Internal Medicine

0521779407-21 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:59

Urethritis Urinary Incontinence 1491

Relative: if a patient is not likely to be compliant with the 7-day

course of therapy. Then, treat with azithromycin single dose.

follow-up

■The patient should be instructed to return for evaluation if symptoms

persist or if they recur after completion of therapy.

■If symptoms recur, laboratory documentation of urethritis needs to

be substantiated.

■Patient should not have sexual intercourse until 7 days after therapy

is initiated or until sexual contacts have been treated.

complications and prognosis

Complications

■The major complication is a reaction to one of the antimicro-

bial agents. Rarely, urethral stricture occurs, if untreated. Post-

Chlamydia, Reiter syndrome can develop.

Prognosis

■Most patients respond promptly to appropriate therapy.

■Re-infection usually relates to initiation of sexual intercourse with

untreated sexual partner.

■Prevention and treatment of urethritis is one of the mainstays of

reducing sexually transmitted diseases.

■Some authorities recommend re-examination within a year of all

patients with urethritis because of high recurrence rates.

■In some settings, such as adolescent women, re-examination within

3 months is indicated.

URINARY INCONTINENCE

ELIZABETH TAKACS, MD; GARY E. LEMACK, MD;

and PHILIPPE ZIMMERN, MD

history & physical

History

■Determine onset, duration, evolution and inciting event (cough,

sneeze, laugh, change of position, sport, sex, urge to void, unaware)

■Other symptoms: urge, frequency, nocturia, straining to urinate,

hematuria, recurrent urinary tract infections

■Detail patient’s attempts to improve symptoms (medications, pre-

vention by frequent voiding, Kegel exercises).