CS UTI

Case Scenario

• A 25-year-old lady, who works as a teacher in a secondary school, has presented to the clinic today with the complaint of painful and burning micturition, lower abdominal pain, and increased frequency of urination.
• These complaints initiated for the last 2 days. She has got married just a week ago. Bowel movements are normal. No history of fever, chills, or rigor.
• On examination:
  • She looks well, not in pain, not pale or jaundiced. Temperature is 37.2 °C.
  • Systematic examination revealed normal findings, apart from tenderness in the lower abdomen in the pubic area.

Summary of the Case

honeymoon uti

Clinical Scenarios

Scenario 1

• A 23-year-old sexually active woman visits a free clinic, reporting a sudden onset of dysuria that began 2 days ago. On further questioning, she also reports urinary frequency, some back pain, and a pink discoloration to her urine. She denies vaginal discharge or irritation and has been afebrile. The clinic has no microscope or urine dipsticks available. Based on this history, what is her most likely diagnosis?
  1. Acute bacterial cystitis
  2. Urethritis
  3. Pyelonephritis
  4. Interstitial cystitis
  5. Vulvovaginitis

Scenario 2

• An 18-year-old woman is seeing you for back pain, frequency, and dysuria. She has never had a urinary tract infection (UTI) in the past, and though she recently became sexually active, she denies vaginal discharge or risk for sexually transmitted infection. In this setting, when would a urine culture be necessary?

  1. a. If a urine dipstick were negative
  2. b. If a urine dipstick was positive for leukocyte esterase and blood
  3. c. If a microscopic evaluation of her centrifuged urine revealed more than 5 white blood cells per high powered field
  4. d. If a microscopic evaluation of her centrifuged urine revealed significant bacteriuria

Scenario 3

• A screening urinalysis in a female patient reveals asymptomatic bacteriuria. In which of the following patients would treatment be indicated?

  • a. A sexually active teenager
  • b. A pregnant 26-year-old
  • c. A 45-year-old with uncontrolled hypertension
  • d. A menopausal woman
  • e. An otherwise healthy 80-year-old woman

Scenario 4

• You are seeing a 34-year-old man with urinary symptoms. He reports frequency, urgency, and moderate back pain. He is febrile and acutely ill. He has no penile discharge. His urinalysis shows marked pyuria. He has never had an episode like this before and has no known urinary tract abnormalities. What is the most likely diagnosis?

  1. Gonococcal urethritis
  2. Nongonococcal urethritis
  3. Acute bacterial cystitis
  4. Pyelonephritis
  5. Acute prostatitis