Cystitis in women: online assessment for an uncomplicated bladder infection
Women with cystitis symptoms can have a simple bladder infection assessed here from a written questionnaire, including whether an antibiotic is needed. The route is only for adult women who are not pregnant and whose symptoms point to a simple lower urinary tract infection. Fever, pain in the side or back, vomiting, pregnancy and urinary symptoms in men all need a doctor who can see you.
Who this route is for
Cystitis is inflammation of the bladder, usually caused by an infection. Typical symptoms are burning or stinging when passing urine, needing to go more often and more urgently, cloudy or strong-smelling urine and pain low in the tummy. It is very common in women, and the HSE notes that it often gets better in a few days without treatment.
An online assessment fits an adult woman who is not pregnant, is otherwise well and has these symptoms without fever or back pain. Irish antibiotic guidance for uncomplicated infection is written for women under 65; if you are 65 or older, the HSE advises contacting your GP, and men and pregnant women should always be seen in person.
How the assessment works
The questionnaire asks about your symptoms and how long you have had them, earlier urinary infections and any urine results, allergies, kidney problems and the medicines you take, plus the safety questions below. A doctor reads it and decides whether an antibiotic is likely to help. He may ask a question, suggest a urine test, recommend pain relief and fluids while the infection settles, or advise you to see a GP. There is no video consultation, no phone appointment and no live chat.
If an antibiotic is appropriate, the prescription is emailed to you as a PDF. Through the HSE Common Conditions Service a pharmacist can also sometimes diagnose and treat cystitis directly, for a fee, which may suit you if you would rather be seen in person.
The questions about your safety
You will be asked whether you are male; whether you have a fever, chills, pain in your side or lower back, or vomiting; and whether you are pregnant. Each of these means the infection needs to be assessed in person. You will also be asked whether symptoms have lasted more than seven days, whether this is at least your third infection in a year or your second in six months, and whether you have a urinary catheter, kidney disease or diabetes.
The last question asks about unusual vaginal discharge or itching, which can point to thrush or a sexually transmitted infection rather than cystitis. A yes to one of the serious questions brings up a short note explaining where to go instead.
Antibiotics used in Ireland
HSE guidance for uncomplicated infection in non-pregnant women places nitrofurantoin first, as a short course. It acts in the urine rather than in the rest of the body, resistance to it remains low across Ireland, and it is not used when kidney function is significantly reduced or when the infection has reached the kidneys.
Where nitrofurantoin is unsuitable, trimethoprim is an alternative only when resistance is unlikely, for example when an earlier urine culture showed the bacteria were sensitive to it, and cefalexin is another option. Fosfomycin, taken as a single dose, is kept as a second-line choice, and a urine sample should be sent for culture before it is started. Nausea is a common side effect of nitrofurantoin, and any antibiotic allergy must be mentioned in the questionnaire.
An antibiotic only when it helps
Not every bladder infection needs an antibiotic. Mild symptoms often settle with fluids and pain relief such as paracetamol or ibuprofen, if those suit you, and the doctor may advise starting the antibiotic only if things do not improve over a couple of days. Unnecessary courses drive resistance, which is why a new infection is assessed on its own symptoms rather than treated with whatever helped last time.
If symptoms are not improving after two days of treatment, or you have taken antibiotics recently, a urine sample sent for culture shows which antibiotic the bacteria respond to.
When to see a doctor in person
Contact a GP urgently, or a GP out-of-hours service or emergency department if your GP is closed, if you have pain in your side or lower back, a high temperature, shivering, vomiting or confusion, because these can mean a kidney infection.
Make a GP appointment if there is blood in your urine, if symptoms have not improved after three days or after a course of antibiotics, if infections keep coming back, if you are pregnant, or if you are a man with urinary symptoms. Symptoms lasting longer than a week need a urine test and an examination rather than another online assessment.
The prescription and the pharmacy
The PDF follows the Annex to Commission Implementing Directive 2012/52/EU and names the antibiotic by its active substance, with strength, quantity and dosage. It is issued by lek. Damian Wojno, registered with the Polish Medical Chamber under licence no. 3211301, who is not on the Irish Medical Council register.
An antibiotic prescription is written for the infection you have now, so take it to a pharmacy promptly, printed, with photo identification. The pharmacist checks the document and decides whether to dispense; the PSI guidance on prescriptions from other EEA countries does not oblige anyone. The antibiotic is paid for at the pharmacy.
Can I get antibiotics for cystitis online in Ireland?
Yes, if your answers show an uncomplicated bladder infection and the doctor judges that an antibiotic is needed. Antibiotics are prescription-only medicines in Ireland, and the doctor may instead advise waiting, a urine test or a GP visit.
Can I just repeat the antibiotic I had last time?
No. Each infection is assessed on its own symptoms. Earlier urine culture results help the doctor choose, so mention them, but leftover tablets or an old prescription should not be used.
Do I need a urine test?
Not always for a typical first episode. A urine sample for culture is useful when symptoms have not improved on treatment, after recent antibiotics or when infections keep returning, and the doctor may ask you to arrange one through your GP.
Is this service suitable for men?
No. Urinary symptoms in men need an examination, so please contact your GP.
What if I am pregnant?
Please contact the GP or maternity team looking after your pregnancy. Urinary infections in pregnancy are treated differently and need follow-up.