Acute simple cystitis presents with symptoms of urinary frequency or urgency, dysuria, and suprapubic pain. Risk Factors for Recurrent Infections include Ī complete history and physical are necessary. Spermicides and lack of estrogen effect will disrupt the normal vaginal flora, while sexual intercourse tends to introduce vaginal bacteria into the urethra and bladder. Of these, the most significant include the use of a diaphragm with spermicide, untreated atrophic vaginitis, and frequent sexual intercourse. Risk factors for recurrent UTIs are given listed below. Indications for imaging include persistent hematuria, history of kidney stones, repeatedly finding Proteus (often associated with urolithiasis), and relapsing infections.
The vast majority of recurrent UTIs typically seen in medical offices and clinics are reinfections and do not warrant an extensive urological evaluation or imaging. It is considered reinfection if the new infection is more than two weeks after completion of therapy even if the organism is the same. A relapse is further defined as a recurrence within two weeks of completing therapy with the same organism.
It is important to differentiate rapid reinfection (a different organism) from a relapse (the same organism which was not completely treated). From there, bacteria can easily ascend and reach the bladder. Research demonstrates a complex relationship between the intestinal, vaginal, and urinary microbiome, which is not well understood. Typically, the rectal bacterial flora contaminates the periurethral area and urethra. (If the organism continues to be the same, this is a relapsing infection and suggests an inadequately treated source such as an abscess, urinary stone, or prostatitis.) The source of these recurrent infections is the same as for any simple cystitis. Recurrent urinary tract infections are usually new infections with different bacterial organisms.
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