Bacteriuria vs Urinary Tract Infection Bacteriuria is defined as bacteria in the urine in a patient who is asymptomatic, whereas symptomatic bacteria in the urine is termed urinary tract infection. Bacteriuria is not usually treated unless the patient is pregnant, immunocompromised or scheduled to undergo a genitourinary procedure, whereas urinary tract infections are treated with antibiotics. History Additional history that would be beneficial for the assessment would include last pelvic exam, and any history of change in color, consistency or volume of vaginal secretions. Medications that the patient is currently taking to assess if any of the medications are immunosuppressive medications in addition to the patient history of menstruation, menstrual frequency or menopause, “Postmenopausal women may be at higher risk for colonization due to a loss of an acidic vaginal pH.” (Crader, M. F. 2020). Past medical history of renal calculi as they can colonize with bacteria, history of frequency of daily urination to assess and history of tobacco use to assess for bladder cancer risk and process used for urine sample to verify clean catch. Additionally personal hygiene habits such as use and frequency of use of feminine napkins, use of feminine hygiene products such as douche that can change the pH of the vagina and inquiry about personal practices of use of sexual lubricants and urination after intercourse. Diagnostic Studies Verifying that the urine specimen has an order for culture would be the first diagnostic study; a culture of the bacteria detected will help guide potential treatment options, additional tests to add on to the urine sample would be urine cytology to screen for bladder cancer if there is a strong history of tobacco use. Vaginal exam with vaginal and urethral smears and culture given the reports of recent marriage and thus new sexual partner to test for STDs. Ultrasound can be useful to assess for abscess or suspected renal calculi in the bladder or urethra. References Crader, M. F. (2020, November 19). Bacteruria - StatPearls - NCBI Bookshelf. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK482276/ Merck Manuals. (2020c). Bacterial Urinary Tract Infections. Merck Manuals Professional Edition. https://www.merckmanuals.com/professional/genitourinary-disorders/urinary-tract-infections-utis/bacterial-urinary-tract-infections?query=Asymptomatic%20Bacteriuria Case #2: 23-year-old woman Differential Diagnosis Possible inflammatory causes for 23-year-old woman reoccurring symptoms could be urethritis, sexually transmitted infections, and vaginitis. Urethritis is inflammation of the urethra that is commonly caused by bacterial or viral source, the most common bacteria for urethritis N. gonorrhoeae, C. trachomatis and Mycoplasma genitalium, and viral causes are commonly HPV, HSV and CMV. Sexually transmitted infections that cause the symptoms include Gonorrhea, Chlamydia, Trichomoniasis and Herpies simplex, gi.

1. Bacteriuria vs Urinary Tract Infection
Bacteriuria is defined as bacteria in the urine in a patient who is
asymptomatic, whereas symptomatic bacteria in the urine is
termed urinary tract infection. Bacteriuria is not usually treated
unless the patient is pregnant, immunocompromised or
scheduled to undergo a genitourinary procedure, whereas
urinary tract infections are treated with antibiotics.
History
Additional history that would be beneficial for the assessment
would include last pelvic exam, and any history of change in
color, consistency or volume of vaginal secretions. Medications
that the patient is currently taking to assess if any of the
medications are immunosuppressive medications in addition to
the patient history of menstruation, menstrual frequency or
menopause, “Postmenopausal women may be at higher risk for
colonization due to a loss of an acidic vaginal pH.” (Crader, M.
F. 2020). Past
medical
history of renal calculi as they can colonize with bacteria,
history of frequency of daily urination to assess and history of
tobacco use to assess for bladder cancer risk and process used
for urine sample to verify clean catch. Additionally personal
hygiene habits such as use and frequency of use of feminine
napkins, use of feminine hygiene products such as douche that
can change the pH of the vagina and inquiry about personal
practices of use of sexual lubricants and urination after
intercourse.
Diagnostic Studies

