Urinary tract infection in gynaecology and obstetrics

Cystitis is a common problem in the general population affecting 50% of women in their lifetime. Pregnant women are prone to asymptomatic bacteriuria and screening and treatment is important, due to the risk of neonatal complications. Gynaecological patients are at greater risk of developing urinary tract infections, because of concomitant prolapse, vaginal atrophy, voiding dysfunction and incontinence. Recurrent UTI is a substantial problem in this group.Dipstick testing is efficient and cost effective in the primary healthcare, but this is not recommended in obstetrics and gynaecology, where precise sensitivities must be used to ensure complete treatment. Nitrofurantoin is the antimicrobial agent of choice, because of minimal adverse effects and low resistance rates, in particular, now that antibiotic resistance is an increasing concern. Recent studies have demonstrated that refractory overactive bladder is associated with low count bacteriuria (<105 CFU/ml); antibiotic randomised trials are in progress.