Cystitis and Other Urinary Tract Infections. Part 2. Diagnosis and Treatment

Last week, we discussed the etiology and epidemiology of cystitis and other urinary tract infections (UTIS). 1 UTIS are among the most common infections encountered by physicians around the world. They are caused primarily by bacteria from the bowels and most often affect women, especially elderly women. However, men and children are also victims. The onset and progression of UTIS are affected by numerous factors. As will be seen here, the diagnosis and treatment of these infections can also be complex. Determining the cause of urinary symptoms is a formidable task. Diagnoses of loweror upper-tract infections based solely on symptoms are frequently inaccurate.z-’t According to a 1971 study of the sites of UTIS and of the patients’ symptoms by K.F. Fairley and colleagues, then at the University Department of Medicine, Royal Melbourne Hospital, Australia, signs of lower-tract disorders were often the only symptoms exhibited by patients with proven renal infections. z Moreover, not all symptomatic patients have a UTI. They may be suffering instead from an inflammation of the vagina or vulva (vaginitis and vulvitis, respectively), or even from such sexually transmitted diseases (STDS) as candidiasis, trichomoniasis, gonorrhea, or genital herpes. s Indeed, it is estimated that 10 to 20 percent of women suffering from symptoms of UTIS have been infected by the sexually transmitted microorganism Ch/amydia trach orrratis. 6 Se~tember 10.1984