First signs of cystitis: when a written questionnaire is enough, and when it is not
Here you can ask a doctor to assess the first symptoms of cystitis in writing, and this page explains when that makes sense and when you need to be seen. The route is only for uncomplicated bladder infections in adult women who are not pregnant. Some symptoms that feel like cystitis turn out to be something else, and mild cases sometimes settle on their own, so the doctor's first question is whether an antibiotic is needed at all.
What the first symptoms usually are
Cystitis is an infection of the bladder. In women it is common, because the urethra is short and bacteria from the skin around it reach the bladder easily. The typical start is a burning or stinging feeling when passing urine, needing to go more often and more urgently, passing only small amounts, and a dull ache low in the tummy above the pubic bone. Urine may look cloudy, smell stronger than usual or show a trace of blood.
What matters for this route is what is not there. Fever, shivering, pain in the side or the lower back and vomiting suggest that the infection may have reached the kidneys. Unusual vaginal discharge or itching points more towards thrush or a sexually transmitted infection, which need different treatment. Burning on passing urine can be a symptom of all of these, so the questionnaire asks about each one separately.
When a written questionnaire makes sense
A doctor can reasonably assess cystitis from written answers when the picture is clear and uncomplicated: you are an adult woman who is not pregnant, the symptoms are the typical ones, they started recently, you have no fever, back pain or vomiting, and this is not one of a run of repeated infections. In that situation the decision does not usually depend on an examination.
That decision is not automatically an antibiotic. NICE guideline NG109 asks prescribers to take account of how severe the symptoms are, the risk of complications and the risk of resistant bacteria, because every unnecessary course makes the next infection harder to treat. The doctor may conclude that an antibiotic is appropriate, may suggest a urine test first, or may advise you that self-care is the right first step. Drinking enough fluid and taking a simple painkiller you would normally use can ease the discomfort.
When it is not enough: reasons to be seen in person
Some situations need a doctor who can examine you or test your urine. A urinary infection in a man needs an examination in person. In pregnancy, urinary infections are managed by the GP or maternity team looking after you. Fever, chills, pain in the side or lower back, or vomiting can mean a kidney infection: contact a GP or a GP out-of-hours service urgently, and go to an Emergency Department if you feel very unwell.
Symptoms that have lasted more than a week need a urine test and a visit to a doctor. So do repeated infections, meaning a third in a year or a second within six months, because they deserve a look at the cause rather than another course. A catheter, kidney disease or diabetes make complications more likely. Blood in the urine that continues after the infection has settled should be checked by a GP. And if you have started an antibiotic and your symptoms get worse at any point, or have not begun to improve within 48 hours, contact a doctor.
What the questionnaire asks, and why
Alongside your symptoms and when they began, the questionnaire asks a short set of safety questions: whether you are male; whether you have a fever, chills, pain in your side or lower back, or vomiting; whether you are pregnant; whether the symptoms have lasted longer than seven days; whether this is at least your third infection in a year or your second in six months; whether you have a urinary catheter, kidney disease or diabetes; and whether you have unusual vaginal discharge or itching. Some answers bring up a message explaining that you need to be seen in person, and the doctor reads every answer before deciding.
Also mention any allergy to antibiotics, your other medicines, any recent antibiotic and any urine test result you already have. Each new infection is assessed as its own episode, so repeating last time's antibiotic is not automatically right.
If an antibiotic is appropriate: the usual options
Three antibiotics are commonly used for uncomplicated cystitis in women: nitrofurantoin, trimethoprim and fosfomycin. Nitrofurantoin is taken as a short course; it is not suitable when kidney function is reduced, it can turn urine dark yellow or brown, which is harmless, and it can cause nausea or headache. Trimethoprim is also a short course and is chosen when resistance to it is unlikely; it interacts with a number of other medicines, so the full list of what you take matters. Fosfomycin is a single dose of granules dissolved in water, and diarrhoea and nausea are among its more common side effects.
The doctor chooses between them on the basis of your allergies, kidney function, other medicines and any recent antibiotic use, and states the dose and duration on the prescription. Take it exactly as prescribed, and finish the course even once you feel better.
How the prescription reaches you
There is no video call, no phone appointment and no live chat; a doctor reads your answers and replies in writing. He may ask for a urine test result, may advise you to be seen, or may decline. Because the reply depends on the doctor's queue, this is not the route for severe symptoms or for feeling unwell, where a GP or out-of-hours service is the right place to go. Prescriptions are issued by lek. Damian Wojno, a doctor registered in Poland, PWZ no. 3211301.
If an antibiotic is appropriate, you receive a cross-border prescription as a PDF by email. Print it and bring it to a pharmacy with photo identification; there is no PIN code. The pharmacist decides whether to dispense, and the antibiotic is priced and paid for at the pharmacy, separately from the assessment.
Do I always need an antibiotic for cystitis?
Not always. Mild symptoms sometimes settle with fluids and simple pain relief, and guidance asks prescribers to weigh whether an antibiotic is really needed because of resistance. The doctor decides, and he may also suggest a urine test.
Can I just repeat the antibiotic I had last time?
Not automatically. A new infection is assessed as its own episode, taking into account your symptoms, kidney function, other medicines and any recent antibiotic use, so the doctor may choose a different option or none.
What should I do if I develop a fever after starting treatment?
Contact a GP or a GP out-of-hours service urgently. Fever, shivering, pain in the side or lower back, or vomiting can mean the infection has reached the kidneys, which needs an examination.
I have had cystitis several times this year. Can I use this?
If this is your third infection in a year or your second in six months, it is better to see your GP, who can test your urine and look for a cause rather than treat each episode separately.