Female UTI
Definition: > 3 proven urinary tract infections within 12 months (positive msu or symptoms of cystitis associated with nitrite positive dipstick).
Women have a 50% lifetime risk of UTI and this increases with age. There is often no significant underlying identifiable cause.
Indications for referral:
- Emergency admissionif features of systemic sepsis: pyrexia/confusion/tachycardia/tachypnoea/hypotension/severe nausea and vomiting.
- 2ww Urology if Persistent haematuria after treatment of infection
C&B referral
- Abnormal USS: refer to appropriate speciality depending on abnormality.
- Women with rec UTI and definite suggestion of bladder outflow obstruction (Residual Volume RV >100ml)
- Recurrent upper UTIs
- Pregnant – consider A&G
- In those who have had the treatments suggested below, eg. low-dose abx, with normal USS and RV, but are still very symptomatic and distressed may be referred for review. Consider via A&G However, it is likely that there is little else to offer.
Possible causes:
- Increasing age with atrophic vaginitis post menopause
- Prolapse
- Intercourse
- Pregnancy
- Diabetes
- Urinary tract abnormality (anatomical/functional/stones/indwelling catheter)
- Residential care
- Immunocompromise
Differential diagnoses:
- STD
- Chronic pelvic pain syndrome
- Drug induced cystitis eg ketamine
Management prior to referral:
- Send MSU prior to starting antibiotics and change according to sensitivities. Consider treatment for 1-2 weeks.
- Request USS renal tract. If this is normal further investigation is not usually required.
- Examine for and manage prolapse (see https://rms.cornwall.nhs.uk/rms/primary_care_clinical_referral_criteria/primary_care_clinical_referral_criteria/gynae/prolapse)
- Lifestyle advice: adequate fluid intake/hygiene/void after intercourse
- Topical oestrogens (intravaginal) in post-menopausal women
Antibiotic prophylaxis
Consider if above measures ineffective/ inappropriate
Discuss risks long term antibiotic use including resistance
Taking into account antibiotic sensitivities on recent MSUs
If pregnant please consider which A/bio are safe at different stages of pregnancy
-
Consider single dose prophylaxis if identifiable trigger such as post sexual intercourse
- Trimethoprim 200mg stat dose or Nitrofurantoin (if eGFR >45 ml/min) 100mg stat dose
-
Daily Prophylactic antibiotic course for six months if no identifiable triggers
- Trimethoprim 100mg nocte or Nitrofurantoin (if eGFR >45ml/min) 50-100mg nocte
Advise If breakthrough infection – needs medical rev, send msu, treat with different antibiotic to prophylaxis antibiotic
Patient information
https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Recurrent%20cystitis.pdf
References
NICE NG112, Urinary tract infection, October 2018
NICE, CKS, Suspected recurrent Urinary Tract Infection in women, June 2021
Contributors
Mr Christopher Blake, Consultant Urologist, RCHT
Dr B Wesson, GP & Kernow RMS Urology Guideline lead
Review date: March 2022
Next review due March 2023