Form for the Diagnosis: Price € 19.90 You will only pay if you have to issue a prescription for treatment With this form our experts will assess your symptoms to diagnose if you have a urine infection or if on the contrary, you could suffer another health problem. In case of a urinary infection, your antibiotic treatment will be sent with the valid printable recipe for any European pharmacy and a series of recommendations to avoid future infections. If you do not have symptoms suggestive of urine infection and therefore should not be treated with antibiotics, we will explain and you will not be cost. We hope to help you. Thank you for your trust. Personal information Age SexManWoman Indicate if you have any allergies to any medications: No Penicillins: ampicilina (Amplipeni®, Pembrintin®, britapren), amoxicilina (augmentine®, Amoxiclin®, Amoxil®, Velamox®. Clamoxyl®), Penicilina G, pivmecillinam, etc. Cephalosporins: cefuroxima (zinnat®, nivador®, selan®), cefixima (denvar®), ceftriaxona, cefepime, cefazolina, cefotaxima (claforan®), ceftibuteno (cedax®), cefditoren(meiact®), cefpodoxime proxetil, etc. Quinolones: ciprofloxacino (baycip®, cetraxal®) , norfloxacino (noroxin®), ofloxacino, levofloxacino (tavanic®), etc. Sulfamethoxazole + Trimethoprim: cotrimoxazol (Bactrin®, Septrin®, Bactifel®, Neocoliq®). Fosfomycin: monurol®, fosfocina®, solufos®, etc Relevant medical history: No Poorly controlled diabetes Mild and moderate renal impairment (I, II y III) Severe renal impairment(IV y V) Severe hepatic impairment Immunosuppression (treatment with chemotherapy, HIV with AIDS, transplanted) You are pregnant. Urological antecedents: No Nephrotic colic by lithiasis (stone) < 1 year. Vesicoureteral reflux Neurogenic bladder due to Multiple Sclerosis or other causes. Recurrent urinary tract infections (> 3 infections per year) Pyelonephritis or urine infection with fever in the last year Urine infection with associated stones Carry bladder catheter Prostatitis Stricture (narrowing) in the urethra Urine infection in the last month: No Yes, but I did not receive treatment Yes. I received treatment. Fosfomycin (Monurol or from the same family)Cephalosporins (zinnat, denvar, or from the same family)Penicillins (augmentine or from the same family)Quinolones (ciprofloxacin or from the same family)Cotrimoxazole (Septrin or from the same family) If yes in the previous question: My symptoms passed completely I was partially symptomatic I did not get the symptoms Time of reappearance of the symptoms of new infection in the case of having presented an infection in the last month: I did not have New symptoms in less than 1 week New symptoms in more than 1 week Which are your current symptoms: Pain or itching when you urinate Feeling of having to run to the toilet and urinate little Urinating many times and few Pain, discomfort or heaviness or discomfort in the suprapubic zone (under the belly) Blood in the urine Turbid and / or smelly urine Fever Lumbar pain radiated to bilateral inguinal / genital area (two sides) Lumbar pain radiated to unilateral inguinal / genital area (only one side) Vaginal itching or stinging (when not urinating) Vaginal redness Altered vaginal discharge (malodorous, thick, greenish) Perineal pain (between anus and genitals) Anal pain Low back pain Testicular pain Reactive strip (Optional) Nitrites: Positive Negative Leukocytes: 0 1+ 2+ 3+ 4+ Hematíes: 0 1+ 2+ 3+ 4+ I accept the privacy conditions of this form.