise healthy women. Cases and controls were recruited from nine practices and clinics in Michigan and a single clinic in Israel. In both countries, several factors were reported significantly more frequently among UTI cases than controls: a previous UTI within 12 months, incontinence symptoms, a recent episode of 30-plus minutes of cold hands, feet, back or buttocks, and recent antibiotic use. Cases were less likely than controls to report recent estrogen use, but the results were only statistically significant in Michigan. Sexual activity during the previous 2 weeks and having ceased menses were modestly, but not statistically significantly, protective at both study sites. Risk factors for UTI among women 40-65 differ from those for younger women and these differences cannot be attributed solely to changes in menopausal status.

Article

1. Introduction

Urinary tract infection (UTI) is a common condition among women in their middle years; an estimated 10% of women 40 to 65 report a physician-diagnosed UTI that was treated with prescription medication during the previous year . Despite the high incidence, most UTI research has focused on younger women (<40 years of age). Therefore, it is unknown whether the most common UTI risk factors among younger women (frequent vaginal intercourse, spermicide, diaphragm and condom use, UTI history and recent antibiotic use) are associated with UTI among middle-aged women.

There are hints in the literature that some risk factors may be specific to UTI among women aged 40 to 65. Several chronic conditions, including diabetes, stroke, dementia, incontinence, hysterectomy and atrophic vaginitis increase with age, and were found more frequently among women with first UTI in this age group than matched controls in a large record review study . Women with diabetes, stroke and hysterectomy are more likely to have voiding defects and increased risk of bacteriuria and subsequent symptomatic disease . The prevalence of hysterectomy almost doubles between ages 35-39 and 40-44: from 8.8% to 16% . Risk of urinary incontinence and bacteriuria both rise with age; whether incontinence increases risk of UTI or UTI leads to incontinence is unknown.

Women 40 to 65 are peri-, pre-, or postmenopausal, and likely to be initiating estrogen replacement therapy. Estrogen replacement therapy minimizes physiologic changes associated with menopause that lead to genitourinary symptoms and potentially UTI, but whether estrogen replacement therapy is an appropriate therapy for preventing recurring UTI among postmenopausal women is uncertain .

We conducted a case-control study of women aged 40 to 65 to explore the relationship of various hypothesized behavioral, sexual and medical history variables and risk of UTI. Our age range was chosen to bracket the menopausal years so we could also investigate the effects of menopause on UTI risk. Because of collaborative relationships, participants were recruited from Michigan, USA and Israel. A comparison of results across sites strengthens study results: similarities between these two disparate geographic ares increase the generalizability of the findings, and differences highlight the ...