Updates to Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2025).

Abstract

Purpose: Our perceptions of recurrent UTI (rUTI) have evolved due to additional insights into rUTI pathophysiology, an appreciation for the adverse effects of repetitive antimicrobials ("collateral damage"), rising rates of bacterial antimicrobial resistance, and better reporting of the natural history of localized cystitis and rUTI. This document seeks to guide the evaluation and management of patients with rUTIs to prevent inappropriate antibiotic use, decrease the risk of antibiotic resistance, reduce adverse effects of antibiotics, provide guidance on strategies for rUTI prevention, and improve outcomes and quality of life for women with rUTIs.

Materials and methods: In 2024, this Guideline was reviewed via the AUA Update Literature Review process, which identified 87 studies for full-text review published between June 1, 2021 and November 1, 2024. Of those 87 studies, 14 met inclusion criteria for review. The subsequent amendment is based on data released since the last review of this Guideline in 2021.

Results: The Panel developed evidence- and consensus-based statements based on an updated review to provide guidance on evaluation and management of rUTI in women. These updates are detailed herein.

Conclusions: This update provides several new insights, including expansion of non-antibiotic options for UTI prophylaxis, greater understanding of the value of a negative urinalysis in ruling out UTI, and a paradigm shift away from microbial detection to reliance on clinician judgement when weighing the individual risks and benefits of antibiosis. This Guideline will require further review as the diagnostic and treatment options in this space continue to evolve.