Acute cystitis

Last reviewed: 30 Aug 2023
Last updated: 31 Jan 2023

Summary

Definition

History and exam

Key diagnostic factors

  • dysuria
  • urgency
  • frequency
  • suprapubic pain
  • prior history of urinary tract infections (UTIs) and treatment history
More key diagnostic factors

Other diagnostic factors

  • recent urinary tract instrumentation
  • flank pain
  • abdominal pain
  • fever
  • vaginal discharge
  • vaginal pruritus
  • dyspareunia
  • structurally or functionally abnormal bladder
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • urinalysis
  • urine microscopy
  • urine culture with sensitivity
More 1st investigations to order

Investigations to consider

  • pregnancy test
More investigations to consider

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 Astellas, Bayer, Contura, Ferring, Symimetic, Takeda, and Urovant Sciences. He is an author for Astellas and Ferring. He is an investigator for Allergan, Astellas, Bayer, Ferring, and Poesis Medical. 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 Differentials
  • Guidelines

    • Guidelines on urological infections
    • Recurrent uncomplicated urinary tract infections in women: AUA/CUA/SUFU guideline
    More Guidelines
  • Patient leaflets

    Cystitis

    More Patient leaflets
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