Question

A 30-year-old woman comes to the physician because of a 2-day history of urinary frequency and pain with urination. This is her third episode within the past 2 months Urine cultures at her last two visits grew Escherichia coli, and she was treated with trimethoprim-sulfamethoxazole and nitrofurantoin, respectively Urine outures noted sensitivity to these antibiotics. She is sexually active with one new partner. Her temperature is 37.1°C (98.8°F), puise is 84/min, and respirations are 16/min. Abdominal examination shows no abdominal tendemess or distention. There is no costovertebral angle tenderness. Pelvic examination shows no abnormalities, Urinalysis shows greater than 20 WBC/hpf and 3+ bacteria. Which of the following is the most likely diagnosis?

A) Acute cystitis
B) Bladder diverticulum
C) Hydronephrosis
D) Pyelonephritis
E) Urethral prolapse

Answer 1

The most likely diagnosis is acute cystitis, a bacterial infection of the bladder. The urinalysis findings indicate an active bacterial infection and previous treatment with trimethoprim-sulfamethoxazole and nitrofurantoin both were effective.

Step-by-step explanation:

The most likely diagnosis for the 30-year-old woman with urinary frequency and pain with urination is acute cystitis. Acute cystitis is a bacterial infection of the bladder, which commonly occurs when bacteria from the lower gastrointestinal tract enter the urinary tract. The presence of greater than 20 white blood cells per high-power field and 3+ bacteria in the urinalysis indicates an active bacterial infection.

Escherichia coli is the most common bacteria associated with cystitis, and the sensitivity of the urine cultures to trimethoprim-sulfamethoxazole and nitrofurantoin suggests that these antibiotics were effective in treating the previous episodes. The patient's symptoms and urine analysis findings are consistent with acute cystitis, and further treatment with appropriate antibiotics is recommended.