Looking beyond the obvious is sometimes key to diagnosis

Ms. M is a healthy 22 year-old woman who presented to the office for her annual exam. She has been in a monogamous relationship for the past two years and denies any unusual vaginal discharge or irritation. 

She has no history of sexually transmitted infections and uses oral contraceptives and condoms for birth control.  She has no significant medical, surgical or family history.  Ms. M does not smoke or use illicit drugs and drinks alcohol socially — about two to three drinks per week. 

While reviewing Ms. M's medical history, she mentioned that she had been treated for five “bladder infections” during the past year.  She reported that she was once again having “the usual symptoms” and asked to be treated for this “bladder infection.”

According to Ms. M, she was experiencing urinary frequency, dysuria and pelvic pain. She denied ever having fever, chills, nausea, vomiting or any other systemic symptoms. Each time Ms. M had these symptoms, she visited a local pharmacy's “minute clinic” where she was seen by a nurse practitioner, provided a urine sample for urinalysis and treated with a three-day course of antibiotics. Ms. M states that the symptoms were not always immediately relieved with antibiotic treatment but eventually went away. 

Ms. M voiced concerns that maybe she needs a longer course of antibiotic or a different antibiotic. She inquired if she should see a specialist because she has had so many infections. 

Ms. M also stated that she did some research online and is voiding regularly after intercourse and always wipe front to back. She is also drinking large amounts of cranberry juice to acidify her urine and help prevent these frequent infections. 

Urinalysis by dipstick in the office revealed a small amount blood but was otherwise negative. Clean-catch urine was sent for culture and sensitivity, but there was no growth of any bacteria at 48 hours. Ms. M was referred to a local urologist. 

What's your diagnosis?

  1. Chronic UTI
  2. Overactive bladder syndrome
  3. Interstitial cystitis
  4. Chlamydia

For the answer, click "NEXT."

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