Box 1: Differential diagnosis for premenopausal women with symptoms of frequent urinary tract infections2

Diagnosis	Clinical features
Sexually transmitted infection	History of new sexual contacts
Bladder pain syndrome (interstitial cystitis)^*	Pain with a full bladder, which improves with voiding. Often associated with substantial urinary frequency.
Pelvic floor dysfunction^*	Vaginal pain, dyspareunia and urinary symptoms.
Overactive bladder^*	Urinary frequency and urgency, with or without urge incontinence.
Vaginal infection or vaginitis	Primary complaint is vaginal irritation, itch or discharge.
Bladder cancer	Gross or microscopic hematuria in the setting of negative urinary cultures. May have severe urinary frequency and urgency.

↵* For bladder pain syndrome, pelvic floor dysfunction and overactive bladder, symptoms persist over time with negative cultures and little response to antibiotics.