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Old 06-03-2012
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Urine Sample three urinary tract infections in the past 2 years

A 64-year-old woman is evaluated for a urinary tract infection. She has had three urinary tract infections in the past 2 years. She is not sexually active. She has no other medical problems and takes no medications. A pelvic examination reveals pale, dry vaginal epithelium that is smooth and shiny with loss of most rugation. Urinalysis reveals 2+ leukocyte esterase, leukocytes too numerous to count, and 10 to 20 erythrocytes/hpf. Urine culture grows Escherichia coli. In addition to treating the current urinary tract infection, which of the following is the most reasonable management option for this patient?

A Continuous antibiotic prophylaxis
B CT imaging of the abdomen and pelvis
C Topical estrogen therapy
D Vaginal lubricants
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Old 06-03-2012
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C.............??????
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Old 06-03-2012
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A
antibiotics prophlx
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Old 06-03-2012
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-pt has symptoms of atrophic vaginitis:vaginal dryness+tendency to recurent uti due to lake of estorogen=C.
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Old 06-04-2012
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This patient has evidence of atrophic vaginitis, and this condition puts her at risk for recurrent urinary tract infections (UTIs). Recurrent UTIs are common in women and are believed to represent new infection rather than relapse of a previous episode. Postmenopausal women are at risk because reduced estrogen levels favor colonization by uropathogenic gram-negative bacteria because of less acidic vaginal secretions, a decrease in vaginal secretions, and thinning of the vulva and vaginal walls. Use of topical estrogen can restore altered genital mucosa and thus reduce the risk of UTIs. A recent Cochrane review found evidence to support the efficacy of vaginal estrogen cream in preventing recurrent UTIs in postmenopausal women.

Continuous antibiotic prophylaxis is not a recommended strategy to prevent recurrent UTIs because of the greater incidence of antibiotic-related side effects and the risk of promoting the emergence of resistant bacteria.

Evaluation for subtle predisposing factors (such as CT imaging to evaluate for anatomic urinary tract abnormalities) is seldom useful and cannot be recommended in this otherwise healthy woman. Inquiring about behavioral practices can be helpful, however. Sexual intercourse is a risk factor for acute or recurrent UTIs, as is the use of spermicides or spermicides plus a diaphragm.

For women with mild urogenital atrophy symptoms, vaginal moisturizing agents and lubricants may be helpful, particularly in the treatment and prevention of dyspareunia in sexually active women. However, vaginal lubricants do not restore the natural protective effect of estrogen on the vaginal mucosa and are not associated with a decreased incidence of recurrent UTIs.
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Infectious-Diseases, ObGyn-, Step-2-Questions

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