A woman presenting with symptoms suggestive of bacterial cystitis is a frequent
occurrence in the general practice setting. One in three women develop a urinary tract
infection (UTI) during their lifetime (compared to 1 in 20 men).
In this article we provide an outline of the aetiology, pathogenesis and treatment of
bacterial cystitis in the primary care setting. We suggest measures that may assist before
urological referral and work through a common clinical scenario.
Bacterial cystitis in unlikely if the urine is both nitrite and leuco-esterase negative.
Empirical antibiotics are justified if symptoms are present with positive urinary dipstick,
but microscopy, culture and sensitivity of urine is warranted to ensure appropriate empirical
therapy and identification of the causative organism. Risk factors for UTI in women include
sexual intercourse, use of contraceptive diaphragms and, in postmenopausal women,
mechanical and/or physiologic factors that affect bladder emptying such as cystocoele or
atrophic vaginitis. Discussion regarding risk factors and UTI prevention is important. Women
with recurrent UTIs (defined as three or more episodes in 12 months or two or more episodes
in 6 months) should be screened for an underlying urinary tract abnormality (ultrasound)
and may benefit from prophylactic therapy. Patients with complex or recurrent UTIs,
persistent haematuria, persistent asymptomatic bacteriuria, or urinary tract abnormalities
on imaging may benefit from referral to a urologist.
Cystitis is a clinical syndrome characterised by dysuria, frequency and urgency, with or without suprapubic pain. Causes of cystitis can be infective (bacterial, viral, other) or noninfective. The commonest clinical entity is bacterial cystitis due to common urinary tract pathogens.
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