UTIs In Women

Question 1

What is a urinary tract infection?

Answer 1

This is an infection of the kidneys, bladder or urethra.

Question 2

What is infectious cystitis?

Answer 2

Bacterial infection of the bladder

Question 3

What is the most common cause of UTIs?

Answer 3

E.Coli is the cause in 70-95% of uncomplicated cases.

S. Saprophyticus is the cause in 5-20% of cases

Question 4

Pathophysiology of UTIs

Answer 4

Common route of infection in females is via an ascending pathway.
Colonisation of the vagina may occur first, then ascends into the urinary tract.

Question 5

Classification of UTIs

Answer 5

Uncomplicated/ complicated
OR
Acute/ recurrent.

Uncomplicated UTIs occur in healthy non-pregnant women.
Complicated UTIs occur in patients with functional impairments that reduce efficacy of antimicrobial therapy.

Recurrent UTIs is when there are >3 UTIs in 12 months.

Question 6

Signs and symptoms of UTIs

Answer 6

Dysuria
Haematuria
Costovertebral angle tenderness 
Urinary frequency 
Urinary urgency 
Supra-pubic pain and tenderness 
Fever 
Back/flank pain

Question 7

Risk factors for UTIs

Answer 7

Sexual activity 
Spermicide use 
Post-menopause 
Positive FHx of UTIs
Hx of recurrent UTIs 
Presence of a foreign body (catheter, suture, surgical material)

Question 8

Investigations of UTIs

Answer 8

Urine dipstick (nitrite and leucocytes)
Urine microscopy (bacteria, WCC, RBC)
Urine culture and sensitivity 
Renal ultrasound 
Abdominal and pelvic CT scan 
Cystoscopy

Question 9

Differentials of UTIs

Answer 9

Overactive bladder 
Urothelial carcinoma of bladder
Non-infectious urethritis 
Urethral diverticulum
Foreign body in bladder 
Vaginitis due to candida or trichomonas

Question 10

Management of UTIs

Answer 10

Uncomplicated:
Nitrofurantoin or trimethoprim

Complicated: ciprofloxacin or levofloxacin

Inpatient- gentamicin, ceftriaxone

Recurrent-low dose prophylactic nitrofurantoin or trimethoprim