A 34-year-old sexually active female comes to your office because of urinary frequency and dysuria for two days. She has had two such episodes in the past, each treated with oral antibiotics. Physical examination reveals suprapubic tenderness and her urinalysis is positive for nitrite, leukocyte esterase, many WBC, and a moderate amount of bacteria. Which of the following is the most common reason for the higher incidence of urinary tract infections in females than in males?

Question

A 34-year-old sexually active female comes to your office because of urinary frequency and dysuria for two days.  She has had two such episodes in the past, each treated with oral antibiotics.  Physical examination reveals suprapubic tenderness and her urinalysis is positive for nitrite, leukocyte esterase, many WBC, and a moderate amount of bacteria.  Which of the following is the most common reason for the higher incidence of urinary tract infections in females than in males?

Quizplus · Accepted Answer

Urinary tract infections (UTI) are more commonly seen in females than males, and half of all adult women have a UTI at some time in their life. The high incidence of UTIs in women is primarily due to the shorter length of the female urethra. After the periurethral area becomes colonized by rectal flora, the bacteria ascend to the bladder to cause infection. This is facilitated in females by a short urethra. Predisposing factors for UTIs include alteration of the normal vaginal flora by recent antibiotic use, sexual intercourse, diaphragm or spermicide use, or a family history of multiple UTIs. Males, on the other hand, are less likely to develop a UTI mainly because they have a longer urethra than females. They also have a drier periurethral environment and antibacterial substances in prostatic fluid, which also help to fight off infection. (Choice A) A shorter distance between the anus and urethra in women is associated with a higher incidence of recurrent UTIs within the female population, but is not the main reason for the difference in UTI frequency between men and women. (Choice B) Spermicide and diaphragm use are risk factors for UTIs in females. A shorter urethral length in females, however, is responsible for their higher frequency of UTIs compared to males. (Choice D) Increased post-void urine residual is not associated with a higher incidence of recurrent UTIs in females. (Choice E) Female hormonal fluctuation is not related to an increased incidence of UTIs in females. Educational objective: The increased incidence of urinary tract infections in women is due to the shorter length of the female urethra compared to males. Other predisposing factors for UTIs include sexual intercourse, recent antibiotic use, the use of spermicidal contraceptives, and a close proximity of the urethra to the anus.

A 34-Year-Old Sexually Active Female Comes to Your Office Because