Urinary Tract Infection

The correct answer is C.

This patient has a presentation that is most consistent with urinary tract infection (UTI). Two of the major risk factors for uncomplicated UTI are sexual intercourse and hypoestrogenism. Sexual intercourse is believed to lead to urinary tract infection by introducing colonizing bacteria into the bladder. Sexual intercourse has been shown to increase the number of bacteria in the urine up to ten times.

Hypoestrogenism is believed to be a risk factor for UTI because it is known that postmenopausal women not receiving estrogen replacement therapy (ERT) are at greater risk for developing a UTI compared with those women who do use ERT. Furthermore, estrogen administration has been shown to prevent recurrent infection.

Cardiac disease (choice A) is a major risk factor for a number of conditions. However, cardiac disease is not a known risk factor for UTI.

Cranberry juice ingestion (choice B) has, for many years, been believed to help prevent UTIs. Many in the medical establishment viewed this as an "old wives tale." However, there have been many studies that have shown that cranberry juice contains substances that inhibit bacterial adherence. Moreover, a recent study showed that elderly women that drank cranberry juice have lower rates of pyuria and bacteriuria and a decreased need for antibiotics.

Nephrolithiasis (choice D) can be a risk factor for the development of an eventual infection, but it is not as common a risk factor as is hypoestrogenism or sexual intercourse. Furthermore, this patient has no evidence of nephrolithiasis, which typically causes severe to excruciating episodes of pain.

Sexual intercourse (choice E), as noted above, is a well-known risk factor for the development of a UTI. Sexually active women with recurrent UTIs may be treated with a single dose of antibiotic prophylactically after intercourse. This patient, however, has stated that she is not sexually active.

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