A two-arm randomized control trial evaluating rates of urinary tract infection in post-menopausal women on vaginal estrogen with recurrent urinary tract infections.

There is a critical need for low-cost, non-antibiotic interventions that are feasible for patients to utilize for risk reduction and prevention of recurrent urinary tract infections (UTIs). The current most effective non-antibiotic prophylaxis for recurrent UTI is vaginal estrogen; however, approximately 50% of women will continue to experience UTIs. The investigators propose a randomized control trial of postmenopausal women on vaginal estrogen with the diagnosis of recurrent UTIs to evaluate a novel post-defecation hygienic strategy utilizing a 2% chlorhexidine perineal lavage. Participants will be randomized to either a 2% chlorhexidine perineal lavage or a water lavage. Study participants will be followed for up to 6-months, and UTIs will be tracked with culture proven samples throughout study participation.

Inclusion Criteria:

• Post-menopausal female between age 55 and 89
• No post-menopausal bleeding
• Diagnosis of recurrent urinary tract infection (UTI) in the electronic health record or as two culture proven UTIs in 6 months or three culture proven UTIs in 12 months
• At least one UTI in the 6 months prior to entering the study
• Asymptomatic for UTI symptoms at the time of enrollment.
• On vaginal estrogen therapy for at least 6 weeks prior to enrollment
• Ready access to email and internet

Exclusion Criteria:

• Recent prophylactic antibiotic use (washout period of 4 weeks)
• Neurogenic bladder
• Diagnosis of urinary retention
• Uncorrected Stage III-IV prolapse
• Indwelling catheter or need for intermittent self-catheterization
• History of complicated UTIs
• History of interstitial cystitis or bladder pain syndrome
• History of fecal incontinence/accidental bowel leakage
• Greater than 14 bowel movements per week
• Non-English speaking
• Allergy to chlorhexidine gluconate
• Inability to utilize vaginal estrogen therapy
• Recent urogynecological or urologic surgery (<12 weeks)

Participants will be blinded to their assigned treatment. All participants will receive a box containing their randomized intervention and identical use instructions. Opaque bottles will contain either a sterile water solution or 2% chlorhexidine. Spray bottles will be identical in external appearance.