Why South African Women Are Battling with UTIs

Urinary tract infections are a common health issue among South African women, but their frequency and recurring nature often make them feel like an endless cycle. If it feels like déjà vu every time you reach for cranberry juice, you are not alone.

Understanding why UTIs are so prevalent in South Africa – and why they keep coming back – is the first step toward breaking the pattern.

Why are UTIs so common in South African women?

Several factors make South African women particularly vulnerable to urinary tract infections. Some are biological, some are environmental, and some are the result of how we approach treatment.

Why UTIs keep coming back

Recurrent UTIs are defined as two or more infections in six months, or three or more in a year. They are unfortunately common, affecting over 100 million people worldwide annually (Newland et al., 2024). Here is why the cycle continues:

The problem with guessing

Most women who visit a GP for a UTI receive a broad-spectrum antibiotic based on symptoms alone. This approach has two problems:

First, if the wrong antibiotic is prescribed – targeting E. coli when the actual cause is Candida, Staphylococcus, or Group B Strep – the infection will not clear, and you will be back at the doctor within weeks.

Second, every unnecessary course of antibiotics contributes to antibiotic resistance. South Africa already faces significant challenges with drug-resistant infections, and broad-spectrum prescribing without testing makes the problem worse.

What Epicentre's UTI test covers

This panel covers the most common bacterial and fungal causes of UTIs. The inclusion of seven Candida species – including resistant strains like C. glabrata and C. krusei – is important because fungal UTIs are frequently misdiagnosed as bacterial, leading to repeated courses of antibiotics that make the problem worse.

When should you get tested?

Consider PCR testing rather than relying on symptoms alone if:

• You have had two or more UTIs in the past six months
• Your symptoms did not resolve after antibiotics
• You experience recurring burning, urgency, or pelvic discomfort
• You have diabetes, are pregnant, or have a weakened immune system
• You want to identify the exact organism before starting treatment

UTIs across South Africa

UTIs affect women across all socioeconomic groups in South Africa, but the experience and access to care differ significantly.

In private healthcare and affluent communities, the primary problem is self-treatment without testing. Over-the-counter remedies and leftover antibiotics are easily accessible, but without identifying the specific organism, treatment often misses the mark – particularly when the cause is a resistant Candida species rather than bacteria. Women in private care may also be prescribed broad-spectrum antibiotics by GPs who do not have access to species-level diagnostics, contributing to antibiotic resistance.

In public healthcare and lower-income communities, delayed access to care, limited sanitation, and overcrowded clinics mean UTIs are more likely to become recurrent before treatment begins. Standard urine dipsticks – the primary diagnostic tool in many public facilities – cannot identify the specific organism causing the infection, let alone distinguish between bacterial and fungal causes.

For travellers and foreign nationals in South Africa, changes in climate, water exposure, and diet can disrupt the urinary microbiome. If you develop a UTI during your stay, Epicentre's walk-in branches in Durban (Hillcrest), Cape Town (Observatory), and Johannesburg (Parktown North) offer PCR testing without a doctor's referral – with results delivered digitally wherever you are.

How to reduce your UTI risk

While testing identifies the cause, prevention reduces the frequency. Evidence-based steps that make a difference:

• Wipe front to back – prevents introducing gut bacteria to the urethra
• Urinate after sex – flushes bacteria before they can travel to the bladder
• Stay hydrated – dilutes urine and flushes bacteria more frequently
• Avoid holding urine – a full bladder gives bacteria time to multiply
• Wear breathable underwear – tight, synthetic fabrics trap moisture and warmth
• Avoid irritating products – scented soaps, douches, and sprays disrupt vaginal flora
• Understand your microbiome – your gut microbiome and urinary tract are closely connected. Gut bacteria like E. coli are the leading cause of UTIs
• Consider probiotics – Lactobacillus strains help maintain a healthy urinary microbiome

If you experience recurrent UTIs, testing your vaginal microbiome can also reveal whether an underlying imbalance in your vaginal flora is contributing to the cycle. Epicentre's Vaginal Microbiome Test analyses 17 organisms to identify dysbiosis that predisposes you to repeated infections.