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Last updated: 30 March, 2020 15:59pm

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Recurrent Urinary Tract Infections in women – Information for GPs

Referral criteria / commissioning position

Routine referral to secondary care recommended for:

Recurrent cystitis – three episodes of UTIs in previous 12 months or two episodes in previous six months.

Those with risk factor for an abnormality of the urinary tract including women with:

  • past history of urinary tract surgery or trauma
  • past history of bladder or renal calculi
  • obstructive symptoms such as straining, hesitancy, poor stream
  • urea splitting bacteria on culture of the urine such as Proteus or Yersinia
  • persistent bacteriuria despite appropriate antibiotic treatment
  • past history of abdominal or pelvic malignancy
  • symptoms of a fistula such as pneumaturia
  • who are immunocompromised or who have diabetes
  • who have a known abnormality of their renal tract who might benefit from surgical correction, such as cystocele, vesicoureteric reflux, or bladder outlet obstruction
  • who have not responded to preventive treatments

Red flag symptoms

  • Recommended for women with recurrent UTIs associated with haematuria (Non-Visible Haematuria (NVH) or frank) for investigations to exclude urological cancer.
  • Acute pyelonephritis: consider admission for any woman with loin pain, rigors and fever, especially with poor oral intake/ vomiting.

Investigations prior to referral

  • Baseline USS

Information to include in referral letter

  • Details of treatments and measures tried including outcomes
  • Drug history (prescribed and non-prescribed)
  • Relevant past medical/surgical history
  • Current regular medication
  • BMI
  • Smoking status
  • Alcohol consumption

References and Patient information

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