Recurrent urinary tract infections (rUTIs) are a common and burdensome condition among adult women, with a multifactorial etiology involving behavioral, gynecologic, host-related, and microbiological factors. Despite extensive research on individual risk factors, comprehensive evidence integrating these domains remains limited. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A comprehensive search of PubMed, Scopus, Web of Science (WOS), and the Cochrane Library was performed from database inception to the final search date. Studies were included if they evaluated gynecologic and/or behavioral risk factors associated with UTI recurrence in adult women. Eligible study designs included observational studies and relevant clinical trials. Data extraction and methodological quality assessment were conducted using standardized tools, including the Mixed Methods Appraisal Tool (MMAT) and the modified Downs and Black checklist. Eleven studies met the inclusion criteria. Sexual intercourse was identified as the most consistent and strongest behavioral risk factor, demonstrating a clear dose-response relationship with UTI recurrence. Spermicide-based contraception further increased risk, whereas hygiene practices showed inconsistent associations. Habitual urine holding emerged as a potential modifiable risk factor, while increased daily water intake was identified as the most robust protective factor, supported by evidence from randomized controlled trials. Gynecologic and host-related factors, including estrogen deficiency, urinary incontinence, pelvic organ prolapse, and comorbidities, were also associated with recurrence. A prior history of UTI and early-life susceptibility further contributed to increased risk. From a microbiological perspective, Escherichia coli predominated, with significant antimicrobial resistance observed among recurrent infections. Overall, rUTIs in adult women are driven by a complex interplay of behavioral, gynecologic, host-related, and microbiological factors. Sexual activity and spermicide use represent the most consistent risk factors, whereas increased hydration appears to be the most effective non-pharmacological preventive measure. These findings support a multifactorial approach to prevention and highlight the need for individualized, evidence-based strategies to reduce recurrence and antimicrobial use.
Alhazmi et al. (2026) studied this question.