A 27 Year Old Woman Complains Of Dysuria And Suprapubic Pain

A 27 year old woman presents to her primary care physician with the complains of increased urinary frequency, pain and burning on urination as well as pain in the supra pubic area for the last 2 days. She also noticed that she had fever last night. She took acetaminophen which gave her temporary relief. Patient remembers having similar symptoms a few months back. She is sexually active with her husband. Her menstrual cycle is normal and regular.
On Examination patient is febrile with a temperature of 101 F. On abdominal examination she feels discomfort on palpation in the supra pubic region.

She is advised to get some lab workup done including a urine dipstick which revealed +ve  nitrites and + leukocytes. Her urine is sent for culture which showed the following picture in the lab.

Culture in the laboratory showing growth of Escherichia Coli.

Patient is diagnosed as a case of Urinary tract infection.

Case Discussion:


Urinary tract infection is an infection involving the kidneys, ureter, bladder or urethra. Women are more prone to develop this infection as compared to men.

It may be divided to infection of the lower urinary tract involving only the urethra or bladder and infection of the upper urinary tract when the infection extends to involve the kidneys and the ureters.

Risk Factors: Include:

• Female gender
• Sexual intercourse
• Pregnancy
• Immunosuppressed condition.
• Diabetes
• Urinary tract obstruction secondary to stones or an enlarged prostate.
• Urinary catheters

Clinical Features: Patients may present with:

• Frequent urination.
• Sense of incomplete bladder emptiness
• Burning and pain when urinating
• Urine that may appear cloudy or sometime with blood.
• Pelvic or rectal pain
• Pain in the suprapubic region.

On examination patient may have:

• Fever
• Abdominal or loin tenderness
• sometimes distended bladder or enlarged prostate may be palpable. 

Causes: In more than 90% of uncomplicated infections the type of bacteria involved is E coli. Other organisms that may also cause UTI include Staphylococcus saprophyticus, Proteus mirabilis, Enterococcus fecalis, Seratia species and Staph aureus. 

Diagnosis: The diagnosis of UTI is made when there is presence of a pure growth of > 10,0000 organisms per ml of fresh mid stream urine. 

The urine dip stick may show positive for nitrites and leukocytes. Urine should be sent for culture before starting antibiotics. 

Some times an ultrasound may detect kidney stones as an underlying cause for the infection.

Treatment:

1. Drinking plenty of fluids. 

2. Antibiotics like Amoxicillin, Sulphamethaoxazole-trimethoprim, ciprofloxacin and levofloxacin are effective.

3. Any underlying cause should be managed accordingly.