Scenario: A 28-year-old woman presents to the clinic with symptoms of a urinary tract infection (UTI) for the fourth time in 5 months. The woman describes urinary frequency and dysuria. The woman denies blood in the urine or a foul smell to the urine. A clean catch urine specimen demonstrates cloudiness, alkaline pH, increased nitrites, and leukocyte esterase. Some mucus is present, as well as bacterial overgrowth. The woman indicates that she uses proper hygiene measures by wiping from front to back, has completed the full course of antibiotics previously prescribed, wears cotton underwear, avoids tub baths, and drinks increased fluids each day to encourage voiding. Upon further discussion, the woman reveals the use of a diaphragm and spermicide for birth control. The previous urine culture from the last UTI demonstrated gram-positive cocci, which were not present in the most recent UTI culture. The woman is not currently pregnant.

1. What risk factor(s) for UTI does the woman demonstrate?
2. What are the differential diagnoses for this patient?
3. What additional medication management should be considered? Provide full prescription details.
4. What patient education should be considered?
5. What would your follow-up care for this patient include?
6. Would this be considered a complicated or uncomplicated UTI. What are the differences in treatment for each? How does the management change based on this knowledge?

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