Intended for healthcare professionals

Clinical Review

Diagnosis and management of recurrent urinary tract infections in non-pregnant women

BMJ 2013; 346 doi: (Published 29 May 2013) Cite this as: BMJ 2013;346:f3140

Re: Diagnosis and management of recurrent urinary tract infections in non-pregnant women

Recurrent urinary infections and progesterone contraception

Gupta and Traunter write that recurrent urinary tract infection is common in otherwise healthy women.

They mention an increased risk due to sexual intercourse and use of spermicides but omit the increased risk of infection due progesterone based hormonal contraception which is immunosuppressive.1,2

It has long been known that urinary infections are more common in pregnancy. The Royal College of General Practitioners’ large oral contraceptive study cohort found increases in pyelitis and cystitis, and also in a range of various viral, bacterial and fungal infections, in women using combined progestogen/oestrogen oral contraceptives.3

Recent studies confirm that progesterone based hormonal contraceptives are immunosuppressive with increases autoimmune diseases and a wide range of infections including HPV and HIV.4-6 Invasive breast cancers and cervical cancers are still increasing. 7-8

1 Gupta K, Traunter BW. Diagnosis and management of recurrent urinary tract infections in non-pregnant women. BMJ 2013;346:f3140.

2 Brabin L. Interactions of the female hormonal environment, susceptibility to viral infections, and disease progression. AIDS Patient Care STDS 2002;16:211-21.

3 The Royal College of General Practitioners. Oral contraceptives and health. Pitmam Medical London 1974.

4 Huijbregts RP, Helton ES, Michel KG, Sabbaj S, Richter HE, Goepfert PA, Hel Z. Hormonal Contraception and HIV-1 Infection: Medroxyprogesterone acetate suppresses innate and adaptive immune mechanisms. Endocrinology 2013;154:282-95.
5 Heffron R, Donnell D, Rees H, et al; Partners in Prevention HSV/HIV Transmission Study Team. Use of hormonal contraceptives and risk of HIV-1 transmission: a prospective cohort study. The Lancet Infectious Diseases, 2012;12:19 – 26.
6 Gollub E, Stein Z. Living with uncertainty: acting in the best interests of women. AIDS Res Treat. 2012;2012:524936.
7 Johnson RH, Chein FL, Bleyer A. Incidence of breast cancer with distant involvement among women in the United States, 1976 to 2009. JAMA 2013;309(8):800-805.
8 Foley G, Alston R, Geraci M, Brabin L, Kitchener H, Birch J. Increasing rates of cervical cancer in young women in England: an analysis of national data 1982-2006. Br J Cancer 2011;105:177-84.

Competing interests: No competing interests

09 June 2013
Ellen CG Grant
physician and medical gynaecologist