Behavioral and Hygienic Risk Factors for Recurrent Urinary Tract Infections in Women: Results of a Questionnaire Study

Introduction: Recurrent urinary tract infections (UTIs) remain an urgent problem in the practice of obstetricians, gynecologists, and urologists. Despite anatomical predisposing factors, in recent years, increasing attention has been paid to the role of behavioral and hygiene habits in the pathogenesis of recurrent cystitis. Goal: To evaluate the influence of behavioral factors and intimate hygiene features on the risk of recurrent urinary tract infections in women. Materials and methods: A cross-sectional study was conducted with the participation of 348 women who applied to PHC with symptoms of cystitis. The main group included 118 patients with ≥2 episodes of UTI in the last 6 months or ≥3 in the last year; the control group consisted of 230 women without relapses. The survey was conducted using an author's questionnaire (50 questions, 8 thematic blocks). The analysis included the χ² criterion, OR, Cramér's V, and Spearman correlations. Results: Statistically significant risk factors for UTI recurrence were: no urination act after sexual intercourse (OR=11.2; p<0.001), incorrect direction of hygiene (OR=4.9; p<0.001), sexual intercourse during menstruation (OR=4.5; p=0.001), sexual intercourse with symptoms of bacterial vaginosis (OR=4.7; p=0.151), frequent loose stools (OR=2.5; p=0.009), touching genitals without washing hands (OR=1.9; p=0.033), and lack of confidence in partner hygiene (OR=2.0; p=0.014). The majority of women did not receive hygienic recommendations from medical practitioners (89% of the main group and 83% of the control group), but patients in the main group were more likely to show awareness (93% vs. 41%, p<0.001). A high correlation was found between the level of education and compliance with hygiene standards (r=0.75 and r=0.81; p<0.001). Conclusions: The key behavioral risk factors for UTI recurrence include improper intimate hygiene, no postcoital urination act, and low awareness. Increasing the level of education and including hygiene issues in specialist consultations can significantly reduce the frequency of relapses.