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Pharmacotherapy Casebook: A Patient-Focused Approach, 10e

Chapter 132: Lower Urinary Tract Infection: Where Is the Bathroom? Level I

PATIENT PRESENTATION
Chief Complaint

“It burns when I urinate. I am urinating all the time.”

HPI

Sarah Ramsey is a 26-year-old woman who presents to a family practice clinic in Seattle with complaints of
dysuria, urinary frequency and urgency, and suprapubic tenderness for the past 2 days.

PMH

Patient has been diagnosed with three UTIs over the past 8 months based on symptoms, each treated with
oral TMP–SMX

FH

Mother has DM; remainder of FH is noncontributory

SH

Denies smoking but admits to occasional marijuana use and social EtOH use. Patient has been sexually
active with one partner for the past 9 months and typically uses spermicide-coated condoms for
contraception.

Meds

None

All

No known allergies

ROS

Patient reports urethral pain and burning with urination, as well as mild suprapubic tenderness. Patient
denies systemic symptoms such as fever, chills, vomiting, or back pain, and does not report any urethral or
vaginal discharge. Upon further questioning, the patient notes that the UTIs started soon a er she met her
boyfriend, and she does not always completely empty her bladder a er sexual intercourse.

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Physical Examination

Gen

Cooperative woman in no acute distress

VS

BP 110/60, P 68, RR 16, T 36.8°C; Wt 57 kg, Ht 5′5″

Skin

No skin lesions

HEENT

PERRLA; EOMI; TMs intact

Neck/Lymph Nodes

Supple without lymphadenopathy

Chest

CTA

CV

RRR, no MRG

Back

No CVA tenderness

Abd

So ; (+) bowel sounds; no organomegaly or tenderness

Pelvic

No vaginal discharge or lesions; LMP 2 weeks ago; mild suprapubic tenderness

Ext

Pulses 2+ throughout; full ROM

Neuro

A & O × 3; CN II–XII intact; reflexes 2+; sensory and motor levels intact
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Labs

Urinalysis

Yellow, cloudy; pH 5.0; WBC 50 cells/hpf; RBC 1–5 cells/hpf; protein neg; trace blood; glucose (–); leukocyte
esterase (+); nitrite positive; many bacteria (Fig. 132-1)

FIGURE 132-1.
Urine sediment with neutrophils (solid arrow), bacteria (small arrow), and occasional red blood cells (open
arrow) (Wright–Giemsa × 1650). (Photo courtesy of Lydia C. Contis, MD.)

Urine Culture

Not performed

Assessment

Acute uncomplicated cystitis (Fig. 132-2)

FIGURE 132-2.
Anatomy and associated infections of the urinary tract.

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