2. Verifying that the urine specimen has an order for culture
would be the first diagnostic study; a culture of the bacteria
detected will help guide potential treatment options, additional
tests to add on to the urine sample would be urine cytology to
screen for bladder cancer if there is a strong history of tobacco
use. Vaginal exam with vaginal and urethral smears and culture
given the reports of recent marriage and thus new sexual partner
to test for STDs. Ultrasound can be useful to assess for abscess
or suspected renal calculi in the bladder or urethra.
References
Crader, M. F. (2020, November 19). Bacteruria - StatPearls -
NCBI Bookshelf. StatPearls.
https://www.ncbi.nlm.nih.gov/books/NBK482276/
Merck Manuals. (2020c). Bacterial Urinary Tract Infections.
Merck Manuals Professional Edition.
https://www.merckmanuals.com/professional/genitourinary-
disorders/urinary-tract-infections-utis/bacterial-urinary-tract-
infections?query=Asymptomatic%20Bacteriuria
Case #2: 23-year-old woman
Differential Diagnosis
Possible inflammatory causes for 23-year-old woman
reoccurring symptoms could be urethritis, sexually transmitted
infections, and vaginitis.
Urethritis
is inflammation of the urethra that is commonly caused by
bacterial or viral source, the most common bacteria for
urethritis N. gonorrhoeae, C. trachomatis and Mycoplasma
genitalium, and viral causes are commonly HPV, HSV and
CMV. Sexually transmitted infections that cause the symptoms
include Gonorrhea, Chlamydia, Trichomoniasis and Herpies

3. simplex, given the information that the recurrent infections
started after marriage there is possibility of STI due to
introduction of a new sexual partner and previous treatment for
acute cystitis may have helped with the infection but subsequent
sexual encounters reintroduced the infectious agent. Vaginitis is
a bacterial infection with symptoms of discharge, odor irritation
and itching that can also cause dysuria. The most common
causes of vaginosis include candidiasis, and trichomoniasis.
Possible non-inflammatory causes for 23 year old womans
reoccurring symptoms include non-inflammatory causes could
be urethral anatomic abnormalities, local trauma, and
endometriosis. Urethral anatomical abnormalities such as
strictures or diverticulum can cause reflux of urine and
recurrent urinary infections, however most common anatomical
abnormalities are present at birth and this is usually diagnosed
in childhood in patients with a family history or urethral
anatomical abnormalities. Local trauma such as “genitourinary
instrumentation or surgery, pelvic irradiation, foreign body
presence, horseback or bicycle riding” Michels, T., & Sands, J.
(2015). Endometriosis of the bladder can cause acute flank pain,
microscopic hematuria, dysuria, increased frequency, and
urgency when the endometrial tissue grows within the bladder
wall. Bladder endometriosis is extremely rate, with an
occurrence rate of 1-2% of women who have endometriosis.
Diagnostic Tests
Urine culture and sensitivity could help determine if there is a
bacterial cause of the recurrent dysuria if it is of a infectious
nature. A pelvic exam with assessment for discharge, odor, and
screening with vaginal and urethral smears and culture for
possible vaginosis or sexually transmitted infections. For
diagnosis of anatomical abnormalities or endometriosis of the
bladder an cystoscopy would be required to visualize the
causative nature of the symptoms.

4. Recurrent Lower UTIs
Common causes of recurrent UTIs in women include use of
spermicides for contraception, new sexual partner, and voiding
dysfunction. “Many other factors have been thought to
predispose women to RUTIs, such as voiding patterns pre- and
post-coitus, wiping technique, wearing tight undergarments,
deferred voiding habits and vaginal douching; nevertheless,
there has been no proven association” (Scholes D et all 2000).
Renal Failure
Acute kidney failure also known as acute renal injury (AKI) is
an sudden decrease in renal function and is defined as one or
more of the defining criteria of rise in serum creatinine of at
least 0.3 mg/dL, serum creatinine >1.5 times the baseline value
or urine volume of < 0.5mL/kg per hour for 6 hours. The cause
of acute kidney injury can be subdivided into 3 causes, prerenal,
intrarenal and post renal. Prerenal is associated with decreased
renal profusion that is related to volume depletion or decreased
arterial pressure that causes the glomular filtration rate to
decrease.
Intrarenal AKI results from an ischemic or nephrotoxic cause
such as prolonged hypotension or exposure to a nephrotoxic
substance or medication that cause an acute inflammation of the
glomeruli.
Postrenal AKI is due to a blockage or obstruction of urinary
flow and is seem most often in prostate hypertrophy in men.
“Patients with acute kidney injury are more likely to develop
chronic kidney disease in the future. They are also at higher risk
of end-stage renal disease and premature death”( Goldberg R,
Dennen P 2008).