Urinary tract infections in women

Last reviewed: 6 Sep 2022
Last updated: 19 Jul 2022

Summary

Definition

History and exam

Key diagnostic factors

  • dysuria
  • urinary frequency
  • hematuria
  • back/flank pain
  • costovertebral angle tenderness
  • fever
More key diagnostic factors

Other diagnostic factors

  • urinary urgency
  • suprapubic pain and tenderness
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • urine dipstick
  • urine microscopy
  • urine culture and sensitivity
More 1st investigations to order

Investigations to consider

  • postvoid residual (PVR)
  • renal ultrasound
  • abdominal/pelvic CT scan
  • cystoscopy
More investigations to consider

Treatment algorithm

ACUTE

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

ONGOING

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
Una J. Lee

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.

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