Diagnosis and Management of UTI in Women

1. Diagnosis and Management of UTI in Women Joanna Coy

2. Scope Incidence Causes Symptoms Differential Diagnosis Red flags and concerns Management

3. Incidence • Very common- particularly in sexually active women • Majority of women will have at least one symptomatic UTI in their lifetime • 1-2% of GP consultations

4. Causes • 95% of UTIs caused by bacteria ascending through urethra to the bladder • Commonest organisms are those present in the perineum: In the community E. coli 75%, Staph. saprophyticus 10%

5. Symptoms • Dysuria • Frequency • Suprapubic tenderness/low back pain • Urgency/Haematuria • Concerning features- Fever, severe pain, systemic upset

6. Differential diagnosis • Renal colic-pain +++ from loin to groin, haematuria • Ascending UTI- unwell, fever, rigors loin pain, dysuria • Renal tract malignancy- painless haematuria, recurrent cystitis • Pelvic Inflammatory disease, vaginal infections- pelvic pain, vaginal discharge • Sexually transmitted infections- vaginal discharge, urethritis, pelvic pain

7. Red Flags • Recurrent symptoms • Persistent haematuria • Severe pain • Vaginal discharge • Systemic upset • Pregnancy

8. Management • Woman aged 16-65 with typical symptoms and no contraindications – Trimethoprim 200mg bd for 3 days • Woman with typical symptoms and no red flags, but cautions or contraindications to trimethoprim- ROUTINE GP appointment, could be telephone call, or nurse practitioner appointment. Symptoms may settle without treatment. No evidence of benefit from cranberry juice in acute treatment of uti, although may have some role in prevention. • Red flag symptoms- severe pain, systemic upset, high fever, SAME DAY/URGENT GP appointment