Updated Guidelines Offer Patient-Focused Approach to Recurrent UTIs in Women
New guidance released by the American Urological Association (AUA),the Canadian Urological association (CUA),and the Society for Urodynamics,Female Pelvic Medicine and Urogenital Reconstruction (SUFU) aims to modernize the management of recurrent uncomplicated urinary tract infections (rUTIs) in women. The 2025 amendment to existing guidelines emphasizes a more patient-centered, risk-based, and microbiome-aware approach to care.
According to A. Lenore Ackerman, MD, PhD, director of Research for the Division of Urogynecology and Reconstructive Pelvic Surgery at UCLA and chair of the guideline amendment, the update seeks to “balance diagnostic accuracy with clinical judgment,” redefining treatment success as symptom resolution rather than complete bacterial eradication.A key focus is also placed on antimicrobial stewardship and prioritizing patient-centered care, reflecting a growing understanding of the urinary microbiome and the limitations of current diagnostic methods.The changes also respond to a public health need to reduce unnecessary antibiotic use.
The amended guideline includes several key recommendations:
Diagnostics: Accurate documentation of symptomatic episodes is crucial, utilizing urine cultures while minimizing the use of possibly unnecessary procedures like cystoscopy or upper tract imaging.
Antibiotic Use: Clinicians are advised to prescribe first-line antibiotics – nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin – for the shortest effective duration, typically no more than 7 days. Prophylactic antibiotics may be considered after a thorough discussion of potential risks and benefits with the patient.
non-Antibiotic Prophylaxis: The guideline now includes recommendations for non-antibiotic preventative strategies. Cranberry products may be offered for prevention, though the variability in available formulations is acknowledged. D-mannose, lactobacillus, and methenamine were reviewed, but currently lack sufficient evidence to support routine use.
Hormone Therapy: Vaginal estrogen therapy is recommended for peri- and postmenopausal women experiencing rUTIs, provided there are no contraindications.
Follow-Up: Routine “test-of-cure” urine cultures are discouraged in asymptomatic patients. Treatment success will be persistent by the resolution of symptoms, rather than the absence of bacteria.Looking ahead, the guideline highlights the potential of emerging diagnostic and therapeutic tools, including molecular technologies, vaccines targeting urinary pathogens, and therapies focused on modulating the host’s immune response.
The authors emphasize the need for individualized care that balances responsible antibiotic use with effective management of rUTIs, a condition affecting millions of women globally. The updated guideline aims to equip clinicians with evidence-based strategies aligned with current scientific understanding and patient priorities.
References:
- Ackerman AL, Bradley M, D’Anci KE, Hickling D, Kim SK, and Kirkby E. Updates to Recurrent Uncomplicated Urinary tract Infections in Women: AUA/CUA/SUFU Guideline (2025). J Urol*. Published online September 4, 2025. 10.1097/JU.0000000000004723
- American Urological Association. American Urological Association release Recurrent Uncomplicated Urinary Tract Infections in Women Guideline Amendment. Global Newswire.September 4, 2025. Accessed September 4, 2025. https://www.globenewswire.com/news-release/2025/09/04/3144698/0/en/American-Urological-Association-Release-Recurrent-Uncomplicated-Urinary-Tract-Infections-in-Women-Guideline-Amendment.html
