Summary
Definition
History and exam
Key diagnostic factors
- dysuria
- urinary frequency
- hematuria
- back/flank pain
- costovertebral angle tenderness
- fever
Other diagnostic factors
- urinary urgency
- suprapubic pain and tenderness
Risk factors
- sexual activity
- spermicide use
- postmenopause
- positive family history of UTIs
- history of recurrent UTI
- presence of a foreign body
- insulin-treated diabetes
- high lifetime number of UTIs
- recent antibiotics
- poor bladder emptying
- increasing age
Diagnostic investigations
1st investigations to order
- urine dipstick
- urine microscopy
- urine culture and sensitivity
Investigations to consider
- postvoid residual (PVR)
- renal ultrasound
- abdominal/pelvic CT scan
- cystoscopy
Treatment algorithm
uncomplicated
complicated suitable for outpatient therapy: not pregnant
complicated suitable for outpatient therapy: pregnant
complicated requiring inpatient therapy: not pregnant
complicated requiring inpatient therapy: pregnant
uncomplicated recurrent (3 or more in 12 months): related to sexual intercourse
uncomplicated recurrent (3 or more in 12 months): unrelated to sexual intercourse
Contributors
Authors
Una J. Lee, MD
Female Pelvic Medicine and Reconstructive Surgery
Section of Urology and Renal Transplantation
Virginia Mason Medical Center
Seattle
WA
Disclosures
UJL declares that she has no competing interests.
Acknowledgements
Dr Una J. Lee would like to gratefully acknowledge Dr Elliot Blau for his contribution to this monograph, and Dr Bhavin N. Patel and Dr Howard B. Goldman, previous contributors to this topic.
Disclosures
EB, BNP, and HBG declare that they have no competing interests.
Peer reviewers
Priyanka Sharma, MD
Associate Staff
Cleveland Clinic Foundation
Cleveland
OH
Disclosures
PS declares that she has no competing interests.
Timothy J. Benton, MD
Associate Residency Director
Texas Tech University Health Sciences Center
Amarillo
TX
Disclosures
TJB declares that he has no competing interests.
Paul Little, BA (Oxon), MBBS, MRCP, MSc, FRCGP, MD
Professor of Primary Care Research
Community Clinical Sciences Division
University of Southampton
Southampton
UK
Disclosures
PL declares that he has no competing interests.
Differentials
- Overactive bladder
- Urothelial carcinoma of the bladder or upper urinary tract
- Noninfectious urethritis
More DifferentialsGuidelines
- Guidelines on urological infections
- Recurrent uncomplicated urinary tract infections in women
More GuidelinesPatient leaflets
Cystitis
More Patient leaflets
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