Urinary Tract Infections

Question 1

What is the prevalence of UTIs in women?

Answer 1

Half of all women experience a UTI by age 32, leading to 8.6 million ambulatory care visits in 2007 and $2.3 billion in expenditures in 2010.

Question 2

What factors contribute to UTI susceptibility in women?

Answer 2

Female anatomy: short urethra, proximity to anus. Moist perineal environment encourages bacterial migration. Most common pathogen: Escherichia coli (50% of cases).

Question 3

What is asymptomatic bacteriuria, and who should be treated?

Answer 3

Presence of bacteria in urine without symptoms. Treat only if the patient is pregnant or undergoing a urologic procedure.

Question 4

How is cystitis characterized?

Answer 4

Simple cystitis: Involves bladder/urethra with dysuria, frequency, urgency. No fever, flank pain, or CVA tenderness. Complicated cystitis: Occurs in pregnant women, those with recent antibiotics, recurrent UTIs, or immunodeficiency.

Question 5

What are the symptoms of pyelonephritis?

Answer 5

Fever, chills, back pain, CVA tenderness, and flank pain. Complicated cases (e.g., pregnancy, vomiting, immunodeficiency) require hospitalization.

Question 6

When can bacterial cystitis be treated without lab tests?

Answer 6

Uncomplicated, nonrecurrent cystitis can be treated based on history alone.

Question 7

What diagnostic findings indicate a UTI?

Answer 7

Dipstick test: Positive for nitrites, leukocyte esterase, and RBCs. Microscopy: RBCs, WBCs, and WBC casts (pyelonephritis). Urine culture: Reference standard for diagnosis and sensitivity testing.

Question 8

What are differential diagnoses for UTI symptoms?

Answer 8

Bacterial cystitis, pyelonephritis, interstitial cystitis, VVC, GSM, STI-related urethritis, nephrolithiasis.

Question 9

What does persistent fever after antibiotic treatment suggest?

Answer 9

Possible abscess, obstruction, or resistant organism.

Question 10

How is uncomplicated cystitis treated?

Answer 10

3-day antibiotic regimens tailored to resistance patterns, patient history, and allergies. Symptoms should resolve within 72 hours.

Question 11

How is uncomplicated pyelonephritis treated?

Answer 11

Fluoroquinolones for 5–7 days if resistance is below 10% in the community. Hospitalization for parenteral antibiotics in severe cases.

Question 12

What are key components of UTI patient education?

Answer 12

Drink fluids as needed, but do not force fluids. Avoid delaying voiding. Complete the antibiotic regimen and report unresolved symptoms after 48 hours.

Question 13

How can UTIs be prevented?

Answer 13

Postcoital antibiotics for UTIs linked to sexual activity. Daily or every-other-day antibiotics for recurrent UTIs. No strong evidence supporting cranberry products for prevention.

Question 14

How does UTI management differ in adolescents?

Answer 14

May indicate sexual activity, requiring discussions on pregnancy and STI prevention.

Question 15

Why are postmenopausal women at higher risk for UTIs?

Answer 15

Strongest predictor is a history of more than 6 UTIs premenopause. Vaginal estrogen therapy is recommended for recurrent infections.

Question 16

How are UTIs managed during pregnancy?

Answer 16

Urine culture at the first prenatal visit. Treat all bacteriuria, symptomatic or not. Pyelonephritis is associated with serious risks, including preterm labor and sepsis.

Question 17

What cultural factors influence UTI incidence?

Answer 17

Women in professions where voiding is delayed have higher UTI rates. Education on voiding when needed and avoiding fluid restriction can help.

Question 18

What are common antibiotic therapies for UTIs?

Answer 18

Cystitis (Uncomplicated): Nitrofurantoin (5 days), Trimethoprim-sulfamethoxazole (3 days), Fosfomycin (single dose). Pyelonephritis (Uncomplicated): Fluoroquinolones (5–7 days) if resistance is <10%. Complicated Cases: Parenteral antibiotics (e.g., ceftriaxone, piperacillin-tazobactam). Recurrent UTIs: Postcoital antibiotics (single dose), Prophylactic low-dose antibiotics (daily or alternate days).