Recurrent Urinary Tract Infections

Recurrent Urinary Tract Infections
Urinary tract infections (UTIs) are the most common type of clinical bacterial illness in women. UTIs are more common in women than in men. Research shows that between 50% and 60% of women will get a UTI at some point in their lives, and most of the time, Escherichia coli will be found to be the reason (Aydin et al., 2015). Many women have trouble with UTIs coming back, which is linked to drug resistance and other things that can be avoided. This talk is about a 26-year-old woman who keeps getting urinary tract infections (UTIs). It looks at the reasons, possible diagnoses, tests, and special care for the patient.

Differential Diagnoses The woman has had five episodes of severe cystitis in the past year, and she is now having trouble urinating, going to the bathroom more often, and feeling like she needs to go right away. The physical check shows that the area above the pubic bone is a little sore, but the vital signs are normal. You can make the following different conclusions.

Pyelonephritis is an illness of the kidney that starts in the bladder and moves up to the kidney. Most of the time, patients will have urinary complaints like dysuria, urgency, and going to the bathroom often. (Douglas-Moore & Goddard, 2017) However, this condition always causes fever and pain in the sides instead of the suprapubic area. Gross blood in the urine is also a sign of pyelonephritis. None of these classic signs are present in the patient, so pyelonephritis cannot be diagnosed.

Pelvic inflammatory disease: This disease affects the fallopian tubes, ovaries, cervix, and uterus, which are all female reproductive systems in the pelvis. Symptoms of the disease include pain when urinating, pain in the lower belly, abnormal bleeding, and fever. PID is not likely because there is no fever, irregular bleeding, or discharge from the uterus.

Cystitis is the most common type of urinary tract infection (UTI) in women. It affects both the bladder and the urinary system. It happens when germs move up the urethra and into the bladder, making the bladder ring inflamed (Douglas-Moore & Goddard, 2017). Symptoms include having to go to the bathroom often but only passing a few drops, pain when urinating, pain in the lower abdomen, and bloody pee.

Preliminary Diagnosis

My first guess is that this person has cystitis. Laboratory tests have shown that the patient has had five episodes of the same disease. Second, the symptoms seen are signs of cystitis. These include slight pain in the lower abdomen, difficulty urinating, a strong need to urinate, and the need to urinate more often. Since there is no sign of vaginal bleeding or fever, it is safe to rule out vaginitis, PID, pyelonephritis, and other diseases that cause dysuria.

Tests

Urine microscopy and culture: The first test I will ask for is a study of the urine to look for bacteria, blood, and other signs of inflammation like white blood cells (leukocytes). To find the cause germs and see if they are resistant to drugs, a bacterial culture of the urine will be needed.

Ultrasound: Since the patient has had the same infection more than once, I will ask for an ultrasound to look for structural problems in the bladder and kidneys. This test will be important, especially if there are no signs of illness in the lab.

Cystoscopy is a medical process in which a doctor inserts a cystoscope into the bladder to look at the inside of the bladder. The test will be able to find signs of infection and structural problems inside the bladder, such as stones, a blockage, or lesions (Douglas-Moore and Goddard, 2017).

Why it keeps happening

Recurrence of UTIs is when the same bacteria that caused the infection comes back within two weeks of treatment or when a different organism grows at any time after treatment. Recurrence happens when the bacteria that caused the infection stay in the feces and then recolonize the urethra and bladder (Aydin et al., 2015). Second, practices like douching can change the local PH in the vagina, which can cause bacteria to grow back. Recurrent infections can be caused by things like delaying urination and changing sexual partners. High repeat rates are seen in women who are sexually active more often and whose mothers had UTIs in the past.

The most likely reason

I think the patient’s problem keeps coming back because the bacteria that caused it is still there, especially the E. coli, which comes back to life after treatment is done. There is proof that the bacteria are gone after a few days of treatment, but small clusters stay inside the cells and can become active again in the future (Wales et al., 2019).

Working together with experts

When I get the results of the lab study and the other tests I ordered, I will work with professionals. If imaging shows that the bacteria that caused the infection before are still there, I will definitely call in the doctor team because it could be because the bacteria have become resistant to antibiotics. The joint practice will help figure out the best way to treat a person, such as by changing their medications or teaching them how to clean themselves better. Also, since the infection keeps coming back, you will need to see an expert, and tests like a cystoscopy are best understood by a specialist.

References

Aydin, A., Ahmed, K., Zaman, I., Khan, M. S., & Dasgupta, P. (2015). Recurrent urinary tract infections in women. International Urogynecology Journal, 26(6), 795-804. https://doi.org/10.1007/s00192-014-2569-5

Douglas-Moore, J. L., & Goddard, J. (2017). Current best practice in the management of cystitis and pelvic pain. Therapeutic Advances in Urology, 10(1), 17–22. https://doi.org/10.1177/1756287217734167

Wales, K. E., Mecia, L., & Gray, T. (2019). Recurrent urinary tract infection in women. InnovAiT, 12(12), 697-702. https://doi.org/10.1177/1755738019876667

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