Typical symptoms include dysuria, urinary frequency, and urinary urgency. Some patients may also have suprapubic pain, urinary incontinence, or hematuria. In children old enough to report symptoms, symptoms are similar to adults. In infants, symptoms may be nonspecific and include failure to thrive or vomiting.
Pyelonephritis refers to infection of the kidney and is a different clinical entity. If the patient has flank pain or fever, the physician should consider the possibility of pyelonephritis.
The phrase "complicated urinary tract infection" is used to indicate that host factors exist that may make the urinary tract infection (UTI) difficult to treat. Some of these risk factors include significant health care exposure (increases risk of colonization with resistant organisms), male sex, pregnancy, immunosuppression, recent antibiotic use, indwelling catheter, the presence of foreign body, or an abnormality of the urinary tract.
Of note, pyuria or even a positive urine culture should not be interpreted as evidence of an infection in the absence of compatible urinary symptoms. Asymptomatic bacteriuria is common in certain patient populations (including the elderly) and only requires treatment in very specific situations (patients undergoing certain urologic procedures).
N30.90 – Cystitis, unspecified without hematuria
38822007 – Cystitis
Differential Diagnosis & Pitfalls
- Pyelonephritis – Infection of the kidney; patients have fever and usually have flank pain.
- Viral cystitis – Due to adenovirus or BK virus in select populations.
- Medication-induced cystitis – cyclophosphamide
- Prostatitis – Men may present only with dysuria and fever.
- Vaginitis (eg, bacterial, candidal, trichomoniasis, non-infectious) – Patients may give a history of vaginal discharge and history of vaginal irritation; pelvic examination should be performed.
- Herpes genitalis – Patients may have dysuria with lesions near the urethra.
- Urethritis (eg, due to chlamydial or gonorrheal infection) – Symptoms usually progress more slowly; patients may have a new sexual partner.
- Chronic pelvic pain syndrome – Symptoms may be similar to patients with cystitis but are chronic and urine culture is negative.
- Bladder outlet obstruction – Symptoms are typically long-standing and urine culture is negative.
- Overactive bladder – Patients complain of chronic urinary frequency, urgency, or incontinence.
Drug Reaction Data