When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Acute cystitis

Last reviewed: 23 Nov 2024
Last updated: 03 Oct 2024

Summary

Definition

History and exam

Key diagnostic factors

  • dysuria
  • urgency
  • frequency
  • suprapubic pain
  • prior history of urinary tract infections (UTIs) and treatment history
Full details

Other diagnostic factors

  • recent urinary tract instrumentation
  • flank pain
  • abdominal pain
  • fever
  • vaginal discharge
  • vaginal pruritus
  • dyspareunia
  • structurally or functionally abnormal bladder
Full details

Risk factors

  • frequent sexual intercourse
  • history of UTI
  • anatomic or functional abnormalities within the urinary tract
  • spermicidal jelly
  • urinary catheter
  • asymptomatic bacteriuria during pregnancy or prior to urological surgery
  • diabetes
  • spinal cord injuries
  • pregnancy
  • immunosuppression
  • older age
  • lack of circumcision
  • age <15 years for first UTI
  • new sex partner in past year
  • UTI history in mother
  • diaphragm use
  • obesity
  • vaginal atrophy
  • low socioeconomic status
Full details

Diagnostic tests

1st tests to order

  • urinalysis
  • urine microscopy
  • urine culture with sensitivity
Full details

Tests to consider

  • pregnancy test
Full details

Treatment algorithm

ACUTE

uncomplicated urinary tract infection (UTI): nonpregnant

complicated UTI: nonpregnant

uncomplicated or complicated UTI: pregnant

ONGOING

​​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 MUVON Therapeutics, Proverum (on safety committee), Symimetic (non-financial), and Urovant Sciences. He is an author for Astellas and Ferring. He is a speaker for Allergan.

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 Differentials
  • Guidelines

    • Urinary tract infections in pregnant individuals
    • Guidelines on urological infections
    More Guidelines
  • Patient information

    Cystitis

    More Patient information
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer