Acute cystitis

Last reviewed: 7 Jun 2022
Last updated: 06 May 2020

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 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
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, 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 Differentials
  • Guidelines

    • Guidelines on urological infections
    • Clinical practice guideline for the management of asymptomatic bacteriuria
    More Guidelines
  • Patient leaflets

    Cystitis

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

Use of this content is subject to our disclaimer