Has anyone else had repeated urine cultures that grow E. coli even when symptoms are mild or barely there? I’m trying to understand what actually matters here and what’s noise, and would love a gynecology-focused perspective.
Questions I’m struggling with:
- When to treat vs watch-and-wait: If a culture shows E. coli but I feel fine or have super mild irritation, is it safe to skip antibiotics if I’m not pregnant? How do you decide? Do you ever do a “test of cure” after finishing treatment?
- How to read culture reports: What colony count is considered meaningful for someone with symptoms vs no symptoms? What does “mixed flora/likely contamination” really mean? If E. coli shows up at a lower count but it’s a pure growth, is that still a real infection?
- Best sample technique: Any tips to avoid contamination with a clean-catch, especially around periods or if you have discharge/BV? Is a catheterized sample ever worth asking for to get a clear answer?
- Gynecology links:
- Sex-related UTIs-are certain contraceptives (spermicides, diaphragms, maybe caps) higher risk than others (condoms, hormonal methods, IUDs)? Any data on copper IUDs and UTIs?
- Do certain lubes or vaginal products (pH balancers, boric acid, lactic acid gels) help or hurt?
- Menstrual cups/tampons vs pads-any difference in UTI risk?
- Prevention that actually works:
- Vaginal estrogen for peri/postmenopause-how effective?
- Methenamine hippurate-when do gyns use it?
- Cranberry (PAC-standardized) vs D‑mannose-hearing mixed evidence lately; is either still recommended?
- Oral vs vaginal probiotics-any strains with decent evidence for reducing E. coli colonization?
- Behavioral stuff that’s evidence-based beyond “pee after sex”: timing of hydration, bowel regularity, bidet settings, showers vs baths, underwear materials, etc.
- Microbiome angle: Is addressing gut or vaginal dysbiosis (e.g., recurrent BV) key for preventing E. coli UTIs? Has anyone seen benefit from targeted probiotics or even experimental approaches like vaginal microbiome transplants?
- Pelvic floor and emptying: Can a tight pelvic floor, prolapse, or incomplete bladder emptying set you up for persistent bacteriuria? Would pelvic floor PT actually reduce UTIs?
- Antibiotic resistance: If a culture says ESBL E. coli, does the prevention plan change? For uncomplicated cases, are nitrofurantoin or fosfomycin still first line? Should I always ask for susceptibilities before treating?
- Pregnancy and preconception: I know asymptomatic bacteriuria gets treated in pregnancy-do you screen before trying to conceive or before procedures like IUD insertion?
- When to see a specialist: What counts as “recurrent” UTIs for referral, and what workup (imaging, cystoscopy) is reasonable if it’s always E. coli?
Would love to hear what’s actually helpful in real life vs myths, and any checklists you give patients to cut down on recurrences without overusing antibiotics.