Uncomplicated cystitis in women

What it is

When considering treatment, first determine whether the UTI is complicated or uncomplicated in nature, because that one call decides everything after it.

Uncomplicated infections include acute cystitis in a non-pregnant, premenopausal female, and acute pyelonephritis in an otherwise healthy patient. Put another way, an uncomplicated UTI occurs in healthy asymptomatic, non-pregnant women with no history of urinary tract abnormalities, and not posted for any urological procedure.

Causes and risk

Young post-pubertal females are susceptible to uncomplicated UTIs because of sexual intercourse in combination with delayed post-coital bladder emptying. Use of diaphragm and spermicidal contraceptives alter the normal vaginal flora and may allow colonization by pathogenic E. coli.

What makes a UTI complicated instead, with an increased chance of treatment failure:

• Male sex, postmenopausal, pregnant
• Presence of hospital-acquired urinary tract infection
• Symptoms present for seven or more days before presentation
• Diabetes mellitus, immunocompromised status
• History of childhood or recurrent urinary tract infections
• Indwelling catheter, neurogenic bladder, polycystic kidney disease
• Recent urologic instrumentation, renal transplant, urologic stents
• Urolithiasis, urologic obstruction

Some experts consider three of these groups uncomplicated after all: healthy postmenopausal women, patients with well-controlled diabetes, and patients with recurrent cystitis that responds to treatment.