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Repeated Urinary Infections

Dear Dr. Roach: I am a 62-year-old woman and am at my wits’ end. For the past two years, I have suffered from recurrent UTIs, usually Group B strep infections. I am not diabetic, and my weight, blood pressure and cholesterol are all good. I do take thyroid medication and also use a vaginal estriol cream.

It seems like every three months I need another round of antibiotics, and despite making many lifestyle changes — such as wearing cotton underwear and no tight jeans, taking only showers and adding D-Mannose, apple cider vinegar and vitamins C and B-12 to my diet daily — I still get these Group B strep infections. I had a urodynamic test done, which was negative. Where do I go from here, and could this Group B strep possibly be related to food sensitivities? Also, I had a partial hysterectomy at 34 due to a prolapsed uterus, with repair to my bladder and rectum, and was wondering if after all these years something had torn or moved and might be causing the strep to move from these areas into the urinary tract. Do any medical centers specialize in treating these types of infections? — D.A.

Answer: Recurrent urinary infections should prompt a careful look for anatomical abnormalities in the urinary tract. The most common cause of recurrent UTI that I see in a woman your age is atrophic vaginitis, but you already are on appropriate medication (estriol) to both treat and prevent that. A urodynamic study also should have picked up many of the anatomic causes that might predispose to recurrent infection. I can’t imagine that your surgery 28 years ago would be likely to predispose you.

Group B streptococci in nonpregnant adults is indeed strongly associated with diabetes, and a definitive test for diabetes, such as a glucose tolerance test or A1c, should be done, even if you have never been diagnosed.

Cranberry juice has been shown to reduce urine infections in women with frequent recurrences. I recommend mixing 100 percent cranberry juice with seltzer water to avoid the added sugar of most cranberry juice cocktails. Healthy bacteria, such as in live yogurt or probiotics, also can reduce recurrences. I have had a handful of cases in which I have needed to use prophylactic antibiotics, but neither the patients nor I were really happy with that solution, although it is effective.

Gynecologists, urologists, urogynecologists and infectious disease specialists may all be expert in helping prevent recurrent UTI.

Dear Dr. Roach: My younger sister was pregnant when we took a flight. When the plane stopped in Brazil, the cabin was sprayed with an aerosol that caused the cabin to remain milky white for two to three hours.

Her newborn was born one month premature and was diagnosed with achondroplasia, a form of dwarfism. Do you know of any studies linking achondroplasia with chemical exposure during the first trimester of pregnancy? — M.T.

Answer: The spray probably was an insecticide. The U.S. stopped spraying cabins after the Centers for Disease Control and Prevention found the practice ineffective and potentially harmful. Spraying the cabin is humiliating and creates an entirely reasonable fear.

Achondroplasia is caused by a specific gene abnormality. It can be inherited, but also occurs as a spontaneous change in the DNA (mutation). It is estimated that every person has several spontaneous mutations. In your sister’s case, the mutation would likely have happened before your sister was born. For this specific case, I believe the spray did not cause the achondroplasia.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or write to P.O. Box 536475, Orlando, FL 32853-6475. All Rights Reserved