There is negative evidence (i.e. did worse than placebo)? Drinking cranberry juice was part of a regimen I tried to stop frequent UTIs. Obviously, I’d like to know if it were the other things that caused the cessation so I don’t neglect them!
My husband would be surprised about the lack of evidence, as well. His urologists have recommended cranberry juice and/or capsules for years. He purchases a straight cranberry juice that costs $4/bottle 2 x wk. His mother’s MD even ordered daily cranberry juice when she was admitted to a stroke rehab as she gets frequent UTIs. Their idea of cranberry juice is Ocean Spray cocktail so we’re bringing the expensive stuff when we visit. The recommendations noted in NJEM will most certainly end up in Natural News and publications like it. Sigh.
I had fun researching the evidence for cranberry products when I wrote this piece for Planned Parenthood Advocates of Arizona‘s blog. It seems that there might be some plausibility behind the claims, but so far the evidence just doesn’t support it. Now, it’s true that drinking cranberry juice won’t do any harm … unless, of course, you’re receiving your advice from one of those sadists who thinks that you must suffer for your health, in which case they recommend unsweetened, 100% cranberry juice rather than a nice pleasant cranberry juice cocktail.
I’m really curious about the claim that one must void after intercourse to avoid UTIs. I’ve never found confirmation for this oft-repeated women’s health advice. Of course the vagina and urethra are two separate openings, but I’ve also heard people say that the friction can push cells into the urethra anyway. Does anyone here know about evidence for the efficacy (or lack thereof) in urination after vaginal intercourse in preventing UTIs?
I have to confess that I have never looked into the original literature re: mechanical issues for the prevention of UTI, and have repeated the advice for 30 years. The advice probably predates the antibiotic era, given the antiquity of the UTI. The one exception is sex leading to UTI, and there I like to sneer at the outdated concept of honeymoon cystitis, as if sex starts at the honeymoon. Of which there are only 6 hits on pubmed. Whether fiction, due to friction or exposure to new E. coli strains is not known.
I used to have a lot of problems with UTIs when I was a kid. And then it went away, when my doctor decided to try a rather non-standard drug for it. It hasn’t returned in the last 15 years, during which time I happened to get married, so honeymoon cystitis does not seem a valid concept to me. The only thing I do to protect my urinary tract is drinking a lot of water but I suppose it’s really one of the basics.
Mark — I know that I was getting plenty of UTIs before I got married and became “active”. Mechanical prevention strategies (voiding after intercourse, wiping front to back) *seemed* to help. But I did not collect data systematically. Complete voiding is probably the most important one; I have a urinary diverticulum which makes this difficult, and is believed to be why I have recurrent cystitis. On average, I get 1-3 infections a year; not quite enough to justify routine antibiotics, for which I am grateful.
In the excerpt of the NEJM article, I, a patient, have to wonder why the first step contemplated for this patient seems to be taking cranberry supplements. Why not first make sure they actually killed the damn bug? After my last pregnancy, I got several bouts of cystitis, treated with sulfa because I was breastfeeding and that’s considered a relatively safe one for nursing moms. The last time, it didn’t make a dent, and so they sent a specimen in for culture, had me wean the baby (she was losing interest in the breast anyway, so it was timely), and put me on ciprofloxacin. Sure enough, culture came back that the specimen was resistant to sulfa — I’d bred me some sulfa-resistant e. coli. Maybe this lady’s system has managed to breed sulfa-resistant bacteria, and the right thing to do would be to culture it, find out it’s weaknesses, and really hit it hard to kill it all off. Is she finishing her antibiotic courses, or stopping as soon as she feels better? Did they verify she actually had a bacterial infection each time, or just treat based on symptoms?
One more thought regarding voiding after intercourse . . . this is gonna sound grody. Fair warning. When I do this, I notice that it is more difficult to get the stream started, with a sensation not unlike trying to blow a really stuffed up nose. I find it pretty plausible that stuff does get pushed up there. It should be fairly straightforward to study; the only difficulty would be recruiting test subjects.
I reread the excerpt. So, this hypothetical woman got a three-day course of sulfa a month ago and has UTI symptoms again . . . if both UTIs were confirmed by tests, then the first suspect has to be that the last infection wasn’t really killed off by that pretty wimpy treatment.
Another thought: if the UTI diagnoses are based on symptoms alone, we have another confounder that I think may be responsible for a lot of the anecdotal reports of alt med working for UTIs: it is not that unusual for some women to experience burning during urination during certain portions of the menstrual cycle. It must also be considered that this may not be an infection at all. “A 30-year-old woman calls you to report a 2-day history of worsening dysuria and urinary urgency and frequency. She reports having no fever, chills, back pain, or vaginal irritation or discharge.” I used to get that too, but annoyingly, the UA would be negative. And then I’d get my period, and the symptoms would disappear. My doctor put me on hormonal birth control, and I haven’t had it since. (Just the actual UTIs.)
“I am also not a fan of ideological purity, a foolish consistency being the hobgoblin of little minds, adored by little statesmen and philosophers and science bloggers.”
“For those of you not in medicine, the word of the NEJM is close to that of god. In clinical medicine, there is the NEJM then everyone else.”
Well, there you go. You’ve been hoping in a foolish consistency at NEJM, that they would always publish science-based articles while simultaneously reporting its words are regarded in much the same way as the utterances of an invisible being standing apart from everything else. How can expectations of scientific consistency be reconciled with analogous notions of belief in an exceptional being and the revelations from it?