Understanding Chronic Urinary Tract Infections and Sex

One of the frustrating things about a urinary tract infection (UTI) is that it interferes with sex. It is one thing when it happens every once in a while; it's another when it becomes an ongoing, chronic condition.

A UTI can affect anyone and involve either the lower urinary tract (comprised of the bladder and urethra), the upper urinary tract (the kidneys and ureters), or both. Women are more prone to getting UTIs than men—up to 30 times more likely, in fact—with lower tract infections accounting for the majority of sexual difficulties.

This article explains common symptoms of UTIs and how they relate to sexual intercourse. It also covers prevention tips and when to call your healthcare provider.

closeup of woman washing hands

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Symptoms of of Chronic UTIs

A UTI can often be recognized by symptoms involving the lower urinary tract, including:

UTIs and Painful Intercourse

A UTI can also cause painful intercourse, also known as dyspareunia. This is more likely to occur in women who experience chronic UTIs, especially those who are postmenopausal.

Causes of Chronic UTIs

Bacteria such as E. coli can easily enter the urinary tract through the urethra, which is situated close to the genital area in both men and women. It can then travel up the urethra and into the bladder where infection can develop.

Honeymoon cystitis is a term used to describe a UTI that a person gets after having sex with a new partner. It is most common in sexually active younger women. It is believed that women get UTIs more frequently because their urethra is shorter, making it easier for bacteria to enter the bladder.

There are two types of recurrent or chronic UTIs: bacterial persistence and bacterial reinfection. Persistence refers to an infection that does not clear up even after treatment and persists for two or more weeks. Bacterial reinfection occurs when a UTI comes back after two weeks. It is caused by a different organism, or in some cases, from the same organism as the original infection.

A chronic UTI is different from an acute UTI in that it either doesn't respond to traditional treatment or recurs frequently.

Risk Factors

Some people are more likely to develop a UTI from sexual intercourse due to the make-up of their urinary tract, lifestyle behaviors, genetics, or pre-existing health conditions.

Factors that place a person at risk of developing a chronic UTI include:

Complications

An infection in your bladder can move up your urinary tract and spread to the kidneys. An infection of one or both kidneys, known as pyelonephritis, requires immediate medical attention. Without proper treatment, pyelonephritis can lead to kidney failure and sepsis.

Treatment involves the administration of antibiotics. In some instances, the infection is resistant to antibiotic treatment and hospitalization may be needed.

Preventing Chronic UTIs

To better reduce your risk of getting a UTI, there are several things you can do:

  • Wash your hands before and after sex, and try not to touch your genitals after you touch your or your partner's anus. The rectum, anus, and groin have a high density of bacteria that can easily be transferred to the urethra.
  • Urinate as often as needed, especially after sex, as this can help clear bacteria from the urinary tract. Drink plenty of water to flush bacteria out of the system. Women should wipe from front to back after urinating.
  • Wash your foreskin before and after sex if you are uncircumcised, and use condoms regularly.
  • Reduce your number of sex partners.
  • Drinking cranberry juice daily is sometimes recommended for persons with a chronic UTI.
  • Take low-dose antibiotics which are sometimes given as a daily preventive routine (although overuse can increase UTI risk by altering the bacterial flora of the vagina). In some cases, they are recommended only after you have sex.

Diaphragms and Spermicides

Speak with your healthcare provider if you use a diaphragm or spermicide for contraception and are getting frequent bouts of UTI. A diaphragm can make it harder to empty your bladder completely (leaving bacteria behind to cause an infection).

Spermicide can alter the natural bacterial makeup of the vagina, allowing foreign bacteria to flourish more readily. Alternate methods for contraception may need to be considered.

Precautions After Menopause

While most studies investigating chronic UTIs have focused on younger age groups, there is now compelling evidence that shows a strong relationship between sexual intercourse and UTIs in postmenopausal women.

It is, therefore, just as important for older women to take the same preventive measures as younger ones, irrespective of how often they have sex or how many sexual partners they have.

Guidelines for Sex With a UTI

If you have been diagnosed with a UTI or suspect you have a UTI, you should not have sexual intercourse. It's advised that you wait until the infection has completely cleared up before engaging in sex; otherwise, you run the risk of further irritating already inflamed tissue and possibly introducing new bacteria into your urinary tract. If that happens, you can develop a second UTI and will have an even longer recovery time.

How long after sex can you develop a UTI?

Studies show that a UTI is likely to begin within 24 hours of sexual intercourse. When introduced into the urinary tract, E. coli will adhere to the walls of the urethra and begin to multiply almost immediately.

Once you start treatment for a UTI, you should see symptoms improve within 24 to 48 hours. However, it's important to remember that the resolution of UTI symptoms doesn't mean that the bacteria is gone; therefore, it is best to wait until you have finished the course of antibiotics before resuming sex.

To ensure the infection clears up completely, you need to take the antibiotics as prescribed and finish the entire course. Failure to do so can lead to antibiotic resistance.

UTIs and Sexually Transmitted Infections

Several sexually transmitted infections (STIs), including trichomoniasis and chlamydia, present with symptoms similar to a UTI, including itchiness and painful urination. This can lead to STIs being frequently misdiagnosed as UTIs or the STI, which may have caused the urinary tract infection, being missed.

It is, therefore, vital to see your healthcare provider whenever you have symptoms related to your urinary or genital tracts. Be upfront about your sexual history, including any recent unprotected intercourse, intercourse with a new sex partner, or experience with multiple sex partners.

Current pediatric guidelines recommend that doctors take a comprehensive sexual history of any adolescent with urinary tract complaints and routinely test them for STIs.

Sexually active men under the age of 35 who don't use condoms can experience a condition called epididymitis. It is an infection of the epididymis, the coiled tube to the back of the testicles, that can be caused either by bacteria or an STI, most often gonorrhea or chlamydia. Treatment varies based on the cause and severity.

Safer sex practices, which include the consistent use of condoms, are always the best plan for reducing the risk of these and other STIs.

When to Call a Healthcare Provider

Urinary tract infections require treatment with antibiotics. Even if a UTI is relatively mild, your healthcare provider will likely recommend a one- to three-day course of antibiotics.

If a UTI is causing dyspareunia, it is typically due to frequent or recurrent UTIs that require more extensive treatment. In some cases, low-dose antibiotics may be prescribed for six months or longer. In postmenopausal women, estrogen replacement therapy may be advised.

When to Seek Urgent Care

Seek immediate medical attention if you have signs and symptoms of pyelonephritis, including:

  • Back or side (flank) pain
  • High fever
  • Chills
  • Vomiting

Summary

A urinary tract infection (UTI) occurs when bacteria enter your urethra and travel to the bladder. This bacteria is often passed on during sexual intercourse although there are other reasons why you may develop a UTI.

Antibiotics are the standard treatment for a UTI. Be sure to complete the entire prescribed course to help ensure that the infection clears up.

To help lower your risk of a UTI, follow good hygiene practices, urinate after sex, and avoid using condoms with spermicide. If the infection does not get better after taking antibiotics, follow up with your healthcare provider.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Laura Newman
Laura Newman is an award-winning journalist with expertise in clinical medicine, health policy, urology, oncology, neurology, and targeted therapies.