ABCs

• Check vitals
• Assess for fever, tachycardia, or hypotension → red flag for systemic infection

HPI & Examination

• Urinary symptoms: dysuria, urgency, frequency, suprapubic pain
• Upper UTI signs: flank pain, fever, nausea/vomiting
• Discharge, pruritus, or genital ulcers (suggests urethritis/STI)
• Hematuria or cloudy/malodorous urine
• LUTS: hesitancy, dribbling, weak stream (esp. in men)
• PMH: UTIs, STIs, nephrolithiasis, GU instrumentation
• Risk factors: diabetes, immunosuppression, pregnancy, recent antibiotics
• Examine
  • Abdomen: suprapubic or flank tenderness
  • Genital exam: discharge, ulcers, rash (if indicated)
  • CVA tenderness → pyelonephritis
  • Consider DRE in males (tender prostate → prostatitis)

Management

• Encourage oral hydration; consider IV fluids if needed
• If a catheter is present → change it, then send urine for R/M and culture
• Investigations
  • Urine R/M and culture
  • CBC CRP
  • Blood cultures, serum lactate and RFT if febrile or looks septic
  • β-hCG if indicated
  • STI testing if history or symptoms suggest urethritis/STI
• Medications
  • Start empirical antibiotics
    • Narrow-spectrum for uncomplicated UTI
    • Broader coverage for complicated cases (e.g., diabetes, immunosuppressed, recent hospitalization)
  • Paracetamol or NSAIDs for pain/fever relief
• Consider imaging, e.g., CT KUB or renal U/S if
  • Suspected nephrolithiasis
  • No improvement or red flags for pyelonephritis
  • Recurrent UTIs or known anatomical abnormalities

Escalation

• Persistent symptoms despite treatment
• Hemodynamic instability
• Concern for
  • Complicated UTI
  • Pyelonephritis
  • Prostatitis
  • Nephrolithiasis
  • Anatomical abnormality
  • Obstruction or urinary retention
• Need for urology consult (e.g., stones, malignancy, instrumentation)