10 minute consultation: Recurrent urinary tract infection in women
A 23 year old female student complains of urinary frequency and pain on micturition. She has had similar episodes on four other occasions in the last six months. She wants to know what can be done now and how to prevent further infections.
Is it really a urinary tract infection?--Differential diagnoses include common genital infections (such as sexually transmitted infections and Candida vulvovaginitis), non-infective cystitis (caused by non-steroidal anti-inflammatory drugs and other drugs), and urethral syndrome (a complex of symptoms that indicate a urinary tract infection but without an underlying infection).
Type of urinary tract infection--Symptoms that indicate a lower urinary tract infection are discomfort on urination, increased frequency of urination, urgency, and a change in the smell of the urine. Symptoms that indicate an upper urinary tract infection are a high temperature, pain in the loin, nausea, vomiting, and rigors.
History--When was the last infection? Recurrent episodes of urinary tract infection may be a relapse of illness (defined as recurrence of infection by the same species within two weeks) or reinfection.
Predisposing factors--Renal problems (such as hydronephrosis), bladder problems (such as atonic bladder), and pregnancy all increase the risk of urinary tract