Asymptomatic UTI, Symptomatic Stupidity

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Every time we come across a midlevel social media consult, we sacrifice several brain cells, and this post in the "Nurse Practitioner Newbies" Facebook group is no exception. "What is prescribed for 20 y.o. pregnant woman asymptomatic UTI?" The complete lack of proper English grammar here is about as inexcusable as the question itself. And what the fuck is an "asymptomatic UTI"? By definition, it's not a UTI if the patient is asymptomatic - likely this n00b midlevel really means asymptomatic bacteriuria.

In any case, this isn't even something that deserves to be called a "newbie" question. This is the kind of basic, fundamental shit that gets drilled into the heads of every medical student that makes it to day two of their third-year core OB/GYN rotation. This is the kind of basic, fundamental shit that medical students get tested on inside and out on shelf exams and the USMLE Step 2/3. This is the kind of basic, fundamental shit that has an entire fucking UpToDate article devoted to it in nauseating detail. In fact, UpToDate has an entire goddamned chart devoted to the very topic of what antibiotics to use for asymptomatic bacteriuria and cystitis in pregnancy, for anyone who could be bothered to spare the 10 seconds to look it up. A blurred version is shown below, so as to discourage any midlevels too lazy to put in the effort to do their own research.

Disease pathophysiology doesn't dumb itself down to compensate for the gross clinical and educational deficits of midlevels, and patients don't deserve to suffer medical malpractice at the hands of incompetent midlevels. Quite frankly, anyone who didn't learn about the management of urinary tract infections and asymptomatic bacteriuria has no fucking business touching patients, especially pregnant ones. If these kinds of vexing clinical dilemmas are the product of nurse practitioner education in the United States...God help us all.