A 28 white female calls the office frequently requesting antibiotics for symptom

Question

A 28 white female calls the office frequently requesting antibiotics for symptoms of a UTI. She comes in for a visit 4-6 times yearly for dysuria, urgency, frequency and receives treatment for a positive urine for infection. She uses a combination low-dose OCP for contraception. She and her husband have sexual intercourse 1-2 times most weeks. On close questioning the patient, she usually washes her perineum before and gets up and empties her bladder after intercourse. In spite of this, she has recurrent ( ? 3 per year or 2 or more in 6 months) UTI’s that always occurs within 12 hours of intercourse. Today, she calls complaining of UTI symptoms and asks, “What can I do to prevent this from happening?”

What are the typical symptoms this patient complains of when she experiences a UTI? Make sure to define each one?

What is the perineum, and why would it beneficial for a person with recurrent UTIs to wash this area before intercourse?

What is the purpose of emptying the bladder post intercourse?

Explanation / Answer

Symptoms include

a strong, frequent urge to urinate

a painful and burning sensation when urinating

Passing frequent, small amounts of urine

Urine that appears cloudy

The urine may have an unpleasant odour

suprapubic pain

The perineum is the area between the anus and the vulva (the labial opening to the vagina) in the female. It is an anatomical region in the pelvis. It is located between the thighs, and represents the most inferior part of the pelvic outlet. The perineum is separated from the pelvic cavity superiorly by the pelvic floor.

This region contains structures that support the urogenital and gastrointestinal systems – and it therefore plays an important role in functions as such micturition, defecation, sexual intercourse and childbirth.

Urinary tract infections (UTIs) are one of the most frequent clinical bacterial infections in women. In most of the cases of UTIs the E.coli is the causative organism. Recurrent UTIs (RUTI) are mainly caused by reinfection by the same pathogen. Having frequent sexual intercourse is one of the greatest risk factors for RUTIs. It would beneficial for a person with recurrent UTIs to wash this area before intercourse because washing the area before intercourse will ensure the removal of bacteria and therefore will be safe male partner.

The purpose of emptying the bladder post intercourse is to flush out any bacteria that may have entered your urethra.

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