A 25-Year-Old Woman Comes to the Office Due to 4

A 25-year-old woman comes to the office due to 4 days of burning with urination, increased urinary frequency, and blood in her urine.  The patient has not had fevers, chills, or abnormal vaginal discharge.  She has tried to treat her symptoms with cranberry juice and increased fluid intake but has had no improvement.  The patient has been in a monogamous relationship for the last 8 months.  She and her partner have intercourse 3 or 4 times a week; they use a progestin subdermal implant and condoms with spermicide for contraception.  The patient voids immediately after intercourse but has had 3 urinary tract infections in the last 7 months.  She has no chronic medical conditions but had a laparoscopic ovarian cystectomy for a mature teratoma at age 20.  The patient takes a multivitamin daily.  She drinks wine on special occasions but does not use tobacco or illicit drugs.  Temperature is 36.7 C (98 F), blood pressure is 110/60 mm Hg, and pulse is 58/min.  BMI is 22 kg/m².  Abdominal examination shows suprapubic tenderness but no costovertebral angle tenderness.  Pelvic examination reveals a small, nontender uterus with no adnexal masses.  Speculum examination reveals a normal cervix with no abnormal discharge.  Urinalysis results are as follows: A 1-week course of antibiotics is prescribed.  In addition to the course of antibiotics, which of the following is the best next step in management of this patient?

A)No further management is indicated
B)Order renal ultrasound
C)Perform cystoscopy and bladder biopsy
D)Perform urodynamic testing and measure postvoid residual urine volume
E)Prescribe postcoital antibiotic prophylaxis

Correct Answer: Explore answers and other related questions