Urinary tract infections (UTIs) are the most frequently diagnosed type of infection in the outpatient setting. About every second women experiences at least one UTI in her lifetime, of those 30% experience another UTI, and 3% further recurrences. Especially young healthy women without underlying anatomical deficiencies suffer from recurrent UTIs (rUTI), which are associated with significant morbidity and reduction in quality of life. The increased susceptibility of women to rUTI is based on the female anatomy in addition to behavioral, genetic and urological factors. Why some women are more likely than others to develop and maintain rUTI, however, remains to be clarified. Invasive characteristics of certain uropathogenic Escherichia coli (UPEC) that are able to form extra- and intracellular biofilms and may therefore cause delayed release of bacteria into the bladder may play a role in this setting. Treatment recommendations for an acute episode of rUTI do not differ from those for isolated episodes. Given the nature of rUTI, different prophylactic approaches also play an important role. Women with rUTI should first be counseled to use non-antibiotic strategies including behavioral changes, antiadhesive treatments, antiseptics and immunomodulation, before antibiotic prophylaxis is considered. In addition to the traditional treatment and prophylactic therapies, new experimental strategies are emerging and show promising effects, such as fecal microbiota transfer (FMT), a treatment option that transfers microorganisms and metabolites of a healthy donor’s fecal matter to patients using oral capsules, enemas or endoscopy. Initial findings suggest that FMT might be a promising treatment approach to interrupt the cycle of rUTI. Furthermore, bacteriophages, infecting and replicating in bacteria, have been clinically trialed for UTIs. Due to the limitation of available data, this treatment option requires further clinical research to objectify the potential in treating bacterial infections, particularly UTIs.
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