Urinary tract infection (uncomplicated)MANAGEMENT

GENITOURINARY AND REPRODUCTIVE PRESENTATIONS · 12 SECTIONS

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478 items

☷ Legend

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Cardiovascular Presentations71▾

Respiratory Presentations52▾

Neurological Presentations83▾

Gastrointestinal Presentations74▾

Genitourinary and Reproductive Presentations48▾

Acute Kidney Injury (ATN)Acute Kidney Injury (Post-renal)Acute Kidney Injury (Pre-renal)Amniotic Fluid Embolism Balanitis Bladder Rupture Breast Abscess Cystitis Dialysis access complications Ectopic pregnancy Epididymitis Glomerulonephritis Hematuria (gross)Hydrocele Interstitial Cystitis Mastitis Mittelschmerz Nephrolithiasis Nephrotic Syndrome Flare Nutcracker Syndrome Orchitis Ovarian Cyst Rupture Ovarian hyperstimulation syndrome Ovarian torsion Paraphimosis Pelvic Congestion Syndrome Pelvic Inflammatory Disease (PID)Peritoneal dialysis peritonitis Phimosis Priapism Prostatitis Pyelonephritis Renal laceration Renal transplant complications and rejection Ruptured ovarian cyst Testicular torsion Torsion of Appendix Testis Tubo-ovarian abscess Ureteral Rupture Urethritis Urinary Retention Urinary tract infection (uncomplicated)Urolithiasis (renal colic)Vaginal bleeding (non-pregnant)Vaginitis (Bacterial)Vaginitis (Candidal)Varicocele Vulvovaginal Hematoma

