October 23, 2006 — Women with recurrent urinary tract infections (UTIs) are more likely to present with specific clinical features than those without, including the presence of symptoms after intercourse and prior history of pyelonephritis, according to new research.
These clinical symptoms can help to "identify women with recurrent UTIs at the initial presentation even if urine culture reports are not available," note Lily Arya, MD, MS, assistant professor of obstetrics and gynecology at the University of Pennsylvania School of Medicine in Philadelphia, and colleagues.
"Recurrent UTIs should be ideally diagnosed on the basis of urinalysis and cultures," Dr. Arya told Medscape. "But if these are not available, then these clinical symptoms can be useful predictors," she said.
The researchers presented their findings at the 2006 scientific meeting of the American Urogynecologic Society in Palm Springs, California, on Friday.
The retrospective case-control study included 139 women (44 with recurrent UTI and 95 without) who presented with irritative voiding symptoms between January 2003 and December 2005.
A recurrent UTI was defined as the occurrence of 3 positive urine cultures within the preceding year. Symptoms predictive for recurrent UTI were identified with univariate and multivariate analyses.
The case and control groups were similar with regard to age, prevalence of pelvic organ relapse, parity, incontinence, and pelvic surgery. The mean age of the women was about 28 years (range, 18-40 years).
Univariate analysis found that women diagnosed with recurrent UTI were significantly more likely than the control subjects to report symptoms after intercourse (odds ratio [OR], 7.3; 95% confidence interval [CI], 2.7 - 20.39); prior pyelonephritis (OR, 7.2; 95% CI, 2.5 - 22.0); and prompt resolution of symptoms with antibiotics (OR, 10.7; 95% CI, 4.3 - 26.9).
"History of hematuria and dyspareunia were not significant predictors of recurrent UTIs," the researchers noted. However, women with recurrent UTI were significantly less likely to report nocturia (OR, 0.2; 95% CI, 0.06 - 0.75) and persistence of symptoms between UTIs (OR, 0.2; 95% CI, 0.1 - 0.5) than women in the control group.
Multivariate analysis found that report of symptoms after intercourse (OR, 12.4; 95% CI, 3 - 59); prior history of pyelonephritis (OR, 7.4; 95% CI, 2.1 - 29); prompt resolution of symptoms with antibiotics (OR, 3.9; 95% CI, 1.4 - 11); and absence of nocturia (OR, 0.2; 95% CI, 0.1 - 0.9) remained significant predictors for women with recurrent UTI.
"We were surprised that prompt resolution of urinary symptoms after taking antibiotics was not a stronger predictor for recurrent UTI, since women often get diagnosed with recurrent UTIs based on how many courses of antibiotics they have taken in the previous year," Dr. Arya said. "But it turns out that prior antibiotic use is not a great predictor of recurrent UTI."
According to Dr. Arya, it is important to "think outside the box" with women who may have a recurrent UTI. "The patient may not be having a recurrent UTI but may, in fact, have some other disorder such as interstitial cystitis or overactive bladder," she said. "These symptoms help to provide clues to diagnosis of recurrent UTI, although confirmation must be done by urine cultures," she added.
"The symptoms predictive of recurrent UTI that were identified by this study are clinically sound," said Deborah L. Myers, MD, from the Women and Infants Hospital of Rhode Island, Brown University School of Medicine, in Providence, Rhode Island. "Many women have UTIs after intercourse and will have prompt resolution of symptoms once antibiotics are given, but interestingly, the factors that were not predictive of recurrent UTI are more suggestive of other conditions that mimic UTIs, such as overactive bladder and interstitial cystitis," she told Medscape.
"This research confirms that what seems like a UTI may not always be a UTI, and for those women whose symptoms do not resolve with antibiotics, further work-up is recommended," Dr. Myers added.
The authors report no relevant financial relationships.
AUGS 2006 Scientific Meeting: Paper 36. Presented October 20, 2006.
Medscape Medical News В© 2006 Medscape
Cite this: Emma Hitt. Clinical Predictors of Recurrent Urinary Tract Infection Identified - Medscape - Oct 23, 2006.
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