UTIs in Young Women

00:01 How about our next population, acute uncomplicated cystitis in young women? So the symptoms that people will feel or if a young woman presents was cystitis is going to be dysuria frequency urgency and suprapubic pain.

00:16 That's what our patient case presented with.

00:19 Often times It's associated with sexual intercourse.

00:22 The differential diagnosis that you have to think about is something like a cute urethritis that could be due to chlamydia trachomatis or neisseria gonorrhoeae.

00:30 We also have to think about vaginitis with candida or trichomonas vaginalis.

00:35 Empiric treatment can be done as outpatient standard therapy that we talked about already and if symptoms persist or recur, then it's going to be very important to actually obtain a urine culture in sensitivity instead of just empiric treatment.

00:49 How about somebody who presents with recurrent uncomplicated cystitis in our young female population.

00:55 This is often times due to persistence of an initially infecting strain.

01:01 Long-term management really is going to be focused on improving the quality of life while also minimizing anti microbial exposure.

01:08 Remember, we don't want to generate multi-drug resistant organisms.

01:13 Behavioral treatment is going to be critical in this population.

01:16 We want to ensure that our young women are increasing their fluid intake and staying well hydrated.

01:21 We want them to avoid spermicides because that can actually promote UTI.

01:26 And we want to ensure postcoital voiding.

01:29 So after intercourse, it's very important to void immediately.

01:33 We can do antimicrobial prophylaxis as well.

01:36 This has been shown to reduce the risk of recurrent cystitis on the order of about 95 percent.

01:41 And it's something that should be considered if a patient has greater than three infections within a 12-month period of time or if they perceive significant reduction in quality of life by having these recurrent infections.

01:53 So this is going to consist of things like either continuous prophylaxis where they're taking an antimicrobial on a daily basis.

02:00 Intermittent self treatment.

02:02 That means when somebody starts to feel the initiation of the cystitis symptoms, they can start antimicrobial therapy.

02:09 Or postcoital prophylaxis.

02:11 So this is going to include after intercourse taking an antimicrobial agent.

02:16 And remember the same agents that we've talked about before for empiric treatment often times work here that's going to be trimethoprim things like keflex furantoin.