1. Diagnosis and Management of UTI in Women
Joanna Coy

2. Scope Incidence Causes Symptoms Differential Diagnosis
Red flags and concerns
Management

3. Incidence Very common- particularly in sexually active women
Majority of women will have at least one symptomatic UTI in their lifetime
1-2% of GP consultations

4. Causes
95% of UTIs caused by bacteria ascending through urethra to the bladder
Commonest organisms are those present in the perineum: In the community E. coli 75%, Staph. saprophyticus 10%

5. Symptoms Dysuria Frequency Suprapubic tenderness/low back pain
Urgency/Haematuria
Concerning features- Fever, severe pain, systemic upset

6. Differential diagnosis
Renal colic-pain +++ from loin to groin, haematuria
Ascending UTI- unwell, fever, rigors loin pain, dysuria
Renal tract malignancy- painless haematuria, recurrent cystitis
Pelvic Inflammatory disease, vaginal infections- pelvic pain, vaginal discharge
Sexually transmitted infections- vaginal discharge, urethritis, pelvic pain

7. Red Flags Recurrent symptoms Persistent haematuria Severe pain
Vaginal discharge
Systemic upset
Pregnancy

8. Management
Woman aged with typical symptoms and no contraindications – Trimethoprim 200mg bd for 3 days
Woman with typical symptoms and no red flags, but cautions or contraindications to trimethoprim- ROUTINE GP appointment, could be telephone call, or nurse practitioner appointment. Symptoms may settle without treatment. No evidence of benefit from cranberry juice in acute treatment of uti, although may have some role in prevention.
Red flag symptoms- severe pain, systemic upset, high fever, SAME DAY/URGENT GP appointment