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Recurrent uncomplicated UTI — USMLE Step 3 MCQ

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HardAmbulatory Medicine / Primary CareRecurrent uncomplicated UTIUSMLE Step 3

A premenopausal woman has four culture-confirmed uncomplicated cystitis episodes in 8 months, nearly all within 24 hours of intercourse. Anatomy is normal and she wants to minimize antibiotic exposure. What is the best preventive strategy after discussing nonantibiotic measures?

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Correct answer: A — Take one culture-directed antimicrobial dose after intercourse

The best answer is “Take one culture-directed antimicrobial dose after intercourse”. For clearly intercourse-associated recurrent cystitis, postcoital prophylaxis targets the exposure with less total antimicrobial use than continuous therapy. Agent choice reflects cultures, allergy, and local resistance. Intercourse-associated recurrent cystitis may be prevented with single-dose postcoital antimicrobial prophylaxis.

Reference: AUA Recurrent UTI Guideline: https://www.auanet.org/guidelines-and-quality/guidelines/recurrent-uti