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Old 03-05-2013
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Question Post coital or daily prophylaxis antibiotics?

A 32 year old woman presents to the office for evaluation of dysuria, frequency and urgency. She has had two episodes of urinary tract infection in the last 4 months. Her previous episodes were managed with 3 day course of trimethoprim-sulfamethoxazole. She has been using cranberry juice but has not experienced any improvement in recurrences. At this time, she denies any flank pain or fever. She is sexually active with one partner and uses diaphragms with spermicide for contraception. Physical examination is normal except for mild supra-pubic tenderness. There is no costo-vertebral angle tenderness. Urinalysis reveals pyuria and 3+ leukoesterase. There are no WBC casts. Which of the following is the most appropriate recommendation to avoid recurrent urinary tract infections in this patient?

A) Post-coital voiding
B) Post-Coital Trimethoprim-sulfamethoxazole
C) Avoid vaginal spermicides
D) CT scan abdomen
E) Daily Trimethoprim-Sulfamethoxazole
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Old 03-05-2013
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C.avoid vaginal spermicides
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Old 03-05-2013
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Default A) Post-coital voiding

A) Post-coital voiding
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Old 03-05-2013
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C) Avoid vaginal spermicides

Quote:
The 3 main risk factors for recurrent urinary tract infection (UTI) in women are an increased frequency of sexual intercourse, the use of a spermicide and diaphragm, and the loss of estrogen’s effect in the vagina and periurethral structures. The last 2 situations lead to eradication of the vaginal lactobacilli. Patients using a spermicide should consider alternative methods of contraception.
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Last edited by Novobiocin; 03-05-2013 at 04:48 PM.
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