Dear Dr G,

My wife and I have been married since January, and the last few months have been a bit of a nightmare when it comes to sex. We are both in our late twenties and started courting at university. Although we had numerous opportunities, we did not engage in any sexual contact until we were finally married four months ago.

Don’t get me wrong, the erection and penetrative sex itself are all great as expected. However, my wife started having pain and bloody urine a few days after each intercourse. She has been to the doctors each time and was given antibiotics for the infections. The pain was so intense on several occasions she is simply too fearful to engage in sex. We were recommended to see a specialist to resolve this problem.

The urologist told us this is a common condition called Honeymoon Cystitis. Apparently, this can persist for several months before it finally resolves by itself.

Besides, my wife also started wondering whether this has anything to do with STIs (Sexually Transmitted Infections). I tried to assure her I have no other sexual partner and have never even had sex with anyone.

However, when she started getting such frequent infections, she began to lose trust and patience in our marriage. Hence, I am putting Dr G on the spot for some clarifications on Honeymoon Cystitis.

What exactly is Honeymoon Cystitis and how common is it? Is Honeymoon Cystitis a type of STI as it is induced by sex?

What bacteria can cause Honeymoon Cystitis? Can Honeymoon Cystitis be prevented at all and how long will it take to resolve? And why are Urinary Tract Infections more common in women than men?

Yours truly,

Honeymoon Herman

Urinary tract infections are bacterial infections affecting the bladder or the kidneys. When the bladder is affected, this is described as cystitis. On the other hand, when kidneys are affected, this tends to be a more serious condition known as pyelonephritis. Both cystitis and pyelonephritis are more common in women.

Urinary tract infections are known to affect more than half of women in their lifetime. The infection can also occur recurrently in one-third of women. The real pathogenesis of susceptibility of women to UTIs is not well understood, however, it is believed to be due to the short urethra in women that is more exposed to external pathogens.

Urinary tract infections are known to be common during high-risk periods of a woman’s life, especially childhood, sexual debut, pregnancy, and menopause. When the infections affect women during the initiation of sexual activities, this infection is also known as honeymoon cystitis. Honeymoon cystitis typically describes acute infection of the bladder occurring primarily during sexual debut.

Statistics suggest that about 60% of women experience at least one UTI during their lifetime, with a significant increase in incidence during the first year of marriage. Although there is no real data in medical literature on the true incidence of honeymoon cystitis, it is believed to affect up to 30% of newly-weds or women starting to engage in sexual intercourse. Generally, the symptoms of honeymoon cystitis are mild and self-limiting with adequate hydration.

However, the symptoms of painful urination, frequency, and urgency of urination can affect the quality of life for some women. In some cases, bleeding and constant fever requiring long-duration treatment can also be debilitating for the newlywed. Honeymoon cystitis almost exclusively occurs in women with the pathogenesis of infection intertwined with the close nature of penetrative intercourse.

During sexual activity, the short urethra in women can come into contact with bacteria from the genital area. This exchange can introduce unwelcome bacteria into the bladder. The warm, inviting environment of the urinary tract provides these bacteria with a perfect breeding ground, leading to infection and all the unpleasant symptoms that follow.

Up to 78% of bacteria that induce honeymoon cystitis are caused by E. Coli. Other common bacteria that induce such infections are Proteus Mirabilis and Klebsiella Pneumonia. As these pathogens are generally not related to Sexually Transmitted Infections and spontaneously occur without sex, honeymoon cystitis is not considered an STI.

Although some couples may start getting frustrated and losing faith in each other, assurance from healthcare professionals is generally adequate. The treatment of honeymoon cystitis is readily available and effective.

Short courses of antibiotics ranging from one, three, and five-day treatments are usually sufficient. The regular consumption of antibiotics may be frustrating and result in undesirable side effects. For some individuals, the infections may be prolonged or recurrent; under such circumstances, regular consumption or even long-term prophylactic antibiotics may be warranted.

Despite all the potential complications of regular antibiotics, very few individuals require more medications beyond six months of initiation of treatment. The key to avoiding Honeymoon Cystitis is prevention. Staying hydrated by drinking plenty of water assists in flushing out harmful bacteria from the urinary system, which is crucial. Urinating frequently and ensuring the bladder is emptied regularly can also help to eliminate any bacterial proliferation.

Good hygiene practices before and after sexual activity, ensuring a clean and healthy environment for you and your partner, are also important. Other measures such as cranberry juice or supplements may help to prevent bacterial adhesion and reduce the risk of UTIs.

Honeymoon cystitis can be a pesky little surprise that can put a damper on the honeymoon period. As frustrating as honeymoon cystitis may be, don’t let it steal the joy of newlywed bliss. By following good hygiene practices and staying hydrated, you can overcome such infections.

Dr G is often put on the spot by troubled couples facing this bumpy path of romance. His opinion is that honeymoon cystitis is just like the bittersweet taste of cranberry juice; the bitterness of early infection is just a small price to pay to ensure a long sweet journey of intimacy for many years to come.