ABSTRACT
Background
Sexual intercourse increases the risk of symptomatic urinary tract infections (UTI) in young women, but its role among post-menopausal women is unclear.
Objective
To determine whether recent sexual intercourse, as documented by daily diaries, is associated with an increased risk of symptomatic UTI in post-menopausal women.
Design
A 2-year prospective cohort study conducted from 1998 to 2002.
Participants
One thousand and seventeen randomly selected post-menopausal women enrolled at Group Health Cooperative (GHC), a Washington State HMO.
Measurements and Main Results
Women were asked to enter daily diary information on vaginal intercourse, medication use, and genito-urinary symptoms. The outcome of interest, symptomatic UTI, was defined as a positive urine culture ≥105 CFU/mL of a uropathogen and the presence of ≥2 acute urinary symptoms. Nine hundred thirteen women returned diaries and were included in this study. Seventy-eight women experienced 108 symptomatic UTIs, and 361 (40%) reported sexual intercourse in their diaries. There was an increased hazard for UTI 2 calendar days after the reporting of sexual intercourse in the diaries (adjusted hazard ratio [HR], 3.42, 95% CI 1.49–7.80), while there was no evidence for an increased hazard associated with intercourse at other times. When the UTI criterion was relaxed from ≥105 CFU/mL to ≥104 CFU/mL, adding 9 UTI events to the analysis, the HR for UTI 2 days after intercourse changed slightly to 3.26 (95% CI 1.43–7.43).
Conclusions
Our data suggest that, as with younger women, recent sexual intercourse is strongly associated with incident UTI in generally healthy post-menopausal women.
Similar content being viewed by others
REFERENCES
US Census Bureau. Female population by age, race, Hispanic or Latino origin: 2000. Available at: http://www.census.gov/population/cen2000/phc-t9/tab03.pdf. Accessed December 6, 2006.
Jackson SL, Boyko EJ, Scholes D, Abraham L, Gupta K, Fihn SD. Predictors of urinary tract infection after menopause: a prospective study. Am J Med. 2004;117(12):903–911.
Foxman B, Somsel P, Tallman P, et al. Urinary tract infection among women aged 40 to 65: behavioral and sexual risk factors. J Clin Epidemiol. 2001;54(7):710–718.
Hu KK, Boyko EJ, Scholes D, et al. Risk factors for urinary tract infections in postmenopausal women. Arch Intern Med. 2004;164(9):989–993.
Foxman B, Frerichs RR. Epidemiology of urinary tract infection: I. Diaphragm use and sexual intercourse. Am J Public Health. 1985;75(11):1308–1313.
Foxman B, Frerichs RR. Epidemiology of urinary tract infection: II. Diet, clothing, and urination habits. Am J Public Health. 1985;75(11):1314–1317.
Hooton TM, Scholes D, Hughes JP, et al. A prospective study of risk factors for symptomatic urinary tract infection in young women. N Engl J Med. 1996;335(7):468–474.
Scholes D, Hooton TM, Roberts PL, Stapleton AE, Gupta K, Stamm WE. Risk factors for recurrent urinary tract infection in young women. J Infect Dis. 2000;182(4)1177–1182.
Strom BL, Collins M, West SL, Kreisberg J, Weller S. Sexual activity, contraceptive use, and other risk factors for symptomatic and asymptomatic bacteriuria. A case-control study. Ann Intern Med. 1987;107(6):816–823.
Brown JS, Vittinghoff E, Kanaya AM, Agarwal SK, Hulley S, Foxman B. Urinary tract infections in postmenopausal women: effect of hormone therapy and risk factors. Obstet Gynecol. 2001;98(6):1045–1052.
Nicolle LE, Harding GK, Preiksaitis J, Ronald AR. The association of urinary tract infection with sexual intercourse. J Infect Dis. 1982;146(5):579–583.
Lindau ST, Schumm LP, Laumann EO, Levinson W, O'Muircheartaigh CA Waite LJ. A study of sexuality and health among older adults in the United States. N Engl J Med. 2007;357(8):762–774.
