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For further information, see CMDT Part 23-03: Genitourinary Tract Infections

Key Features

Essentials of Diagnosis

  • Irritative voiding symptoms

  • Patient usually afebrile

  • Positive urine culture; blood cultures may also be positive

General Considerations

  • Most commonly due to the coliform bacteria (especially Escherichia coli) and occasionally gram-positive bacteria (enterococci)

  • The route of infection is typically ascending from the urethra

  • Uncomplicated cystitis in men is rare and implies a pathologic process such as infected stones, prostatitis, or chronic urinary retention requiring further investigation

Clinical Findings

Symptoms and Signs

  • Frequency, urgency, dysuria, suprapubic discomfort, gross hematuria

  • Suprapubic tenderness, no systemic toxicity

Differential Diagnosis

  • In women

    • Vulvovaginitis

    • Pelvic inflammatory disease

  • In men

    • Urethritis

    • Prostatitis

  • In both

    • Pelvic irradiation

    • Chemotherapy (cyclophosphamide)

    • Bladder carcinoma

    • Interstitial cystitis

    • Voiding dysfunction disorders

    • Bladder irritants

    • Psychosomatic disorders


Laboratory Tests

  • Urinalysis: pyuria, hematuria, bacteriuria

  • Urine culture: positive, though colony counts > 105/mL not required

  • Urine culture and sensitivity

Imaging Studies

  • Abdominal ultrasonography, postvoid residual testing, and cystoscopy help identify any underlying problem

  • Obtain CT scan if pyelonephritis, recurrent infections, or anatomic abnormalities are suspected



  • Uncomplicated cystitis: fosfomycin, nitrofurantoin, and trimethoprim-sulfamethoxazole are the medications of choice

    • Fosfomycin trometamol (3 g single dose)

    • Nitrofurantoin (100 mg twice daily for 5–7 days)

    • Trimethoprim-sulfamethoxazole (160/800 mg twice daily for 3 days)

Therapeutic Procedures

  • Symptomatic relief: hot sitz baths or urinary analgesics (phenazopyridine, 200 mg three times daily orally)

  • Uncomplicated cystitis in men warrants elucidation of underlying problem



  • Infections typically respond rapidly to treatment

  • Failure to respond suggests resistance to the selected drug or anatomic abnormalities requiring further investigation


  • Drinking plenty of fluid and emptying the bladder frequently and completely can reduce risk of developing infection

  • Women in whom urinary tract infections tend to develop after intercourse should be advised to void before, and especially after intercourse, and may benefit from a postcoital single dose of antibiotic

  • Postmenopausal women with recurrent urinary tract infections (3 or more episodes per year) may benefit from a topical estrogen cream

  • Women with recurrent episodes of cystitis (3 or more episodes per year) may also benefit, after treatment of the urinary tract infection, from prophylactic antibiotic therapy to prevent recurrences

  • Before starting antibiotic prophylaxis, a thorough urologic evaluation is warranted to exclude any anatomic abnormality (eg, stones, reflux, fistula)

  • An initial course of 6 to 12 months of prophylactic antibiotics can be offered

  • The benefits ...

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