The spectrum of urinary tract infections in family practice

Urinary tract infections are among the most frequently encountered health problems in patients of family physicians. The diagnosis requires the demonstration of more than 100,000 bacterial colonies per milliliter in a freshly voided urine specimen. Dysuria, proteinuria, and pyuria are unreliable diagnostic criteria. The pathogenesis is uncertain although vaginal colonization with enteric bacteria, voluntary avoidance of urination, and sexual intercourse are contributing causes. Vesicoureteral reflux is related to recurrent infection but a causal relationship has not been established. Urinary tract infection in children is related to decreased renal growth and kidney scars, but therapy of the infections does not prevent kidney damage. Infections disappear spontaneously in up to 40 percent of adult women. Bacteriuria in pregnancy, however, is related to low birth weight in infants and increased perinatal mortality. Asymptomatic bacteriuria need not be diagnosed or treated except in pregnant women. For symptomatic infections, short-term antibiotic therapy is as effective as long-term therapy. Prophylactic antibiotics and therapy by modification of behavior using a multifaceted regimen can reduce the frequency of recurrent infection.