Acute cystitis is a UTI (urinary tract infection) localised in the bladder. It can be:
Cystitis occurs almost exclusively in women and is mostly uncomplicated.
In men, cystitis is never alone it comes along with other infections like prostatitis.
Most cystitis in females requires just empiric antibiotic treatment without any test.
Additional symptoms (fever, lumbar pain) are signs of complication and it needs prompt diagnosis and aggressive treatment. Immediate urine culture test and focused antibiotic treatment are mandatory in these cases.
E. coli is a bacterium that causes most of these UTI. After bowel movements, the bacterial count increases in the genital area. If the bowel movements are irregular with constipation and or diarrhoea, this count will be even higher. Moreover, if hygiene is lacking, the bacteria will replicate further infecting the vagina. After that, they enter the bladder easily through the urethra.
Specific risk factors for cystitis in women are:
Sudden onset of pain while urinating and frequent urination (dysuria and frequency) with lower abdominal pain are the typical symptoms of UTI. Additional signs like bloody urine and vaginal discharge mean that we need to differentiate uncomplicated cystitis from other diagnoses, commonly vaginitis or stone disease. Fever and lumbar pain are signs of complicated UTI.
Symptoms are enough to diagnose non-complicated cystitis. Urine dipstick or urine analysis is optional. Additional symptoms like bloody urine or vaginal discharge should prompt differential diagnosis with vaginitis and stone disease. However, taking a urine culture is recommended in patients with atypical symptoms, pregnancy, suspect of kidney infection or who fail to respond to appropriate antimicrobial therapy.
The treatment with Fosfomycin, single-dose, pivmecillinam 400 mg three times a day for three to five days, and nitrofurantoin, should be considered for first-line treatment.
Urine analysis and culture are strong recommendations. Not all antimicrobials are suitable during pregnancy.
Cystitis in men is a complicated infection because of almost constant involvement of the prostate (prostatitis). Therefore, we need treatment with antimicrobials penetrating the prostate tissue. A treatment duration of at least fourteen days is recommended, preferably with trimethoprim-sulfamethoxazole or fluoroquinolone.
To prevent cystitis, you must avoid bacterial growth in the vagina and in the bladder:
The typical symptoms of cystitis in females can be treated empirically without diagnostics.
In selected cases of recurrent cystitis, women can use the self-treatment by taking Fosfomycin 3000 mg one shot at the early symptoms’ onset.
Pregnancy and additional symptoms can lead to complications and are always good reasons to see a doctor.
Prevention is the central part of the strategy in recurrent cases.