EpidemiologyThe lifetime risk of UTI among women may be as high as 60%. Up to 20% of these women will develop recurrent cystitis. Risk factors for acute uncomplicated cystitis include sexual activity, the use of spermicide (especially with diaphragms), delayed micturition (especially after intercourse), recent antibiotic use (especially beta-lactams), and a prior history of UTI. Some women with recurrent UTI have been found to have epithelial glycoproteins and ABO serotype non-secretion, which predispose them to infection. Certain strains of bacteria also have adherence factors that play a role in colonization and infection.
HistoryTypical symptoms of cystitis are dysuria, frequency, urgency, suprapubic pain and, less often, gross hematuria. Symptoms of cystitis often follow sexual intercourse by a few days. Delayed micturition (as with travel) and dehydration may also precipitate symptoms. Menstrual history should be recorded, as this can affect urinalysis and treatment.Pertinent negatives in the history should include the following:- Vaginal discharge or irritation or pruritis (vaginitis)- Back pain, fever, nausea, emesis (pyelonephritis)- Headache, myalgia, photophobia (genital herpes)- High-risk sexual exposure (urethritis)
Physical ExaminationThe physical examination in patients suspected of having cystitis is typically brief, focusing on temperature, abdominal examination, and palpation of the costovertebral angle. Although 15% to 20% of patients have mild suprapubic pain or tenderness, the physical examination findings are generally unremarkable. If abdominal tenderness is diffuse or intense, other causes, such as pelvic inflammatory disease or nephrolithiasis, should be considered. Patients with vaginal discharge or significant abdominal tenderness may require a pelvic examination.*140/348/5*