Make the Diagnosis: Urinary Tract Infection, Women
The pretest probability of UTI among women with compatible symptoms is 48% (95% CI, 41%-55%).
Population for Whom Urinary Tract Infection Should Be Considered
Urinary tract infection should be considered in all adult women who present with 1 or more suggestive symptoms (frequency, dysuria, hematuria, fever, flank, or abdominal pain). Women with complicated UTI from a functional or anatomical abnormality of the urinary tract may present differently.
Detecting Urinary Tract Infection in Adult Women
Combinations of symptoms (Table 51-4) can substantially increase the probability of UTI, effectively ruling in the diagnosis according to the medical history alone. In contrast, the history and physical examination cannot reliably exclude the diagnosis of UTI in women who present with urinary symptoms. A urine culture and pelvic examination should be considered in patients who present with some symptoms of UTI but otherwise a mostly negative history for UTI, a normal physical examination result, and a normal dipstick urinalysis result.
Table 51-4Univariate Findings and Multivariate Approach for Diagnosing Urinary Tract Infection in Adult Women ||Download (.pdf) Table 51-4 Univariate Findings and Multivariate Approach for Diagnosing Urinary Tract Infection in Adult Women
|Univariate Findings |
| ||LR (95% CI)a |
| ||Present ||Absent |
|Dysuria ||1.5 (1.2-2.0) ||0.5 (0.3-0.7) |
|Frequency ||1.8 (1.1-3.0) ||0.5 (0.4-1.0) |
|Vaginal discharge ||0.3 (0.1-0.9) ||3.1 (1.0-9.3) |
|Vaginal irritation ||0.2 (0.1-0.9) ||2.7 (0.9-8.5) |
| ||Abnormal ||Normal |
|Dipstick resultb ||4.2 ||0.3 |
|Multivariate Approach |
|Multiply the above individual LRs for combinations of findings (eg, dysuria present and vaginal discharge absent yields a combined LR = 4.7; dysuria absent and vaginal discharge present yields a combined LR = 0.15). |
The reference standard remains an appropriately obtained urine specimen for culture.
Original Article: Does This Woman Have an Acute Uncomplicated Urinary Tract Infection?
A 24-year-old healthy woman calls her primary care physician, complaining of a burning pain when urinating and increased urinary frequency for several hours. She has had 2 previous urinary tract infections (UTIs), and this episode seems “just like the other ones.” She is sexually active with 1 partner and uses a condom with spermicide. She denies fever, back pain, nausea, vomiting, vaginal discharge, and hematuria.
A 20-year-old woman presents to your office, complaining of urinary frequency, burning on urination, and vaginal discharge. She has had occasional fevers and chills ...