Infectious Disease Presentations148▾

Trauma Presentations89▾

Toxicologic Presentations80▾

Psychiatric Presentations26▾

Musculoskeletal and Rheumatologic Presentations96▾

Dermatology Presentations23▾

Environmental and Exposure Presentations27▾

Hematologic and Oncologic Presentations36▾

Pediatric-Specific Presentations19▾

Endocrine and Metabolic Presentations45▾

ENT and Maxillofacial Presentations27▾

Ophthalmologic Presentations19▾

Obstetric Presentations23▾

Systemic and Miscellaneous Presentations17▾

01Approach to the Critical Patient/attcp39

Triage and acuity

›Immediate risk screen

›Hemodynamic instability

›SBP < 90 mmHg

›HR > 120 beats/min

›Sepsis concern

›Fever 38.0 C or higher

›Rigors

›Altered mental status

›Upper tract features

›Flank pain

›CVA tenderness

›Persistent vomiting

›Complicated UTI risk

›Pregnancy

›Male

›Indwelling catheter

›Recent urologic procedure

›Known anatomic abnormality

›Nephrolithiasis history

›Immunocompromised state

›Diabetes with systemic features

›Obstruction concern

›Anuria

›Severe colicky flank pain

›Single kidney

›Early stabilization triggers

›If sepsis concern, IV access and fluids

02History/hx69

Symptom pattern and timeline

›Cystitis symptom cluster

›Dysuria

›Burning with urination

›Terminal dysuria

›Urinary frequency

›Small volume voids

›Nocturia new onset

›Urinary urgency

›Difficulty delaying voiding

›Urge incontinence

›Suprapubic discomfort

›Pressure sensation

›Mild lower abdominal pain

›Upper tract symptom cluster

›Fever or chills

›Measured temperature

›Rigors

›Flank pain

›Unilateral

›Bilateral

›Nausea or vomiting

›Oral intolerance

›Dehydration symptoms

›Alternative diagnosis flags

›Vaginal discharge

›Change in color

›Odor

03Physical Exam/exam41

Focused exam

›Vital signs

›Fever

›38.0 C or higher

›Hypothermia under 36.0 C

›Tachycardia

›HR over 100 beats/min

›Poor perfusion signs

›Hypotension

›SBP under 90 mmHg

›MAP under 65 mmHg

›Abdominal exam

›Suprapubic tenderness

›Mild localized

›Peritoneal signs absent

›Diffuse tenderness

›Alternative diagnosis concern

›Peritonitis concern

›Flank and back exam

›CVA tenderness

›Unilateral

›Bilateral

›Severe flank pain

›Obstruction concern

›Stone concern

›Hydration and general appearance

›Dry mucous membranes

›Dehydration

04Differential Diagnosis/ddx39

Dysuria and frequency causes

›Infectious

›Acute uncomplicated cystitis ICD-10 N30.0

›SNOMED CT acute cystitis concept

›Typical lower tract symptoms

›Acute pyelonephritis ICD-10 N10

›Fever or flank pain

›Systemic features

›Urethritis ICD-10 N34.1

›Chlamydia

›Gonorrhea

›Vaginitis ICD-10 N76.0

›Candidiasis

›Bacterial vaginosis

›Noninfectious

›Nephrolithiasis ICD-10 N20.0

›Colicky flank pain

›Hematuria common

›Interstitial cystitis bladder pain syndrome ICD-10 N30.10

›Chronic bladder pain

›Negative cultures

›Chemical irritant cystitis

›New soaps or spermicides

›Radiation history

›Genitourinary syndrome of menopause

›Vaginal dryness

›Dyspareunia

05Laboratory Tests/lt52

Urinalysis and culture strategy

›Urinalysis interpretation

›Pyuria

›WBC 10 per HPF or higher supports infection

›Absence lowers likelihood in typical cystitis

›Leukocyte esterase

›Positive supports pyuria

›False positives with contamination

›Nitrites

›Positive supports Enterobacterales

›Negative does not exclude infection

›Hematuria

›Common in cystitis

›Consider stone if prominent flank pain

›Squamous epithelial cells

›High burden suggests contamination

›Repeat clean catch sample if needed

›Urine culture indications

›Pregnancy

›Always culture and tailor therapy

›Test of cure culture commonly used

›Suspected pyelonephritis

›Culture before antibiotics when feasible

›Resistance guidance essential

›Recurrent UTI

›Prior resistance patterns

›Rule out relapse

›Treatment failure

06Diagnostic Tests/dt40

Scoring Systems

›Symptom based diagnosis

›High pretest probability group

›Dysuria and frequency without vaginal discharge

›Female nonpregnant

›Lower probability group

›Prominent vaginal symptoms

›Pelvic pain predominant

›Complicated infection screen

›Fever or flank pain

›Immunocompromise

MRI

›MRI role

›Rare indications

›Pregnancy with suspected renal complication and ultrasound nondiagnostic

›Suspected spinal source for urinary retention with neurologic signs

›Not routine for uncomplicated cystitis

›No added value

›Resource intensive

›CT abdomen pelvis role

›Suspected obstruction or stone

›CT KUB noncontrast

›Hydronephrosis evaluation

›Suspected complicated pyelonephritis

›Persistent fever beyond 48 to 72 hours on therapy

›Severe sepsis or immunocompromised

›Suspected renal or perinephric abscess

07Disposition/dispo29

Site of care decisions

›Discharge criteria

›Stable vital signs

›No hypotension

›No persistent tachycardia from sepsis

