Here’s the typical story, courtesy of my USMLE studying and Kaplan Test Prep:
A 52 year old woman comes to clinic complaining of persistent UTI. She tells you that she has had a burning, almost scalding sensation when she urinates. These symptoms have lasted months. Additionally, she has suffered from intermittent urinary incontinence for the last year, which has tended to correlate with the symptoms. Her PCP treated her with trials of trimethoprim-sulfamethoxazole and levofloxacin, but she has had no improvement in her symptoms. She denies fevers, flank pain, discharge or recent sexual activity, though she notes that she is having hot flashes. Physical exam reveals a think, friable vaginal mucosa with multiple small punctate hemorrhages.
Sound familiar? If so, your PCP may be treating you for a UTI when you don’t have one.
This is a typical case of atrophic vaginitis and the treatment is not an antibacterial medication. Instead, it is estrogen. Atrophic vaginitis can cause urinary incontinence and is another mimicker of UTIs. A topical estrogen can help dramatically.