DEAR DR. GOTT: I am a 47-year-old pre-menopausal woman who has had countless urinary tract infections that have been treated with many types of antibiotics. The UTIs are followed by yeast infections, treated with countless over-the-counter and prescription medications.

I've even taken my husband to the gynecologist with me, and we've both been treated with fluconazole, the generic equivalent of Diflucan. I take 500 milligrams of cranberry extract daily, which helps prevent UTIs, and I am on a multivitamin, iron, calcium and Metamucil or Benefiber to prevent constipation. I use an allergy-fighter detergent without perfumes or dyes and wash in hot water, but no matter what I do, the infections continue. Do you have any suggestions?

DEAR READER: Most urinary tract infections affect the urethra and bladder but may involve any aspect of the urinary system. They are generally caused by E. coli bacteria. Initial symptoms can be urgency, burning, a strong odor and blood in the urine.

Because of the structure of their anatomies, women — particularly those who are sexually active and/or post-menopausal — are more prone to infection than are men. Drink more water than usual, and avoid caffeine, alcohol and citrus juices until any infection has cleared.

Yeast infections are quite common and occur when too many yeast cells grow in the vagina. The most common form is called candida albicans. Other causes are high estrogen levels during pregnancy, hormone-replacement therapy, certain health problems such as diabetes and the use of antibiotics.

Over-the-counter antifungal creams and suppositories, as well as antifungal tablets taken orally, are available for control of symptoms, which can include a cottage cheese-like discharge.

As a general rule, if a person experiences more than four infections within a year, an appointment should be made with a gynecologist or primary care physician for testing. The reason for this is to verify that symptoms are actually being caused by yeast and not diabetes or another medical condition.

Prevention of yeast infection can include avoiding douching, feminine sprays, scented toilet paper and deodorant tampons. Women should wear cotton underwear instead of silk or synthetic fabrics, and they should avoid tight-fitting clothing.

You have a vicious cycle going on here with medication given for a UTI that causes a yeast infection, which causes the problem all over again. Nothing is eradicated consistently. The next time a UTI occurs, have your primary-care physician or gynecologist settle on one prescription medication. Include one or two jars of yogurt or acidophilus tablets in your daily diet while on the drug. Drink a glass or two of 100-percent cranberry juice daily, too. If this doesn't deter infection, obtain a second opinion to find the real source of the problem. Get tested for diabetes, and both you and your husband should be screened for sexually transmitted diseases and infections.

To give you related information, I am sending you a copy of my Health Report "Vaginal Infections and Disorders." Other readers who would like a copy should send a self-addressed, stamped, No. 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.