The Rational Clinical Examination
David L. Simel, Drummond Rennie
Urinary Tract Infection, Women
Stephen Bent, Brahmajee K. Nallamothu, David L. Simel, Stephan D. Fihn, Sanjay Saint
Clinical Scenarios
Topics Discussed:
urinary frequency, urinary tract infection, vaginal discharge, women's health
Excerpt:
"A 24-year-old healthy woman calls her primary care physician,
complaining of a burning pain when urinating and increased urinary
frequency for several hours. She has had 2 previous urinary tract
infections (UTIs), and this episode seems "just like the
other ones." She is sexually active with 1 partner and
uses a condom with spermicide. She denies fever, back pain, nausea,
vomiting, vaginal discharge, and hematuria.A 20-year-old woman presents to your office, complaining of urinary
frequency, burning on urination, and vaginal discharge. She has
had occasional fevers and chills but denies nausea, vomiting, and
back pain. She is sexually active with 1 partner, takes oral contraceptive
pills, and intermittently they use condoms. Physical examination
shows her to be in mild discomfort and febrile but without tenderness
in her costovertebral areas. Pelvic examination demonstrates minimal white
vaginal discharge, no vaginal lesions or rashes, and no cervicitis.
Her dipstick urinalysis result is negative for leukocyte esterase,
nitrite, and blood...."
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