›No systemic toxicity

›Well appearing

›No altered mental status

›Oral intake adequate

›Able to take PO antibiotics

›No uncontrolled vomiting

›Reliable follow up

›Return precautions understood

›Access to pharmacy

›Observation or admission indications

›Sepsis concern

›Hypotension

›Lactate elevated

›Suspected pyelonephritis with instability

›Persistent vomiting

›Intractable pain

›Obstruction concern

›Hydronephrosis

›Anuria

›Complicated host

›Pregnancy with systemic features

›Immunocompromised

08Treatment/t63

Supportive care

›Analgesia strategy

›Acetaminophen 1000 mg PO every 6 to 8 hours PRN

›Maximum 3000 mg per 24 hours for many adults

›Lower maximum with liver disease

›Ibuprofen 400 mg PO every 6 to 8 hours PRN

›Avoid with AKI risk

›Avoid with GI bleed risk

›Urinary analgesic option

›Phenazopyridine 200 mg PO three times daily

›Maximum 2 days with antibiotic initiation

›Orange urine discoloration

›Hydration

›Oral fluids as tolerated

›Avoid forced hydration causing discomfort

›Reassure urinary frequency may persist early

Antibiotics for uncomplicated cystitis

›First line regimens for nonpregnant female

›Nitrofurantoin monohydrate macrocrystals 100 mg PO twice daily for 5 days

›Avoid if suspected pyelonephritis

›Avoid if eGFR very low per local guidance

›TMP SMX DS 160 mg 800 mg PO twice daily for 3 days

›Use when local E coli resistance under 20 percent

›Avoid with sulfa allergy

›Fosfomycin trometamol 3 g PO single dose

›Lower efficacy than nitrofurantoin in some studies

›Useful for adherence barriers

›Alternative regimens when first line not suitable

09Special Populations/sp39

Pregnancy

›Pregnancy considerations

›Lower threshold for culture

›Culture for symptomatic infection

›Test of cure culture often used

›Avoided or cautious agents

›TMP SMX avoidance in first trimester when alternatives available

›TMP SMX avoidance near term with hyperbilirubinemia risk

›Nitrofurantoin timing considerations

›Avoid near delivery in G6PD deficiency concern

›Not for suspected pyelonephritis

›Preferred options often used

›Cephalexin 500 mg PO four times daily for 5 to 7 days

›Amoxicillin clavulanate 875 mg 125 mg PO twice daily for 5 to 7 days

›Pyelonephritis in pregnancy

›Admission commonly indicated

›IV beta lactam therapy common

Geriatric

›Older adult considerations

›Asymptomatic bacteriuria

›Do not treat without urinary symptoms

›Common colonization state

›Delirium without urinary symptoms

›Alternative causes prioritized

›UA abnormalities alone insufficient

›Medication risks

›Nitrofurantoin pulmonary and hepatic rare toxicity risk

›TMP SMX hyperkalemia risk

10Background/b33

Epidemiology

›Frequency patterns

›Common community bacterial infection in females

›Lifetime risk high

›Recurrence common

›Predominant organism

›Escherichia coli majority of cases

›Staphylococcus saprophyticus minority

›Seasonality and behaviors

›Sexual activity associated risk

›Spermicide use associated risk

Pathophysiology

›Ascending infection model

›Periurethral colonization

›Enteric flora reservoir

›Vaginal microbiome disruption

›Bladder mucosal inflammation

›Dysuria mechanism

›Urgency mechanism

›Upper tract progression

›Vesicoureteral reflux contribution

›Obstruction contribution

Therapeutic Considerations

›Antibiotic selection principles

›Narrow spectrum preference when feasible

›Lower collateral damage

›Microbiome preservation

›Short course efficacy

11Patient Discharge Instructions/pdi20

copy discharge instructions

›Uncomplicated bladder infection diagnosis

›Antibiotic course exactly as prescribed

›Symptom improvement expected within 24 to 48 hours

›Symptom relief

›Acetaminophen or ibuprofen as directed

›Phenazopyridine use maximum 2 days if prescribed

›Hydration and habits

›Drink fluids to thirst

›Urinate after sex if sexually active

›Avoid spermicides if recurrent infections

›Return to ED now

›Fever 38.0 C or higher

›Flank pain

›Persistent vomiting

›Worsening pain

›New confusion

›No improvement by 48 to 72 hours

›Follow up

›Primary care follow up if recurrent symptoms

›Culture results review if obtained

12References/r14

Guidelines and evidence sources

›Evidence sources

›IDSA guideline for acute uncomplicated cystitis and pyelonephritis in women

›First line agents nitrofurantoin TMP SMX fosfomycin

›Short course durations

›ACOG guidance for UTI in pregnancy

›Culture based management

›Pyelonephritis admission considerations

›Choosing Wisely recommendations on asymptomatic bacteriuria

›Avoid antibiotics without symptoms in most populations

›Reduce harm and resistance

›CDC STI treatment guidelines

›Dysuria with discharge evaluation

›NAAT testing recommendations

›Instruction source citation

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed August 18, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.