Consultations with a woman for a urinary tract infection can sometimes be the quickest and easiest, or the most complex; involving all the issues of that woman’s lifestyle, diet, contraception, sexual activity, and stresses with relationships.
- Take a history. Is there frequency, and burning dysuria? Is the pain inside (a trigonitis) or outside (a vaginitis)? Is there haematuria? (If just painless haematuria this should be investigated with cystoscopy.) Does the pain radiate up to the flank (complicated or upper urinary tract infection)? Is the patient having rigors? (Do they need to be admitted: immunosuppressed, diabetes out of control, pregnant).
- Test urine for leucocytes and nitrites. If positive for either, treat. If negative, think again. Examine patient if, from history, could be a Chlamydia urethritis, or candidiasis, etc.
- Is she pregnant, or trying to be? Ask about LMP. Prescribe appropriately, and discuss issues of safety of antibiotics in pregnancy to reach concordance.
- What contraception is she using? This may be related to the urinary tract infection. Some spermicides predispose to urinary tract infections. Does she get urinary tract infections after sex? Consider discussing postcoital prophylaxis. Will your antibiotic prescription make her oral contraceptive pill less effective?
- Is she having recurrent urinary tract infections? Why? Has she been previously investigated?
- Treat a simple urinary tract infection in a non-pregnant woman with trimethoprim 200 mg twice daily for 3 days, or nitrofurantoin 100 mg twice a day for 3 days.
- Give her a urine bottle and ask her to bring in a clean-catch specimen (mid-stream with one hand holding bottle, other hand holding labia apart) in 3 days if no better.
- Advise on reasonable fluid intake; some women don’t drink during the day in their offices either because of officious bosses or the disgusting state of the lavatories (this seems a real problem with school children at present). Discuss the useful prophylactic effect of small amounts of cranberry juice (30 ml twice a day).
- Agree follow-up consultation if appropriate.