Boyko EJ, Fihn SD, Scholes D, Abraham L, Monsey B. Risk of urinary tract infection and asymptomatic bacteriuria among diabetic and nondiabetic postmenopausal women. Am J Epidemiol. 2005;161(6):557–564.
Jackson SL, Scholes D, Boyko EJ, Abraham L, Fihn SD. Urinary incontinence and diabetes in postmenopausal women. Diabetes Care. 2005;2871(7):30–1738.
Winkens , Nelissen-Arets H, Stobberingh E. Validity of the urine dipslide under daily practice conditions. Fam Pract. 2003;20(4):410–412.
Sampselle CM, Harlow SD, Skurnick J, Brubaker L, Bondarenko I. Urinary incontinence predictors and life impact in ethnically diverse perimenopausal women. Obstet Gynecol. 2002;100(6):1230–1238.
Hooton TM. Recurrent urinary tract infection in women. Int J Antimicrob Agents. 2001;17(4):259–268.
Svanborg C, Godaly G. Bacterial virulence in urinary tract infection. Infect Dis Clin North Am. 1997;11(35):13–529.
Anderson PK, Gill RD. Cox's regression model for counting processes: a large sample study. Ann Stat. 1982;10:1110–1120.
Lin DY. Cox regression analysis of multivariate failure time data: the marginal approach. Stat Med. 1994;13(21):2233–2247.
Maldonado G, Greenland S. Simulation study of confounder-selection strategies. Am J Epidemiol. 1993;138(11):923–936.
Ronald A. The etiology of urinary tract infection: traditional and emerging pathogens. Am J Med. 2002;113(Suppl 1A):14S–19S.
Armstrong BK, White E, Saracci R. Methods of Exposure Measurement. In: Principles of Exposure Measurement in Epidemiology. Oxford: Oxford University Press; 1992:22–45.23.
Hornsby PP, Wilcox AJ. Validity of questionnaire information on frequency of coitus. Am J Epidemiol. 1989;130(1):94–99.
Boyko EJ, Fihn SD, Scholes D, Chen CL, Normand EH, Yarbro P. Diabetes and the risk of acute urinary tract infection among postmenopausal women. Diabetes Care. 2002;25(10):1778–1783.
McHorney CA, Kosinski M, Ware JE Jr. Comparisons of the costs and quality of norms for the SF-36 health survey collected by mail versus telephone interview: results from a national survey. Med Care. 1994;32(6):551–567.
NCOA National Council on the Aging. Healthy Sexuality and Vital Aging: Executive Summary. Washington, D.C.; 1998.
Patel D, Gillespie B, Foxman B. Sexual behavior of older women: results of a random-digit-dialing survey of 2,000 women in the United States. Sex Transm Dis. 2003;30(3):216–220.
Foxman B, Barlow R, D’Arcy H, Gillespie B, Sobel JD. Urinary tract infection: self-reported incidence and associated costs. Ann Epidemiol. 2000;10(8):509–515.
Van Voorhis BJ. Genitourinary symptoms in the menopausal transition. Am J Med. 19 2005;118(12 Suppl 2):47–53.
ACKNOWLEDGMENTS
This work was funded by the National Institute of Health (T32AI07140, RO1 DK43134, K23DK02660 (KG)). Additional support was provided by the Center for Health Studies (CHS) at the Group Health Cooperative (GHC) and the Health Services Research & Development Center of Excellence and the VA Puget Sound Health Care System (HSR&D) in Seattle, Washington. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. The authors acknowledge Linn Abraham for her data management and statistical programming assistance. We also thank Dr. Walter Stamm for his thoughtful comments on this manuscript. A segment of this project was presented at the Infectious Disease Society of Obstetrics and Gynecology conference in Carmel, California in August, 2006.
Conflict of Interest
None disclosed.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Moore, E.E., Hawes, S.E., Scholes, D. et al. Sexual Intercourse and Risk of Symptomatic Urinary Tract Infection in Post-Menopausal Women. J GEN INTERN MED 23, 595–599 (2008). https://doi.org/10.1007/s11606-008-0535-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11606-008-0535-y