KNOWLEDGE - Students should be able to describe:

  1. The signs and symptoms, in women, of the following:   cystitis, urethral syndrome, vaginitis, estrogen deficiency changes, genital herpes.
  2. The signs and symptoms, in men, of the following:   urethritis, cystitis, prostatitis, genital herpes, balanitis.
  3. The signs and symptoms of pyelonephritis.
  4. The bacteria that most commonly cause UTI.
  5. The definition of uncomplicated vs. complicated (those arising in a setting of catheterization, instrumentation, urologic functional or anatomic abnormalities, stones, obstruction, immunosuppression, renal disease or diabetes) infections.
  6. Predisposing factors including gender, sexual activity, pregnancy, barrier contraceptives (diaphragm) and spermicides, male homosexuality, obstruction, lack of circumcision.
  7. The indications for diagnostic tests, including:   urinalysis, urine culture and sensitivities, intravenous pyelogram, voiding cystourethrogram, renal ultrasound.
  8. The choice and duration of therapy for uncomplicated and complicated urinary tract    infections.



Students should be able to:

  1. History-taking:   obtain, document and present an age-appropriate history that distinguishes cystitis and non-cystitis causes of dysuria, including a sexual history, and upper from lower tract infections.
  2. Physical Exam:   percuss the back for costovertebral angle tenderness (CVAT), percuss and palpate   the bladder, exam of the male urethra with expression of discharge, prostate massage, perineal/vaginal exam for atrophy, inflammation and balanitis.
  3. Laboratory:   interpret the results of a urinalysis including leukocyte esterase, WBC's and RBC's, epithelial cells, urine gram stain, gram stain of urethral discharge, urine culture, vaginal discharge microscopic exam (KOH, NaCl), and post-void urine residual.
  4. Procedural:   proficiently perform a urinary catheterization, urinalysis with microscopy, gram stain of urine and urethral discharge, saline and KOH preps.
  5. Communication:   educate and counsel patients regarding the role of sexual activity in UTI's, communicate the diagnosis and explain the treatment plan.
  6. Management:   select appropriate antibiotic therapy prior to culture results and select the duration of therapy for the type of infection.



  1. Students should appreciate the discomfort associated with dysuria and be sensitive to the issues regarding the patient's sexual activities.



  1. Stamm W.   Urinary tract infections and pyelonephritis.     Harrison's Principles of Internal Medicine.   McGraw Hill.   Online address: (through Loyola University Medical Center's Health Sciences Library)   http://www.harrisonsonline.com/subscr_main.html B updated continuously.
  2. Stamm WE, Hooton TM.   “Management of urinary tract infections in adults.”   N Engl J Med 1993; 329: 1328-1334.
  3. Hooton TM, Stamm WE.   “Diagnosis and treatment of uncomplicated urinary tract infection.”   Infectious Disease Clinics of North America 1997; 11: 551-581.
  4. Kalpana Gupta, Thomas M. Hooton, and Walter E. Stamm   “ Increasing Antimicrobial Resistance and the Management of Uncomplicated Community-Acquired Urinary Tract Infection s”
    Ann Intern Med , Jul 2001; 135: 41 - 50.