Symptoms of Acute Uncomplicated Cystitis
Acute uncomplicated cystitis presents with a classic triad of dysuria, urinary frequency, and urgency, often accompanied by suprapubic discomfort, in the absence of systemic symptoms like fever or flank pain. 1
Classic Presenting Symptoms
The diagnosis can be made with high probability based on focused history alone in nonpregnant women without anatomic or functional urinary tract abnormalities 1:
- Dysuria (burning sensation with urination) 1, 2
- Urinary frequency (needing to urinate more often than usual) 1, 2
- Urinary urgency (sudden compelling need to urinate) 1, 2
- Suprapubic pain or discomfort 3, 2
- Nocturia (waking at night to urinate) 2
Key Distinguishing Features
The absence of vaginal discharge is critical for diagnosis, as its presence suggests alternative diagnoses like vaginitis or cervicitis rather than cystitis 1. Physical examination is typically normal or reveals only suprapubic tenderness 3.
The absence of fever and flank pain distinguishes uncomplicated cystitis from pyelonephritis, which requires different management 1. If systemic symptoms such as fever or costovertebral angle tenderness are present, acute pyelonephritis or complicated UTI must be considered instead 1, 4.
Diagnostic Accuracy
In women presenting with typical lower urinary tract symptoms and no vaginal discharge, self-diagnosis is sufficiently accurate to make the diagnosis without further testing 2. The combination of dysuria and frequency without vaginal symptoms has high predictive value for acute cystitis 1.
Important Caveats
In elderly women, genitourinary symptoms are not necessarily related to cystitis, and alternative diagnoses should be considered 1. Additionally, patients with atypical symptoms warrant urine culture to confirm the diagnosis 1.
When symptoms do not resolve by the end of treatment or recur within 2-4 weeks, urine culture and antimicrobial susceptibility testing should be performed 1, 3.