Bladder and urethral infection (cystitis, cystitis)

 

Symptoms

Typical symptoms are frequent and forced urination and burning when urinating. Sometime blood also come while urination.

Similar symptoms can sometimes be caused by sexually transmitted diseases (chlamydia or gonorrhea), overactive bladder, bladder or pelvic floor pain syndrome, gynecological infections in women 1 and prostatitis in men 2. These can be alarming if not consult to nephrology doctors or family physician to determine the ground reality of disease.

Diagnosis

The diagnosis of gonorrhea can be made on the basis of typical symptoms without laboratory examinations, for example in a telephone interview, if a woman aged 18–65 years without underlying diseases has symptoms that she herself recognizes and if she is not pregnant.

During the interview, a decision is made as to whether another disease such as a venereal disease could be behind the symptoms, or whether they indicate a more serious disease picture, for example an infection that has risen to the kidneys.

For all other patients, the infection is confirmed by bacterial culture on a urine sample taken from the middle part of the urine stream. Before sampling, the urine should, if possible, be in the bladder for at least four hours. The urine sample is taken according to the instructions given so that it is reliable. On Youtube, there are videos produced by HYY about how a reliable urine sample should be taken separately for women and men.

Under emergency conditions, you can get support for the diagnosis and treatment decision by examining the urine with a test strip or so-called particle count. These methods provide faster responses than bacterial culture but sometimes need to be investigated deeply depend on nephrology physicians decision.

Treatment

It is not recommended that cystitis be treated with anti-inflammatory pain alone.

First-line treatment for adult women is a three-day course of pivmecillinam, nitrofurantoin or trimethoprim, or a single dose of phosphomycin.

As an alternative for non-pregnant women, so-called delayed antibiotic treatment has been proposed. This means that the doctor prescribes an antibiotic regimen and the patient receives instructions on self-care and on starting the regimen only if the symptoms worsen or have not recurred within 48 hours. Self-care includes pain treatment with ibuprofen or paracetamol and drinking enough fluids. As there is not much research evidence about this method and it is not known for which patient group it is suitable, the decision to delay treatment is made after consultation with the doctor.

Treatment options for men with an infection without a fever are trimethoprim or sulfa-trimethoprim. Nitrofurantoin and single-dose phosphomycin are also alternatives if the infection has not spread outside the bladder (no fever and prostate does not hurt on examination). For men, the duration of treatment is usually seven days.

A complicated cystitis (structural or functional abnormality in the urinary tract) is usually treated with the same drug but for a longer period of time.

After initiating medicine, it can take up to three days for the symptoms to go away. If the symptoms have not resolved after four days or if they return, the healthcare institution should be contacted again. If the symptoms continue after the drug treatment, a urine sample is taken to ensure that the diagnosis is correct and that the right drug has been selected.