When did doctors start recommending antibiotics after sex for UTI prevention?

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Kate graduated with a B.A. in Journalism from San Diego State University. She is the Content Manager at Uqora and is responsible for Uqora's social media, newsletters and contributing to the UTI Learning Center.

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Sexual activity is a major UTI trigger. Bacteria like E.coli harmoniously exist within the microbiome of our gastrointestinal tract, anus, and perineum. During sexual activity it’s easy for bacteria to shift around and make its way to your urethra. It also doesn’t help that the clitoris is located just above the urethra, let alone the fact that people with vaginas have urethrae that are 4 to 5 times shorter than those of people with penises. Since UTIs and sex have been around since, erm, forever---when did doctors start recommending antibiotics after sex to prevent UTIs?

We know that the first antibiotic, penicillin, was introduced to the general public in the in the mid to latter half of the decade.

The pinpointed date is questionable, but the practice of recommending antibiotics after sex to prevent UTIs could have started around the 1970’s. Kenneth L. Vosti, MD conducted a long-term study in 1975 to monitor 14 patients with chronic or multiple UTIs. They self-administered a single oral dose of antibiotics after sexual intercourse for periods of 19 to 111 months. 19 UTIs occurred while the patients took prophylactic (preventative) antibiotics, but 90 infections occurred when these patients did not take the antibiotics. 

This New York Times article discusses a study led by Dr. Ann Stapleton of the Department of Medicine at the University of Washington in Seattle. The study examines the effectiveness of taking prophylactic antibiotics after sex, versus continuous prophylaxis i.e. daily or weekly low dose, long-term antibiotics. ''It is an important study, even though the idea is not new,'' says Dr. Arieh Bergman, chief of gynecology and urology at the University of Southern California Women's Hospital.

Without better options, sometimes doctors need to put patients on prophylactic antibiotics for a period of time.

Doctors prescribe prophylactic antibiotics to guard patients from bacteria that cause UTIs, but, what’s the catch?

The positive:

• You know your body, and you know what personally sounds your UTI alarm bells. If your doctor prescribes you postcoital prophylaxis aka antibiotics after sex, you can cut out the burden and anxiety that surround inevitable UTIs.
• Studies show that prophylactic antibiotics reduce recurring UTIs by 95%.

The negative:

• When you stop prophylaxis (the period of time you are taking antibiotics), you are likely to experience chronic UTIs at the same rate as before.
• Prolonged use of antibiotics harm the good bacteria in your gut, and increase the possibility of yeast infections.
• Taking antibiotics for a long time during late adulthood may be linked with a higher risk of death among women, because they alter your gut microbiota even after you stop taking them.
• The most detrimental side-effect is that prophylactic antibiotics for UTIs facilitate antibiotic resistance. In 2016, superbug MCR-1, was found in the urine of a patient in Pennsylvania. MCR-1 is resistant to colistin, a “last resort” antibiotic. Eventually, stronger strains of E.coli will outsmart antibiotics.

Postcoital prophylaxis isn’t your only shot at banishing UTIs after sex. Keep up with good urinary health habits; drink plenty of water, urinate after sex, avoid spermicidal lube, feminine sprays and douches. Avoid switching to vaginal sex directly after anal sex, and clean your sex toys after each use with mild soap and water.

As antibiotic resistance is on the rise, this form of treatment will become obsolete. Scientists still agree that prevention is the best treatment.

Any UTI prevention strategy should include common behavioral changes. Ask your doctor about what else you can do to avoid taking prophylactic antibiotics for your chronic UTIs.