What is Cystitis?
Cystitis is acute inflammation of the bladder mucosa, typically presenting with dysuria (painful urination) along with variable degrees of urinary frequency, urgency, hematuria, and new or worsening incontinence. 1
Clinical Definition and Presentation
Uncomplicated cystitis is defined as acute, sporadic, or recurrent bladder infection limited to nonpregnant women with no known anatomic or functional abnormalities in the urinary tract and no comorbidities 1
Dysuria is the central diagnostic symptom, with more than 90% accuracy for UTI in young women when vaginal irritation or discharge is absent 1
The diagnosis should combine laboratory confirmation of significant bacteriuria (≥5 x 10⁴ colony-forming units/mL in catheterized specimens or ≥10⁵ cfu/mL in voided specimens) with acute-onset urinary tract symptoms 1
In patients with typical symptoms, urine analysis leads to only minimal increase in diagnostic accuracy, though dipstick testing can help when the diagnosis is unclear 1
Pathophysiology and Causative Organisms
Escherichia coli accounts for more than 75% of all bacterial cystitis cases, making it the primary target for empirical antibiotic therapy 1
In uncomplicated cystitis, E. coli causes more than 90% of cases in young healthy women 1
Risk factors include sexual intercourse, spermicide use, new sexual partner, maternal history of UTI, and personal history of childhood UTI 1
Distinction from Other Conditions
Cystitis is limited to bladder infection, whereas pyelonephritis involves inflammation of the renal parenchyma and presents with systemic symptoms such as high fever, malaise, vomiting, abdominal or flank pain, and tenderness 1
Cystitis in the absence of pyelonephritis is usually not associated with long-term sequelae 1
Interstitial cystitis/bladder pain syndrome is a distinct chronic inflammatory condition characterized by bladder pain and irritative symptoms lasting more than 6 months, occurring without positive cultures and representing a diagnosis of exclusion 2, 3
Key Diagnostic Pitfalls
Asymptomatic bacteriuria (presence of bacteria without symptoms) should not be confused with cystitis and does not require treatment in most populations 4
In elderly women, genitourinary symptoms are not necessarily related to cystitis, as baseline incontinence and age-related conditions can mimic UTI symptoms 1, 4
Without acute-onset symptoms, bacteriuria of any magnitude is considered asymptomatic bacteriuria, not cystitis 1