Background. Pediatric urinary tract infections (UTIs) are markers for genitourinary reflux or obstruction. Adult UTIs are treated by telephone triage without microbiologic study. The contrast between pediatric and adult UTIs prompted our retrospective review of adolescent UTIs.
Methods. Ninety-six adolescent girls without chronic illness, urogenital abnormalities, pregnancy, enuresis, or constipation had urine cultures with 100,000 colonies/[mm.sup.3].
Results. The 32 patients who were initially sexually active continued sexual activity (75%), became pregnant (25%), and had subsequent sexually transmitted diseases (STDs) (13%). There were no pregnancies, STDs, or subsequent UTIs in 9 patients who were not initially sexually active. The 55 patients with no documentation of sexual activity were comparable to those who were initially sexually active: 66% had evidence of sexual activity; 20% had subsequent pregnancy; 14% had subsequent STDs; and 42% had UTI recurrence.
Conclusion. Adolescents with UTIs have a significant frequency of sexual activity. Information about responsible sexual activity and access to care is important to adolescents, particularly those with UTIs.
IN PEDIATRIC PATIENTS, urinary tract infections (UTIs) are viewed as markers for anatomic abnormalities, resulting from urinary obstruction or vesicoureteral reflux. (1-3) In contrast, adult women having acute cystitis may be treated by telephone triage for 3 days, without a microbiologic study. (4) In healthy women between the ages of 18 and 40 years, there is a positive association between the frequency of sexual intercourse and the frequency of UTIs, hence the term "honeymoon cystitis." (5,6) The contrast between the pediatric UTI experience and that of adults raises questions about the relationship of sexual activity to UTI for adolescents. We studied adolescent girls to measure the relationship of UTIs retrospectively to sexual activity.
The study design involved a retrospective chart review of female adolescents between 10 and 18 years old with a diagnosis of UTI between January 1, 1996, and December 31, 1998. The study was approved by the Institutional Review Board at Scott & White Hospital in Temple, Texas. Medical information was obtained through the Scott & White system of computerized visit and laboratory reports. Patients included in the study were treated in the Scott & White Clinic and Hospital system (pediatric, family medicine, obstetrics and gynecology, or medicine clinics, the emergency department, or the hospital), and had confirmed urine culture of more than 100,000 colonies/ [mm.sup.3]. Initial sampling of patients from the Computerized Data Analysis Laboratory at Scott & White Clinic and Hospital identified 667 separate patient encounters for UTI; many patients had multiple encounters, particularly those with anatomically abnormal genitourinary systems. Patients were excluded if they had chronic illnesses (eg, cystic fibrosis , cerebral palsy,...