UTIs and Walk-In Urinalyses and Counseling for Patients

How I Practice Video Series 
Lydia M. Jeffries, MD, FACOG
Asheville, North Carolina

In my practice I offer walk in urinalyses for established patients during specific hours. This is advertised on our new patient brochure and on our website, this is for non-pregnancy gynecologist patients. Consider this, over 50 percent of women in the United States will have at least one urinary tract infection in their lifetime and three to five percent will have recurrent infections. This results in 10 million doctor visits per year. I use the path of physiology of urinary tract infections to discuss with patients the prevention, the fact that the female urethra is shorter, that these infections are usually ascending and I explain the colonization of the lower urethra by vaginal and bowel flora. If antibiotics are indicated, we prescribe them after reviewing the patient’s history and allergies. And if a culture is indicated the patient is told that we will call her only if the chosen antibiotic does not cover the bacteria that grows in her culture. But all patients understand to call if they are not improved within 48 hours or if a new symptom, such as fever, would develop. I also use this time as an opportunity to do some myth busting, reminding patients that hydration is wonderful in many ways but doesn’t prevent urinary tract infections nor does post coital voiding, and bubble baths don’t cause urinary tract infections. I try to identify patients that might be experiencing menopausal atrophy and bring them back for a separate office visit. We discuss preventive measures, this is cranberry juice and cranberry juice tablets as they contain a substance that prevents the most common bacteria, E. coli, from adhering to the epithelial cells in the uri-genital tract. In my practice, I try to avoid the empiric treatment of urinary tract infections by allowing patients to walk in during prescribed office hours. I think this prevents the overuse of antibiotics and potentially prevents antibiotic resistance. I try to identify the menopausal patients who are presenting with frequency, dysuria, and urgency and bring them back for a separate office visit. In our practice, my practice, we offer walk in urinalyses to prevent the overutilization of antibiotics, to talk to patients about prevention of urinary tract infections and prevent antibiotic resistance.

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