title: Behavioral and Psychosocial Risk Factors Associated with First and Recurrent Cystitis in Indian Women: A Case-control Study.
abstract: BACKGROUND
  The risk factors for urinary tract infections (UTIs) from developed countries are not applicable to women from developing world.
  
  
  OBJECTIVE
  To analyze the behavioral practices and psychosocial aspects pertinent to women in our region and assess their association with acute first time or recurrent UTI.
  
  
  METHODS
  Sexually active premenopausal women with their first (145) and recurrent (77) cystitis with Escherichia coli as cases and women with no prior history of UTI as healthy controls (257) were enrolled at a tertiary care hospital in India, between June 2011 and February 2013. Questionnaire-based data was collected from each participant through a structured face-to-face interview.
  
  
  RESULTS
  Using univariate and multivariate regression models, independent risk factors for the first episode of cystitis when compared with healthy controls were (presented in odds ratios [ORs] with its 95% confidence interval [CI]): Anal sex (OR = 3.68, 95% CI = 1.59-8.52), time interval between last sexual intercourse and current episode of UTI was <5 days (OR = 2.27, 95% CI = 1.22-4.23), use of cloth during menstrual cycle (OR = 2.36, 95% CI = 1.31-4.26), >250 ml of tea consumption per day (OR = 4.73, 95% CI = 2.67-8.38), presence of vaginal infection (OR = 3.23, 95% CI = 1.85-5.62) and wiping back to front (OR = 2.52, 95% CI = 1.45-4.38). Along with the latter three, history of UTI in a first-degree female relative (OR = 10.88, 95% CI = 2.41-49.07), constipation (OR = 4.85, 95% CI = 1.97-11.92) and stress incontinence (OR = 2.45, 95% CI = 1.18-5.06) were additional independent risk factors for recurrent cystitis in comparison to healthy controls.
  
  
  CONCLUSIONS
  Most of the risk factors for initial infection are potentially modifiable but sufficient to also pose risk for recurrence. Many of the findings reflect the cultural and ethnic practices in our country.
authors.affiliation: Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Bharti
authors.initials: B
authors.lastname: Mishra
authors.affiliation: Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Richa
authors.initials: R
authors.lastname: Srivastava
authors.affiliation: Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Jyotsna
authors.initials: J
authors.lastname: Agarwal
authors.affiliation: Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Sugandha
authors.initials: S
authors.lastname: Srivastava
authors.affiliation: Department of Obstetrics and Gynaecology, King George's Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Amita
authors.initials: A
authors.lastname: Pandey
keywords: Behavioral practices; host factors; recurrent urinary tract infections; sexual behavior; urinary tract infections