What is Honeymoon Cystitis?
It is an old-fashioned term which refers to the urinary tract infection or UTI experienced by a girl after her first intercourse, occurring traditionally on her wedding night. However, as sex before marriage has become widespread in western society since the 1960s when oral contraceptive pills (OCP) were discovered, this term is not much relevant today. It is quite a common condition among women. Nearly 50% of women suffer from the disorder at some point in their lives.
Honeymoon Cystitis Microbiology and Pathogenesis
In women who are affected by this cystitis, bacteria from fecal flora can easily get deposited in the vaginal introitus and then gain access to the bladder and urethra. Development of urinary tract infection depends on virulence of host bacteria. Certain bacterial strains have specific virulence aspects like adhesins and fimbriae that enable them to strongly hold on to bladder wall. Escherichia coli bacterium is responsible for most cases of acute uncomplicated cystitis. The rest of the honeymoon cystitis cases are caused by Staphylococcus saprophyticus, Klebsiella, Enterococci and Proteus. It also depends on numerous other factors, such as:
Picture 1 – Honeymoon Cystitis
Exposure to chemicals
Vaginal deodorant, antiseptic lotions, spermicidal contraceptive devices and creams can change the vaginal environment which may make the vagina susceptible to bacterial colonization.
Non secretion of antigens
Girls and women who do not secrete histo-blood group antigens are 3 times more prone to have recurrent episodes of urinary tract infections.
Sexual intercourse
Intercourse can introduce fecal flora into a urethra by its mechanical effects.
Honeymoon Cystitis Causes
Most cases of this disorder are caused by infections from Escherichia coli bacterium that affects a woman through sexual intercourse. Escherichia coli bladder infections can occur due to bad hygienic habits, such as wiping off the bottom starting from back to the front. This brings the bacteria from the bowels into direct contact with the urethral opening.
If the urethral area is exposed to bacteria, the microbe clings to the urethral opening and starts to grow – thereby causing infection. If the bacterium infects the urethra, it leads to a condition known as Urethritis. On the other hand, if the bacteria infects the bladder and continue to multiply, it results in honeymoon cystitis. Some women are less prone to this disorder due to the structure of their body as well as their immune system. Other women can get affected by this disorder while having sexual intercourse. The wear and tear of skin, especially after the first intercourse, increases the risk of this disease for many women.
Honeymoon Cystitis Risk Factors
Some factors that can aggravate the development of this cystitis are:
- Frequency of sexual activity, which is a major risk factor.
- Lack of proper vaginal lubrication during sexual intercourse. It predisposes a woman to urinary tract infection. This may occur due to inexpert or inadequate foreplay or anxiety. An absence of male expertise can also be a probable cause.
- Usage of spermicide or a diaphragm, either separately or together, which increases the risk of Urinary Tract Infection (UTI).
- Asymptomatic bacteriuria, a major risk factor in many sexually active women.
- Postmenopausal vaginal atrophy, which can increase the risk of Honeymoon Cystitis. Recent sexual intercourse by a postmenopausal woman is strongly linked with urinary tract infection. Incidental urinary tract infection is strongly linked with recent sexual intercourse in cases of generally healthy postmenopausal woman.
Honeymoon Cystitis Symptoms
Most patients of this disorder experience either all or some of the following symptoms:
- A frequent urgency to urinate.
- Burning and painful sensation during urination.
- Bleeding while urinating.
- Weakness, tiredness and fatigue.
- An itching sensation around the entire groin area, resulting from persistent ‘wetness’.
- Pain and discomfort, even when not urinating.
- Discomfort around the area above the pubic bone.
- Pelvic pain and discomfort.
- Suprapubic pain, tenderness and haematuria.
- Low urinary output, despite having a strong urgency to urinate.
- Reddish or cloudy appearance of urine.
If fever is present along with other symptoms, such as nausea, vomiting and back pain, it is most likely that the infection has proceeded into the kidneys.
Honeymoon Cystitis Diagnosis
A doctor may conduct a dipstick urine test to detect nitrites and leucocyte esterase or pyuria in the presence of a bacterial infection. Enterobacteriaceae can generate nitrite from urinary nitrate. However, this test cannot detect infections with certain bacteria. It is common to find the usage of dipstick haematuria in case of urinary tract infections, even though it is rare in case of vaginitis or urethritis.
A mid-stream urine test or a MSU helps to detect bacteria, white cells and red cells (if present). Some women show symptoms of Cystitis along with pyuria, even though no signs of bacterial growth are found in MSU test results.
Honeymoon Cystitis Differential Diagnosis
The differential diagnosis of the disorder includes ensuring the absence of other similar conditions, such as:
- Interstitial cystitis
- Candidiasis
- Chlamydia
- Pyelonephritis
Honeymoon Cystitis Prevention
The following measures can help a woman avoid this condition:
- Cleaning the vaginal area before having sexual intercourse
- Urinating prior to and after genital intercourse
- Drinking plenty of water on a daily basis
- Avoid drinking coffee
- Drinking cranberry juice
- Urinating regularly
- Avoiding usage of scented douches and feminine hygiene sprays that may cause irritation of the urethra
- Taking regular showers instead of having baths
- Using a water-based lubricant around the vaginal area for easy insertion during sexual intercourse
- Wiping from front area to the back so that the bacteria around anus is not able to get in contact with the vagina and urethra
- Consulting a gynecologist or urologist as and when required
Honeymoon Cystitis Treatment
The condition is generally treated by antibiotics. The dosage and duration of the specific drug will vary depending on the severity of the symptoms as well as the medical history of a patient. The sensitivity test allows a doctor to determine the best possible antibiotics for a given patient. Although the symptoms of honeymoon cystitis can go away only after taking the antibiotics for one or two days, patients are normally advised to continue with the medication for at least another two weeks. This is due to the reason that some traces of the bacteria may remain around the vaginal area and may start growing again. An analgesic called Pyridium is also prescribed. This drug helps in reducing burning sensation, irritation of lower urinary tract and the urgency for urination. While using Pyridium, the urine takes on a bright reddish-orange color. Drinking lots of cranberry juice and temporarily staying away from sex can help cure Honeymoon cystitis faster.
Honeymoon Cystitis Prognosis
The disorder is generally cured quickly with application of antibiotics. In some cases, recurrence of the symptoms may occur, which needs further medical treatment. Complications may arise if the bacteria spread into critical areas. Special treatment is necessary in such cases.
Honeymoon Cystitis Epidemiology
Almost 50% of all women get affected by the disease at some point in their lives, with many experiencing recurrent episodes of the disorder. However, Honeymoon cystitis makes up only 4% of all bladder infection cases. Naturally, a woman experiencing bladder problems should try to adapt right hygiene habits to ensure protection from the disorder. Most women affected by the condition are in their 20s and 30s, although teenagers and women above 50 have also been found to be affected by this disease.
Honeymoon Cystitis in Men
Usually, men do not get affected by cystitis as their urethra is much longer than women. This makes it difficult for the Escherichia coli bacterium to get into their bladder. Men may develop bladder infections much later in their life if their prostate gets infected and inflamed.
Honeymoon cystitis is a very common condition among women and can cause considerable health problems. However, with proper medical care and some preventive measures, it is very easy to manage its symptoms.