UTIs in Young Women

by Amy Sussman, MD

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      Slides Urinary Tract Infections.pdf
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    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.

    About the Lecture

    The lecture UTIs in Young Women by Amy Sussman, MD is from the course Urinary Tract Infection (UTI).

    Included Quiz Questions

    1. Increased fluid intake
    2. Avoidance of postcoital voiding
    3. Avoidance of oral contraceptives
    4. Continuous IV antibiotic prophylaxis
    5. Potassium citrate intake
    1. Chlamydial and gonorrheal infections should be ruled out.
    2. Treatment requires 14 days of IV antibiotics.
    3. It is typically not associated with sexual intercourse.
    4. If symptoms persist a potent broad-spectrum antibiotic should be used prophylactically.

    Author of lecture UTIs in Young Women

     Amy Sussman, MD

    Amy Sussman, MD

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