Skip to main content

Advertisement

SpringerLink
Log in

Sexual Intercourse and Risk of Symptomatic Urinary Tract Infection in Post-Menopausal Women

  • Original Article
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. 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.

  2. 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.

    Article  PubMed  Google Scholar 

  3. 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.

    Article  PubMed  CAS  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. Foxman B, Frerichs RR. Epidemiology of urinary tract infection: I. Diaphragm use and sexual intercourse. Am J Public Health. 1985;75(11):1308–1313.

    Article  PubMed  CAS  Google Scholar 

  6. Foxman B, Frerichs RR. Epidemiology of urinary tract infection: II. Diet, clothing, and urination habits. Am J Public Health. 1985;75(11):1314–1317.

    Article  PubMed  CAS  Google Scholar 

  7. 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.

    Article  PubMed  CAS  Google Scholar 

  8. 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.

    Article  PubMed  CAS  Google Scholar 

  9. 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.

    PubMed  CAS  Google Scholar 

  10. 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.

    Article  PubMed  CAS  Google Scholar 

  11. 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.

    PubMed  CAS  Google Scholar 

  12. 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.

    Article  PubMed  CAS  Google Scholar 

  13. 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.

    PubMed  Google Scholar 

  14. Jackson SL, Scholes D, Boyko EJ, Abraham L, Fihn SD. Urinary incontinence and diabetes in postmenopausal women. Diabetes Care. 2005;2871(7):30–1738.

    Article  PubMed  Google Scholar 

  15. Winkens , Nelissen-Arets H, Stobberingh E. Validity of the urine dipslide under daily practice conditions. Fam Pract. 2003;20(4):410–412.

    Article  PubMed  Google Scholar 

  16. 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.

    Article  PubMed  Google Scholar 

  17. Hooton TM. Recurrent urinary tract infection in women. Int J Antimicrob Agents. 2001;17(4):259–268.

    Article  PubMed  CAS  Google Scholar 

  18. Svanborg C, Godaly G. Bacterial virulence in urinary tract infection. Infect Dis Clin North Am. 1997;11(35):13–529.

    Article  PubMed  CAS  Google Scholar 

  19. Anderson PK, Gill RD. Cox's regression model for counting processes: a large sample study. Ann Stat. 1982;10:1110–1120.

    Article  Google Scholar 

  20. Lin DY. Cox regression analysis of multivariate failure time data: the marginal approach. Stat Med. 1994;13(21):2233–2247.

    Article  PubMed  CAS  Google Scholar 

  21. Maldonado G, Greenland S. Simulation study of confounder-selection strategies. Am J Epidemiol. 1993;138(11):923–936.

    PubMed  CAS  Google Scholar 

  22. Ronald A. The etiology of urinary tract infection: traditional and emerging pathogens. Am J Med. 2002;113(Suppl 1A):14S–19S.

    Article  PubMed  Google Scholar 

  23. 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.

    Google Scholar 

  24. Hornsby PP, Wilcox AJ. Validity of questionnaire information on frequency of coitus. Am J Epidemiol. 1989;130(1):94–99.

    PubMed  CAS  Google Scholar 

  25. 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.

    Article  PubMed  Google Scholar 

  26. 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.

    Article  PubMed  CAS  Google Scholar 

  27. NCOA National Council on the Aging. Healthy Sexuality and Vital Aging: Executive Summary. Washington, D.C.; 1998.

  28. 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.

    Article  PubMed  Google Scholar 

  29. 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.

    Article  PubMed  CAS  Google Scholar 

  30. Van Voorhis BJ. Genitourinary symptoms in the menopausal transition. Am J Med. 19 2005;118(12 Suppl 2):47–53.

Download references

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

  1. Department of Epidemiology, University of Washington School of Public Health and Community Medicine, Seattle, WA, USA

    Elya E. Moore PhD, Stephen E. Hawes PhD, Delia Scholes PhD & Edward J. Boyko MD, MPH

  2. Health Services Research & Development Center of Excellence, VA Puget Sound Health Care System, Seattle, WA, USA

    Elya E. Moore PhD & Stephan D. Fihn MD, MPH

  3. Center for Health Studies, Group Health Cooperative, Seattle, WA, USA

    Delia Scholes PhD

  4. Department of Medicine, University of Washington, Seattle, WA, USA

    Edward J. Boyko MD, MPH & Stephan D. Fihn MD, MPH

  5. Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA, USA

    Edward J. Boyko MD, MPH

  6. Department of Biostatistics, University of Washington School of Public Health and Community Medicine, Seattle, WA, USA

    James P. Hughes PhD

  7. Murdoch Childrens Research Institute, Royal Children’s Hospital, Victoria, Australia

    Elya E. Moore PhD

Authors
  1. Elya E. Moore PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephen E. Hawes PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Delia Scholes PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Edward J. Boyko MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. James P. Hughes PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Stephan D. Fihn MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elya E. Moore PhD.

Rights and permissions

Reprints 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

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-008-0535-y

KEY WORDS

Search

Navigation