“Uncomplicated cystitis” – non pregnant healthy women without urological tract abnormalities.
Diagnosis can often be made with high probability based on history of lower urinary symptoms (frequency, urgency, dysuria), with the absence of vaginal discharge.
Suprapubic pain, haematuria and fevers may also be present.
Risk factors:
- Sexual intercourse
- Spermicides
- New sexual partner
- History previous UTI
- Maternal history UTI
- Childhood UTI
EAU guidelines suggest dipstick only minimally increases diagnostic accuracy, and cultures only necessary in atypical situations, pregnancy, failure to improve on initial antibiotics, or if suspicious for pyelonephritis.
In practice, I routinely send a midstream urine for culture as I find it helpful for antibiotic selection in the index episode and potentially future episodes
A proportion of symptomatic UTI / cystitis will resolve without antibiotic treatment; but antibiotic treatment is recommended to prevent progression.
What antibiotic do you use?
TMP 300 mg daily 3/7 ; cephalexin 500 mg TDS 5/7 ; nitrofurantoin 50 mg QID 5/7
Do you get a repeat urine culture?
Only if symptoms fail to improve.
When do you get imaging?
Imaging is not necessary for uncomplicated isolated cystitis.
I get an ultrasound if there are complicating features – suspicion for stones, haematuria, any concern for obstruction, fevers requiring hospitalisation, recurrent episodes or persistent UTI (and all men).