Updated 06 July 2015

Answer: What's your diagnosis? – Case 17

In our latest case we met Mrs T (55) who complained of burning urine and occasional lower abdominal pain. Based on her history, examination and side room investigations, she most likely suffers from a urinary tract infection.


Mrs T, a 55 year old secretary, complained of burning urine and lower abdominal pain. Read the full case study here.

Urinary tract infections are common. Many women complain to their GPs about burning urine (dysuria), frequency (urinating more than usual), difficulty holding urine in (urgency) and occasionally pain over the bladder area (suprapubic pain).  Some women may also complain of a vaginal discharge.

What causes urinary tract infections?

The vagina is acidic in nature due to the presence of lactobacillus bacteria. This protects against invasion of other bacteria. If this protection barrier is breached due to a change in the acidity of the vagina, urinary tract infections may follow. Immune compromised people (like diabetics and HIV positive patients) are very prone to developing UTI’s.  Escherichia coli (E. coli) are the most common cause of UTI’s.

How do urinary tract infections present?

Mrs T has typical symptoms of a UTI. It is important to note that all women of childbearing age, despite being on birth control, should be tested for possible pregnancy. Often, in clinical practice, pregnancy or its complications (like ectopic pregnancy) are missed because testing was not done. This is potentially very dangerous.

Not all urinary tract infections present in the same way. Some patients may present with only some of the symptoms, while in some patients they may have only a fever with no urinary complaints. It is therefore very important to exclude urinary tract infections as a possible cause for fever of unknown origin or lower abdominal pain.

Diagnosing urinary tract infections

A proper history is very important in diagnosing a urinary tract infection. Urine testing is done to check for signs suggestive of an infection like the presence of nitrates, white cells (leucocytes) and even blood. (Remember the blood in most cases is not visible – this is what we call microscopic haematuria)

A urine sample may also be sent off to the laboratory where it will be examined under a microscope, cultured to identify the organism and tested against various antibiotics to determine which antibiotic the bacteria is sensitive to.

Treating urinary tract infections

Some urinary tract infections may resolve without any treatment. In some cases antibiotics may be needed. Antibiotics may be necessary in persistent cases or in more complicated cases where fever, pain and vaginal discharges for example are present.

Each case is treated on an individual basis. Depending on the symptoms, the possibility of complications and the patient’s medical history, a treatment plan will be formulated. 

NOTE: Health24's on-site GP Dr Owen Wiese reveals new cases on Thursdays. The answer is posted with the story on Mondays, or you can get it in our Daily Tip – sign up here.


Previously on What's Your Diagnosis?

What's your diagnosis - Case 1: vomiting and weight loss

What's your diagnosis - Case 2: eye pain

What's your diagnosis - Case 3: strange behaviour and a bullet in the back

What's your diagnosis - Case 4: seeing odd things

What's your diagnosis - Case 5: mysterious lungs

What's your diagnosis - Case 6: runner with seizures

What's your diagnosis - Case 7: swollen knee

What's your diagnosis - Case 8: bloody semen

What's your diagnosis - Case 9: confusing neurological signs

What's your diagnosis - Case 10:diabetic teenager with unusual signs and symptoms

What's your diagnosis - Case 11:bruising with no apparent cause

What's your diagnosis - Case 12: severe tummy pain

What's your diagnosis - Case 13: severe sore throat

What's your diagnosis - Case 14:abdominal pain and swelling

What's your diagnosis - Case 15: the world is spinning

What's your diagnosis - Case 16:numbness in forearm

Image: X-ray image with highlighted urinary tract from Shutterstock

Dr. Owen J. Wiese is Health24's resident doctor. After graduating from Stellenbosch University with additional qualifications in biochemistry and physiology he developed a keen interest in providing medical information through the media.


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