The results of the study showed that the recurrence of urinary tract infections in women has an important impact on the quality of life and satisfaction with health. The study also showed that women with recurrent urinary infections have a compromise in physical and psychological aspects related to the quality of life, significantly higher than women in the control group. These results corroborate studies carried out with Asian and European women, with recurrent urinary tract infections, showing a wide negative impact of recurrent infections on the quality of life of women, mainly affecting the physical and mental dimensions [1,13].
The greater impairment in the physical and psychological domains presented by women with recurrent urinary infections can be explained by the chronicity of the symptoms resulting from these diseases, which can compromise work activities, the practice of physical activity, the exercise of family care, and other daily activities of women. Also, these infections cause symptoms such as burning or pain when urinating (dysuria), frequent or urgent urination, polyuria, hematuria, and/or lower abdominal discomfort, which can influence women's daily activities and quality of life [4,14].
In Brazil, a study with women with recurrent urinary infections, using the Whoqol-bref and King's Health Questionnaire (KHQ) instruments, identified the effect of recurrent infections on women's physical, social and sexual activities, with loss of self-esteem and emergence of anxiety and depression . By compromising the performance of daily activities, recurrent infections impact the mental health of women, triggering feelings such as frustration, irritation, and tiredness .
A study with women from five European countries showed that recurrent urinary infections are associated with the development of stress in a large number of women, which can lead to the development of depression . Such findings are similar to a study conducted with women of seven different nationalities, in which more than 60% of women with recurrent urinary tract infections had some degree of depression .
The compromised quality of life-related to sleep and rest conditions, positive feelings and recreation, and leisure, presented by women with recurrent urinary tract infection, may be associated with the clinical picture caused by infectious episodes. This hypothesis is reinforced by the significantly lower scores presented by women with recurrent urinary tract infection in the facets of positive feelings, self-esteem, recreation, and leisure, compared to the control group.
The discomfort from urinary urgency caused by the infection can affect the quality of sleep of women, compromising social life, impairing satisfaction in enjoying life . There are also losses related to leisure activities, such as group social activities, travel, and family activities, which can compromise self-esteem, aggravating the negative impact on the quality of life of these women [15,17].
Recurrence of episodes of urinary infection requires frequent drug treatments, including antibiotic therapy. In addition to generating an important economic burden for the public health system, the inappropriate use of antibiotics can favor the development of multi-resistant microorganisms, complicating the clinical picture of infections. This may explain the low score related to the facet dependence on medication or treatments presented by women with recurrent urinary infection, statistically lower than that presented by women in the control group [2,15,18,19].
European data showed that recurrent urinary infections cause increased absenteeism and medical appointments. According to the literature, each episode of urinary tract infection generates, on average, three days of sick leave. This loss of ability to work associated with emotional exhaustion caused by the infectious condition and its treatment leads to a greater loss of energy and increased fatigue in women with recurrent urinary tract infection, favoring the emergence of negative feelings, such as bad mood, anxiety, and depression, and impacting economic productivity [2,16,18].
Although the literature shows an increase in the level of well-being of women, there are no reports of improvement in the quality of life-related to treatment. For this reason, successful medical treatment of the infection episode will not always lead to an improvement in the patient's quality of life. However, studies indicate that, when treatment-related adverse events occur, women tend to have greater impairment of quality of life [1,2].
Thus, the definition and implementation of effective strategies for the prevention and treatment of recurrent urinary tract infections require that health professionals, especially doctors and nurses, understand the real impact of these infections on women's lives. This implies the sharing of decisions between professional and patient, aiming to meet expectations and improve the quality of life of women [2,20].
Despite a recent multi-center European study pointing out that prophylactic treatment can reduce the number of infectious episodes and improve the quality of life of women, the lack of consensus on prophylaxis and treatment of recurrent urinary infections in Latin America hinders the adoption of prophylactic measures [1,2,13]. Thus, further studies are needed to assess the effectiveness, risks, and benefits of different prophylactic options in the health and quality of life of women with recurrent urinary infections.