CHART NOTE SUBJECTIVE: This is a 24-year-old white married female with complaints of urinary burning and frequency beginning

approximately five days ago. She denies any prior urinary problems. Shes had no chills, fever, flank pain or hematuria. She has noted nocturia x3 since the onset of her symptoms. Shes had no nausea and abdominal pain. She denies vaginal discharge or itching. Last menstrual period begun 17 days ago. Shes on Demulen 135/28 for birth control but has taken no other medicines. She is sexually active in a stable and apparently exclusive marital relationship. Her general health is good and she denies recent URI. She has never been pregnant. OBJECTIVE: Temperature 98.6, pulse 72, and regular blood pressure 116/80. Patient is alert and in no distress. Her skin is pale, warm and dry. There is no costovertebral angle tenderness and palpation of the abdomen indicates no masses or organomegaly. The bladder is not palpable or tender. On pelvic exam, there is no evidence of vulvar edema, erythema and no discharge. The cervix is clean and only scant mucoid material is seen in the vault. She had a negative (class 1) pap smear about eight months ago. Bimanual exam reveals a normal size uterus which is slightly retroflexed. The adnexal areas are normal. There are no masses or abnormal tenderness and the rectal examination is negative. A clean voided urine shows 15-20 WBCs/ higher power field, 8-10 red cells, 4+ occult blood, 1+ protein, negative for sugar and pH 5.5. ASSESSMENT: Acute cystitis PLAN: 1. A Septra DS 1 b.i.d. x7 days. 2. Pyridium 200 mg q. 4-6h. p.r.n. for burning. 3. Increase oral fluids. 4. I discussed the probable origin of her condition was a patient and advice to make a practice of voiding immediately after the intercourse in future. 5. The patient is to report back in one week for repeat urinalysis and to see me and to call in the day after tomorrow if she has any persisting symptoms.