Millions of women present to Emergency Rooms, Walk-In / Urgent Care Clinics and primary care provider offices every year with symptoms of acute cystitis / urinary tract infection (UTI) and recurrent UTIs. Repeated antibiotic use is detrimental for many of these women as it results in development of resistant strains of bacteria which can complicate future treatment options should they be needed. Additionally, many women with symptoms are given antibiotics without having positive urine culture results to guide therapeutic decision making.
In the ideal setting, the proper evaluation includes a carefully taken history of the circumstances leading up to the development of the symptoms. This may identify associated factors such as intimate activity, timing of menstrual cycle, underlying medical conditions, past surgical endeavors, neurologic diseases, etc… that may predispose to infections. A physical exam / pelvic exam, assessment of residual bladder urine volume and documentation of positive urine culture results are also helpful in the assessment.
Antibiotic therapy should be considered carefully to avoid over exposure which can lead to development of resistant strains of bacteria.
Daily or every other day use of antibiotics or timing of antibiotics with intimate contact can be effective ways of preventing subsequent symptomatic infections and should be done under the guidance of a physician.
Topical Estrogen to the urethra in post menopausal women or in women who are otherwise estrogen deficient can maximize local tissue defense to bacteria and at times avoid the need for routine antibiotic use.
Symptoms of acute cystitis may include:
1. Dysuria (burning with urination)
2. Frequency of urination
3. Urgency – the feeling of need to urinate
4. Urge incontinence (leakage of urine)
5. Cloudy urine
6. Microscopic blood in urine or at times blood tinged / pink urine
7. Suprapubic (lower abdominal) discomfort
8. Malodorous urine (strong smelling) urine
9. Dyspareunia – discomfort with intimate contact