Genitourinary & Renal

Dysuria, urinary frequency, and urgency without fever, flank pain, or vaginal symptoms. Suprapubic discomfort may be present.

Often a clinical diagnosis supported by urinalysis showing pyuria, nitrites, and/or leukocyte esterase. Culture is reserved for recurrent, complicated, or treatment-failure cases, or atypical presentations.

Nitrofurantoin (5 days), TMP-SMX (3 days, if local resistance <20%), or fosfomycin (single dose). Fluoroquinolones are reserved due to adverse effects and resistance.

Complicated UTI involves factors increasing failure risk: male sex, pregnancy, indwelling catheter, structural/functional abnormality, immunosuppression, diabetes, or recent instrumentation. These need broader/longer therapy.

Two or more infections in 6 months or three or more in 12 months. Evaluate behavioral factors, consider post-void residual/imaging if abnormalities suspected, and discuss prophylaxis or vaginal estrogen in postmenopausal women.

Flank pain, fever/chills, costovertebral angle (CVA) tenderness, and often nausea/vomiting, with or without lower urinary tract symptoms.