History of Present Illness: This 26-year-old African-American female, Lily R., reports that for the last four weeks, she has been constantly going to the bathroom to urinate, and experiences a burning sensation whenever she eliminates. She states that she literally has to go to the bathroom every hour or two; in addition, she states that her urine has a very strong odor which is different than anything she has ever noticed. She wonders aloud if the infection may have been caused by the fact that she has switched methods of birth control so that she has been using a diaphragm for about five or six weeks. This occurred because she had begun having a sporadic sexual relationship with a man who refuses to use condoms, and expects her to use the birth control method for the couple. She has tried drinking cranberry juice, which was suggested to her by a family member, in order to get rid of the problem, but has only found that as time goes on, it seems to get worse.
The patient reports that she has only had a urinary tract infection once before, about four years ago, and it followed a bout with severe diarrhea; her doctor suggested that bacteria from her rectal area had entered the vagina, leading to the infection. At that time, she was treated with a 10 day course of antibiotics, and the infection seemed to clear up almost immediately.