Treatment of UTI Prior to Dilation and Curettage (D&C)
If a patient has an active, symptomatic UTI, you should treat it with a full course of antibiotics and defer elective D&C until treatment is complete and symptoms have resolved; however, for asymptomatic bacteriuria or patients without evidence of UTI, routine antibiotic prophylaxis is not necessary for D&C.
Clinical Approach
For Patients WITH Active UTI
The evidence strongly supports delaying elective procedures when active infection is present. Elective D&C should be postponed until antimicrobial treatment is complete and symptoms have improved 1. This principle applies broadly to genitourinary instrumentation—attempting procedures in the presence of untreated infection significantly increases postoperative complications.
- Preoperative UTI increases overall postoperative complications (OR 1.551), including both infectious (OR 1.515) and non-infectious complications (OR 1.683) in surgical patients 2
- Complete a full treatment course (typically 3-5 days for uncomplicated cystitis) before proceeding with elective D&C
- Ensure symptom resolution before rescheduling the procedure
For Patients WITHOUT Active UTI
D&C is a low-risk procedure for infectious complications. The bacteremia rate is only 5%, placing it in the same category as other low-risk diagnostic procedures 3. This is fundamentally different from high-risk urologic procedures that breach mucosal barriers.
Routine antibiotic prophylaxis is not indicated for standard D&C in patients without signs of infection. The available guidelines focus on urologic procedures with mucosal trauma (TURP, ureteroscopy, percutaneous procedures), which carry substantially higher infection risk than D&C 1.
Special Circumstances Requiring Prophylaxis
Consider single-dose prophylactic antibiotics only in these specific scenarios:
- Septic abortion (this is therapeutic treatment, not prophylaxis)
- Prosthetic heart valves present
- Immunocompromised patients (transplant recipients, those on immunosuppressive therapy)
Catheterization Considerations
Avoid routine catheterization before D&C unless medically necessary. Recent evidence shows catheterization during minor gynecologic procedures (including D&C) significantly increases UTI rates—5.6% in catheterized patients versus 2.5% in non-catheterized patients 4. Routine catheterization is unnecessary for these procedures 5.
Key Pitfalls to Avoid
Do not screen for or treat asymptomatic bacteriuria before D&C—this is not a mucosal-traumatic urologic procedure requiring such screening 6, 7
Do not confuse D&C with high-risk urologic procedures like TURP or ureteroscopy, which do require prophylaxis and ASB screening 6
Do not give "just in case" antibiotics for routine D&C—this contributes to resistance without proven benefit
If UTI is diagnosed within 1 week preoperatively, retest before surgery to ensure adequate treatment, as this may actually be protective if properly treated 8