Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- dysuria
- urgency
- frequency
- suprapubic pain
- prior history of urinary tract infections (UTIs) and treatment history
Other diagnostic factors
- recent urinary tract instrumentation
- flank pain
- abdominal pain
- fever
- vaginal discharge
- vaginal pruritus
- dyspareunia
- structurally or functionally abnormal bladder
Risk factors
- frequent sexual intercourse
- history of urinary tract infection (UTI)
- congenital abnormality
- spermicidal jelly
- urinary catheter
- asymptomatic bacteriuria
- diabetes
- spinal cord injuries
- pregnancy
- immunodeficiency
- older age
- lack of circumcision
- age <15 years for first UTI
- new sex partner in past year
- UTI history in mother
- diaphragm use
- increasing parity
- obesity
- vaginal atrophy
Diagnostic investigations
1st investigations to order
- urinalysis
- urine microscopy
- urine culture with sensitivity
Investigations to consider
- pregnancy test
Treatment algorithm
uncomplicated urinary tract infection (UTI): non-pregnant
complicated UTI: non-pregnant
uncomplicated or complicated UTI: pregnant
at risk of chronic recurrent UTI
Contributors
Authors
Christopher Chapple, BSc, MD, FRCS (Urol), FEBU
Honorary Senior Lecturer of Urology
University of Sheffield
Consultant Urological Surgeon
Department of Urology
Royal Hallamshire Hospital
Sheffield
UK
Disclosures
CC is a consultant for Astellas, Contura, Ferring, Symimetic, Takeda, and Urovant Sciences. He is an author for Astellas and Ferring. He is an investigator for Allergan, Astellas, Ferring, Poesis Medical, and Bayer. He is a co-patent holder for Symimetic. He is a speaker for Allergan and Astellas.
Altaf Mangera, MBChB (Hons), MD, FRCS (Urol), FEBU
Consultant Urologist
Department of Urology
Royal Hallamshire Hospital
Sheffield
UK
Disclosures
AM declares that he has no competing interests.
Acknowledgements
Dr Christopher Chapple and Dr Altaf Mangera would like to gratefully acknowledge Dr Michael K. Park, a previous contributor to this topic.
Disclosures
MKP declares that he has no competing interests.
Peer reviewers
James Malone-Lee, MD, FRCP
Professor of Medicine
Department of Clinical Physiology
Division of Medicine
Whittington Campus
University College London Medical School
London
UK
Disclosures
JML declares that he has no competing interests.
David Chelmow, MD
Chair
Department of Obstetrics and Gynecology
Virginia Commonwealth University
Richmond
VA
Disclosures
DC declares that he has no competing interests.
Differentials
- Pyelonephritis
- Vaginitis
- Interstitial cystitis
More DifferentialsGuidelines
- Guidelines on urological infections
- Recurrent uncomplicated urinary tract infections in women: AUA/CUA/SUFU guideline
More GuidelinesPatient leaflets
Cystitis
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