A 22-year-old woman has been seeing you for treatment of recurrent UTIs over the past 6 months. She married 6 months ago and became sexually active at that time. She seems to become symptomatic shortly after having intercourse.
Which of the following is the most appropriate treatment?
A. Refer her to an urologistApproximately 11% of women report at least one documented UTI per year, and up to 60% of women will have UTI during the course of their lifetime. Acute cystitis usually presents with the symptoms of dysuria, frequency, and urgency. In contrast, patients with pyelonephritis may have the same symptoms accompanied by fever, chills, and/or flank pain. A UTI may be diagnosed by evaluating a clean, mid-stream urine sample and finding at least 100,000 single isolate bacteria per mL. A urine dipstick is a fast and inexpensive way to diagnose a simple UTI, and has a sensitivity of 75%. Women with a normal urine dipstick who are symptomatic should have a urine culture, because false negative results are common. The most common causative organism is E coli, which is responsible for 80% to 95% of infections. Other organisms include Proteus, Pseudomonas, Klebsiella, Enterobacter, and Staphylococcus Saprophyticus. Uncomplicated UTIs may be treated with a 3-day course of an antibiotic regimen with trimethoprimsulfamethoxazole or nitrofurantoin, which have good coverage against E coli and are relatively inexpensive. Patients treated for a UTI who have persistent symptoms after treatment should have a urine culture performed to evaluate for the presence of resistant organisms. Patients with acute pyelonephritis may be treated on an outpatient basis unless they cannot tolerate oral antibiotic therapy or show evidence of sepsis. Women who experience recurrent UTIs with intercourse benefit from voiding immediately after intercourse. If this treatment method fails, then postcoital prophylactic treatment with an antibiotic effective against E coli may help prevent recurrent UTIs. Urinary antispasmodics do not prevent infection.