New guidance released for managing recurrent urinary tract infections in women

New guidance released for managing recurrent urinary tract infections in women | Image Credit: © 220 Selfmade studio - stock.adobe.com.

The American Urological Association (AUA), in collaboration with the Canadian Urological Association (CUA) and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU), has released the 2025 amendment to its guideline on recurrent uncomplicated urinary tract infections (rUTIs) in women. The updated document provides 20 recommendations designed to guide clinicians in diagnosing, treating, and managing rUTIs, with new emphasis on patient-centered care, antimicrobial stewardship, and recognition of the urinary microbiome.¹

“Recurrent urinary tract infections are a source of great suffering among our patients, and SUFU was thrilled to partner with the AUA on the new rUTI Guideline Amendment,” said Anne Pelletier Cameron, MD, FRCSC, URPS, president of SUFU and professor and vice chair of Academic Affairs in the Department of Urology at the University of Michigan. “Clear guidance on diagnosis and management of this condition will be used by urology providers and the greater medical community, and this updated document incorporates the most recent scientific evidence in a clear and actionable manner.”²

Scope and purpose

The guideline focuses on otherwise healthy adult women with recurrent uncomplicated UTIs, excluding those who are pregnant, immunocompromised, or have anatomic or functional urinary tract abnormalities. It emphasizes the accurate diagnosis, the appropriate use of antibiotics, and the consideration of non-antibiotic preventive strategies.

The amendment reflects growing awareness of antimicrobial resistance and the limitations of traditional diagnostic methods. “In updating the 2025 Guideline Update for Recurrent Uncomplicated Urinary Tract Infections (rUTI) in Women, we hope to take a more patient-centered, risk-based and microbiome-aware approach to rUTI management,” said A. Lenore Ackerman, MD, PhD, director of Research for the Division of Urogynecology and Reconstructive Pelvic Surgery at the University of California, Los Angeles, and chair of the guideline amendment.

Ackerman added, “The updated Guideline tries to balance diagnostic accuracy with clinical judgment, redefining treatment success as symptom resolution rather than microbial eradication and placing a premium on antimicrobial stewardship and patient-centered care. These changes reflect a maturing understanding of the urinary microbiome, the limitations of existing diagnostics, and a public health imperative to reduce unnecessary antibiotic exposure.”

Key recommendations

The 2025 amendment builds upon earlier versions with several new elements:

• Diagnostics: Emphasis on accurate documentation of symptomatic episodes, including urine cultures, while minimizing unnecessary cystoscopy or upper tract imaging.
• Antibiotic use: Clinicians are advised to prescribe first-line therapies such as nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin, with the shortest reasonable duration, generally no longer than 7 days. Prophylactic antibiotics may be offered after discussion of risks and benefits.
• Non-antibiotic prophylaxis: The amendment includes new recommendations for non-antibiotic strategies. Cranberry products may be offered for prevention, though variability in formulations is acknowledged. Other interventions, such as D-mannose, lactobacillus, and methenamine, were noted as having insufficient evidence to support routine use.
• Hormone therapy: Vaginal estrogen therapy is recommended for peri- and postmenopausal women with rUTIs, provided there are no contraindications.
• Follow-up: Routine test-of-cure urine cultures in asymptomatic patients are discouraged, and treatment success is defined by resolution of symptoms rather than eradication of bacteria.

Future directions

The guideline also highlights emerging diagnostic and therapeutic tools, including molecular technologies, vaccines for urinary pathogens, and host-directed therapies.

According to the authors, the amendment underscores the need for individualized care, balancing antimicrobial stewardship with effective management of a condition that affects millions of women worldwide. With the new updates, the guideline aims to provide clinicians with evidence-based strategies that align with evolving scientific understanding and patient-centered priorities.

References:

1. 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
2. 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