Acute and chronic recurrent cystitis in women

Urinary tract infections are among the most common infectious diseases of the genitourinary system in outpatient and hospital practice.

Uncomplicated urinary tract infections are among the most common diseases of women of reproductive age. During the year, 25-35% of women aged 20 to 40 years experience at least one episode of urinary infection. Acute cystitis is detected most often. According to statistics, 26-36 million cases of the disease are registered in Russia per year. The incidence of acute cystitis is 0.5-0.7 cases of the disease per woman per year. According to the latest international study of antibiotic resistance of strains of pathogens of uncomplicated urinary tract infections (2006), in which 61 countries of the world took part, the leading pathogen of these diseases is E. coli, isolated in 76.3% of observations. Then come S. saprophiticus (3.6%), Klebsiella pneumonia (3.5%), Proteus mirabilis (3.1%) and Enterococcus faecalis (3%).

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Causes acute and chronic recurrent cystitis in women

More than 95% of uncomplicated urinary tract infections are caused by a single microorganism. The most common pathogens are gram-negative enterobacteria, usually Escherichia coli (70-95% of cases). The second most common pathogen is Staphylococcus saprophyticus (5-20% of all uncomplicated urinary tract infections), which is somewhat more often isolated in young women. Much less often, uncomplicated urinary tract infections are caused by Klebsiella spp. or Proteus mirabilis. In 1-2% of cases, uncomplicated urinary tract infections are caused by gram-positive microorganisms (group B and D streptococci).

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Diagnostics acute and chronic recurrent cystitis in women

The examination plan for patients with chronic cystitis should include the following steps:

• Careful collection of anamnesis (features of the course of recurrent urinary tract diseases occurring against the background of sexually transmitted infections):
  • duration of the disease is more than two years;
  • the presence of pollakiuria outside the period of exacerbation up to 11-14 times a day;
  • constant severe pain above the pubis, in the area of the urethra and vagina, leading to sexual and social maladaptation;
  • ineffectiveness of traditional antibacterial therapy.
• General urine analysis.
• Bacteriological examination of urine with determination of sensitivity to antibiotics.
• Examination of the vagina using speculums to exclude anatomical changes (using the O'Donnel test).
• Examination by a gynecologist.
• Examination for the presence of sexually transmitted infections (STIs) using two methods from two locations (cervical canal and urethra).
• Ultrasound of the urinary and reproductive systems.
• Cystoscopy with biopsy and morphological examination of the biopsy.

While the diagnosis of cystitis in most cases does not cause difficulties, treatment is not always effective, and the prognosis is not always favorable, since in a number of patients it is not possible to establish and eliminate the cause that led to the onset of the disease.

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Differential diagnosis

Differential diagnosis of chronic cystitis with diseases that have a similar clinical picture is necessary:

• bladder cancer;
• tuberculosis of the urinary tract;
• adenomyosis;
• vulvovaginitis;
• specific urethritis.

Treatment acute and chronic recurrent cystitis in women

Treatment of cystitis should be comprehensive (etiological and pathogenetic) and aimed primarily at eliminating the causes of frequent recurrence of lower urinary tract infection.

Cystitis is an infectious disease, and therefore, without a pathogen there is no infection.

Currently, pathogenetically substantiated algorithms for conservative treatment of inflammatory diseases of the lower urinary tract have been developed.

Acute and chronic recurrent cystitis in women is also treated with surgical methods aimed at correcting anatomical changes and eliminating the causes of urodynamic disorders.