Summary
Definition
History and exam
Key diagnostic 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 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
Diagnostic tests
1st tests to order
- urinalysis
- urine microscopy
- urine culture with sensitivity
Tests to consider
- pregnancy test
Treatment algorithm
uncomplicated urinary tract infection (UTI): nonpregnant
complicated UTI: nonpregnant
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 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 DifferentialsGuidelines
- Urinary tract infections in pregnant individuals
- Guidelines on urological infections
More GuidelinesPatient information
Cystitis
More Patient information- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer