8/13/2016

UrinaryTractInfectionsinPregnancyDifferentialDiagnoses

UrinaryTractInfectionsinPregnancyDifferential
Diagnoses
Author:EmilieKatherineJohnson,MD,MPHChiefEditor:EdwardDavidKim,MD,FACSmore...
Updated:Jul24,2016

DiagnosticConsiderations
Thedifferentialdiagnosisofurinarytractinfection(UTI)inpregnancyincludesthe
following:
Cervicitis
ChlamydialGenitourinaryInfections
Cystitis,Nonbacterial
EctopicPregnancy
InterstitialCystitis
Nephrolithiasis
Trichomoniasis
Trigonitis
Urethritis
Vaginitis
Otherdisorderstoconsiderincludethefollowing:
Glomerulonephritis
GroupBstreptococcalcolonization
Sexuallytransmittedinfection(eg,gonorrhea,nongonococcalurethritis)
Threatenedorincompletemiscarriage
Urgeincontinence
VaginalinfectionscancauseormimicUTIs,whicharecommoninwomenof
reproductiveage,affecting2535%ofwomenaged2040years.Discriminating
betweenthe2dependsontheresultsofvaginalandurinarycultures(seeUrine
Studies).
Workup

ContributorInformationandDisclosures
Author
EmilieKatherineJohnson,MD,MPHHeadofClinicalResearch,AttendingPhysician,DivisionofUrology,Ann
andRobertHLurieChildrensHospitalofChicagoAssistantProfessorofUrology,AssistantProfessor,Center
forHealthcareStudies,InstituteforPublicHealthandMedicineNorthwesternUniversity,TheFeinbergSchoolof
Medicine
EmilieKatherineJohnson,MD,MPHisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,
AmericanUrologicalAssociation,NationalMedicalAssociation,SocietyofWomeninUrology
Disclosure:Nothingtodisclose.
ChiefEditor
EdwardDavidKim,MD,FACSProfessorofSurgery,DivisionofUrology,UniversityofTennesseeGraduate
SchoolofMedicineConsultingStaff,UniversityofTennesseeMedicalCenter
EdwardDavidKim,MD,FACSisamemberofthefollowingmedicalsocieties:AmericanCollegeofSurgeons,
TennesseeMedicalAssociation,SexualMedicineSocietyofNorthAmerica,AmericanSocietyforReproductive
Medicine,AmericanSocietyofAndrology,AmericanUrologicalAssociation
Disclosure:Serve(d)asadirector,officer,partner,employee,advisor,consultantortrusteefor:Repros.
AdditionalContributors
JStuartWolf,Jr,MD,FACSDavidABloomProfessorofUrology,AssociateChairforUrologicSurgical
Services,Director,DivisionofEndourologyandStoneDisease,DepartmentofUrology,UniversityofMichigan
MedicalSchool
JStuartWolf,Jr,MD,FACSisamemberofthefollowingmedicalsocieties:CatholicMedicalAssociation,
EndourologicalSociety,EngineeringandUrologySociety,SocietyofLaparoendoscopicSurgeons,Societyof
UniversityUrologists,SocietyofUrologicOncology,AmericanCollegeofSurgeons,AmericanUrological
Association
Disclosure:Nothingtodisclose.
Acknowledgements
GamalMostafaGhoniem,MD,FACSProfessorofUrology,Chief,DivisionofFemaleUrology,Pelvic
ReconstructiveSurgery,andVoidingDysfunction,DepartmentofUrology,UniversityofCalifornia,Irvine,School
ofMedicine
GamalMostafaGhoniem,MD,FACSisamemberofthefollowingmedicalsocieties:AmericanCollegeof
Surgeons,AmericanUrogynecologicSociety,AmericanUrologicalAssociation,InternationalContinenceSociety,

http://emedicine.medscape.com/article/452604differential

1/3

8/13/2016

UrinaryTractInfectionsinPregnancyDifferentialDiagnoses

InternationalUrogynaecologyAssociation,andSocietyofUrodynamicsandFemaleUrology
Disclosure:AstellasHonorariaSpeakingandteachingColoplastyConsultingfeeBoardmembershipUroplasty
ConsultingfeeConsulting
LeticiaAJones,MDClinicalInstructor,DepartmentofObstetricsandGynecology,IndianaUniversityHospital,
ClarianHealthPartners
LeticiaAJones,MDisamemberofthefollowingmedicalsocieties:AmericanCollegeofObstetriciansand
Gynecologists
Disclosure:Nothingtodisclose.
MarkJeffreyNoble,MDConsultingStaff,UrologicInstitute,ClevelandClinicFoundation
MarkJeffreyNoble,MDisamemberofthefollowingmedicalsocieties:AmericanCollegeofSurgeons,
AmericanMedicalAssociation,AmericanUrologicalAssociation,KansasMedicalSociety,SigmaXi,Societyof
UniversityUrologists,andSouthwestOncologyGroup
Disclosure:Nothingtodisclose.
HenryERuiz,MDChief,ReconstructiveUrologyandUrodynamics,UrologyAssociatesofSouthTexas,PAand
RadiationOncologyCenter
HenryERuiz,MDisamemberofthefollowingmedicalsocieties:AmericanUrologicalAssociation
Disclosure:Nothingtodisclose.
FranciscoTalavera,PharmD,PhDAdjunctAssistantProfessor,UniversityofNebraskaMedicalCenterCollege
ofPharmacyEditorinChief,MedscapeDrugReference
Disclosure:MedscapeSalaryEmployment
PatrickJWoodman,DO,AssistantDirector,Urogynecology(FPMRS)Fellowship,AssociateClinicalProfessor,
IndianaUniversitySchoolofMedicineConsultingStaff,DepartmentofObstetricsandGynecology,Methodist
Hospital
PatrickJWoodman,DOisamemberofthefollowingmedicalsocieties:AmericanCollegeofObstetriciansand
GynecologistsAmericanCollegeofSurgeonsAmericanOsteopathicAssociationAmericanUrogynecologic
SocietyAssociationofProfessorsofGynecologyandObstetricsIndianaStateMedicalAssociation
InternationalContinenceSociety
Disclosure:Nothingtodisclose.

References
1.[Guideline]NicolleLE,BradleyS,ColganR,RiceJC,SchaefferA,HootonTM.InfectiousDiseases
SocietyofAmericaguidelinesforthediagnosisandtreatmentofasymptomaticbacteriuriainadults.Clin
InfectDis.2005Mar1.40(5):64354.[Medline].
2.MinassianC,ThomasSL,WilliamsDJ,CampbellO,SmeethL.Acutematernalinfectionandriskofpre
eclampsia:apopulationbasedcasecontrolstudy.PLoSOne.2013Sep3.8(9):e73047.[Medline].[Full
Text].
3.McKenzieH,DonnetML,HowiePW,PatelNB,BenvieDT.Riskofpretermdeliveryinpregnantwomen
withgroupBstreptococcalurinaryinfectionsorurinaryantibodiestogroupBstreptococcalandE.coli
antigens.BrJObstetGynaecol.1994Feb.101(2):10713.[Medline].
4.[Guideline]AmericanAcademyofPediatricsandAmericanCollegeofObstetriciansandGynecology.
GuidelinesforPerinatalCare.AmericanAcademyofPediatrics.2007.6thed:
5.SmaillF.Asymptomaticbacteriuriainpregnancy.BestPractResClinObstetGynaecol.2007Jun.
21(3):43950.[Medline].
6.AlvarezJR,FechnerAJ,WilliamsSF,GaneshVL,ApuzzioJJ.Asymptomaticbacteriuriainpregestational
diabeticpregnanciesandtheroleofgroupBstreptococcus.AmJPerinatol.2010Mar.27(3):2314.
[Medline].
7.HollowellJG.Outcomeofpregnancyinwomenwithahistoryofvesicouretericreflux.BJUInt.2008Sep.
102(7):7804.[Medline].
8.GhafariA,SanadgolH.Pregnancyafterrenaltransplantation:tenyearsinglecenterexperience.
TransplantProc.2008JanFeb.40(1):2512.[Medline].
9.VersiE,ChiaP,GriffithsDJ,HarlowBL.Bacteriuriainpregnancy:acomparisonofBangladeshiand
Caucasianwomen.IntUrogynecolJPelvicFloorDysfunct.1997.8(1):812.[Medline].
10.MazorDrayE,LevyA,SchlaefferF,SheinerE.Maternalurinarytractinfection:isitindependently
associatedwithadversepregnancyoutcome?.JMaternFetalNeonatalMed.2009Feb.22(2):1248.
[Medline].
11.SheinerE,MazorDreyE,LevyA.Asymptomaticbacteriuriaduringpregnancy.JMaternFetalNeonatal
Med.2009May.22(5):4237.[Medline].
12.WhiteheadNS,CallaghanW,JohnsonC,WilliamsL.Racial,ethnic,andeconomicdisparitiesinthe
prevalenceofpregnancycomplications.MaternChildHealthJ.2009Mar.13(2):198205.[Medline].
13.HillJB,SheffieldJS,McIntireDD,WendelGDJr.Acutepyelonephritisinpregnancy.ObstetGynecol.2005
Jan.105(1):1823.[Medline].

http://emedicine.medscape.com/article/452604differential

2/3

8/13/2016

UrinaryTractInfectionsinPregnancyDifferentialDiagnoses

14.CollierCH,RisnesK,NorwitzER,BrackenMB,IlluzziJL.Maternalinfectioninpregnancyandriskof
asthmainoffspring.MaternChildHealthJ.2013Dec.17(10):194050.[Medline].
15.EasterSR,CantonwineDE,ZeraCA,LimKH,ParrySI,McElrathTF.Urinarytractinfectionduring
pregnancy,angiogenicfactorprofiles,andriskofpreeclampsia.AmJObstetGynecol.2016Mar.214
(3):387.e17.[Medline].
16.[Guideline]U.S.PreventiveServicesTaskForce.Screeningforasymptomaticbacteriuriainadults:U.S.
PreventiveServicesTaskForcereaffirmationrecommendationstatement.AnnInternMed.2008Jul1.
149(1):437.[Medline].
17.DuarteG,MarcolinAC,QuintanaSM,CavalliRC.[Urinarytractinfectioninpregnancy].RevBrasGinecol
Obstet.2008Feb.30(2):93100.[Medline].
18.MillarLK,CoxSM.Urinarytractinfectionscomplicatingpregnancy.InfectDisClinNorthAm.1997Mar.
11(1):1326.[Medline].
19.KodikaraH,SeneviratneH,KaluarachchiA,CoreaE.Diagnosticaccuracyofnitritedipsticktestingforthe
detectionofbacteriuriaofpregnancy.PublicHealth.2009May.123(5):3934.[Medline].
20.GilstrapLC3rd,RaminSM.Urinarytractinfectionsduringpregnancy.ObstetGynecolClinNorthAm.2001
Sep.28(3):58191.[Medline].
21.WidmerM,GlmezogluAM,MigniniL,RogantiA.Durationoftreatmentforasymptomaticbacteriuria
duringpregnancy.CochraneDatabaseSystRev.2011.(12):CD000491.[Medline].
22.MathaiE,ThomasRJ,ChandyS,MathaiM,BergstromS.Antimicrobialsforthetreatmentofurinarytract
infectioninpregnancy:practicesinsouthernIndia.PharmacoepidemiolDrugSaf.2004Sep.13(9):64552.
[Medline].
23.MillarLK,WingDA,PaulRH,GrimesDA.Outpatienttreatmentofpyelonephritisinpregnancy:a
randomizedcontrolledtrial.ObstetGynecol.1995Oct.86(4Pt1):5604.[Medline].
24.FDADrugSafetyCommunication:FDAadvisesrestrictingfluoroquinoloneantibioticuseforcertain
uncomplicatedinfectionswarnsaboutdisablingsideeffectsthatcanoccurtogether.U.S.FoodandDrug
Administration.Availableathttp://www.fda.gov/drugs/drugsafety/ucm500143.htm.May12,2016
Accessed:July21,2016.
25.VazquezJC,AbalosE.Treatmentsforsymptomaticurinarytractinfectionsduringpregnancy.Cochrane
DatabaseSystRev.2011Jan19.CD002256.[Medline].
26.WidmerM,GlmezogluAM,MigniniL,RogantiA.Durationoftreatmentforasymptomaticbacteriuria
duringpregnancy.CochraneDatabaseSystRev.2011Dec7.12:CD000491.[Medline].
27.BozkurtY,PenbegulN,SoylemezH,AtarM,SancaktutarAA,YildirimK,etal.Theefficacyandsafetyof
ureteroscopyforureteralcalculiinpregnancy:ourexperiencein32patients.UrolRes.2012Jan4.
[Medline].
28.LichtenbergerP,HootonTM.Antimicrobialprophylaxisinwomenwithrecurrenturinarytractinfections.Int
JAntimicrobAgents.2011Dec.38Suppl:3641.[Medline].
29.ACOG.ACOGeducationalbulletin.Antibioticsandgynecologicinfections.AmericanCollegeof
ObstetriciansandGynecologists.Number237,June1997(ReplacesNo.153,March1991).IntJGynaecol
Obstet.1997Sep.58(3):33340.[Medline].
30.RouseDJ,AndrewsWW,GoldenbergRL,OwenJ.Screeningandtreatmentofasymptomaticbacteriuriaof
pregnancytopreventpyelonephritis:acosteffectivenessandcostbenefitanalysis.ObstetGynecol.1995
Jul.86(1):11923.[Medline].
31.ThurmanAR,SteedLL,HulseyT,SoperDE.Bacteriuriainpregnantwomenwithsicklecelltrait.AmJ
ObstetGynecol.2006May.194(5):136670.[Medline].
32.KazemierBM,SchneebergerC,DeMirandaE,VanWassenaerA,BossuytPM,VogelvangTE.Costsand
effectsofscreeningandtreatinglowriskwomenwithasingletonpregnancyforasymptomaticbacteriuria,
theASBstudy.BMCPregnancyChildbirth.2012.12:52.[Medline].
33.WingDA,RumneyPJ,PreslickaCW,ChungJH.Dailycranberryjuiceforthepreventionofasymptomatic
bacteriuriainpregnancy:arandomized,controlledpilotstudy.JUrol.2008Oct.180(4):136772.[Medline].
[FullText].
34.UehlingDT,HopkinsWJ,ElkahwajiJE,SchmidtDM,LeversonGE.Phase2clinicaltrialofavaginal
mucosalvaccineforurinarytractinfections.JUrol.2003Sep.170(3):8679.[Medline].
35.MannJR,McDermottS.AreMaternalGenitourinaryInfectionandPreEclampsiaAssociatedWithADHD
inSchoolAgedChildren?.JAttenDisord.2010Sep13.[Medline].
36.SunY,VestergaardM,ChristensenJ,NahmiasAJ,OlsenJ.Prenatalexposuretomaternalinfectionsand
epilepsyinchildhood:apopulationbasedcohortstudy.Pediatrics.2008May.121(5):e11007.[Medline].
MedscapeReference2011WebMD,LLC

http://emedicine.medscape.com/article/452604differential

3/3