Urethritis	·       STD ·       Discharge ·       Dx: NAAT ·       Tx: Azithromycin + Ceftriaxone ·       F/U: HIV
Asx Bacteuria	·       E.coli / GBS ·       If preg + Asx bactiuria –> Amoxicillin –(allergic?)–> Nitrof
Cystitis	·       E.coli ·       choose either: TMP-SMX / Nitrof / Fibronycin
Pyelonephritis	·       IP (really sick): IV ceftriaxone ·       OP (young and okay): ORAL FQ Ciprofloxacin (10 ds) ·       Change to oral w/ improvement of sx in 48 h
Perinephric Abscess	·       Dx CT / US ·       drainage + pyelo Abx (14 ds)

Urinary tract infection
👾	E coli most common cause
Clx	Cystitis	Dysuria, frequency, urgency, hematuria, suprapubic pain.
	Pyelonephritis	Fever >38c, chills, flank pain, costovertebral angle, tenderness & nausea/vomiting, +/- cystitis symptoms
Dx	Urinalysis & urine culture
Tx	Antibiotics

Acute pyelonephritis
Uncomplicated	• Otherwise healthy, nonpregnant • Primarily Escherichia coli • oral Fq, TMP-SMX • IV antibiotics if vomiting, elderly, septic
Complicated	• Diabetes, • urinary obstruction/instrumentation, • renal failure, • immunosuppression, hospital-acquired • ↑ Risk of antibiotic resistance/treatment failure • IV fluoroquinolone. aminoglycoside. extended spectrum beta- lactam/cephalosporin

Acute bacterial prostatitis
Path	·       Intraprostatic reflux of pathogens in urine ·       Gram-negative bacilli (Escherichia coli —75%)
Sx	·       Flu-like illness (eg, fever, chills, malaise, myalgia) ·       Lower urinary symptoms (eg, dysuria, urine retention, pelvic pain)
Dx	·       Digital rectal exam — tender, swollen prostate ·       Urine cx
Tx	·       6 weeks of TMP-SMX or FQ
Comp	·       Sepsis: Bacteremia/systemic spread ·       Abscess: Prostatic abscess ·       Chronic prostatitis

Chronic Bacterial Prostatitis
#	Young & middle-aged men ⤴️ Risk with diabetes, smoking, urinary tract procedure
Path	Coliforms enter from urethra via intraprostatic reflux → Escherichia coli causes >75% of cases
Sx	Recurrent UTIs (with the same organism) Prostatic tenderness and swelling Pain with ejaculation History of Abx Tx → Transient improvement
Dx	Pyuria and bacteriuria on UA Bacteria in prostatic fluid > bacteria in urine
Tx	CIPROFLOXACIN for 4-6 weeks

Chronic prostatitis / Chronic pelvic pain syndrome
Sx	·       Pain in pelvis, perineum, genitalia ·       Irritative voiding sx (eg, urgency, hesitancy) ·       Hematospermia, pain w/ ejaculation
Dx	·       Mild prostate tenderness ·       Sterile urine Cx
Tx	·       Alpha blockers (eg, tamsulosin) ·       Abx (eg, ciprofloxacin), especially if hx of UTI ·       5a-reductase inhibitors (eg, finasteride)