Form for the Diagnosis: Price € 19.90You will only pay if you have to issue a prescription for treatmentWith 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 informationAge SexManWomanIndicate if you have any allergies to any medications:NoPenicillins: 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®, etcRelevant medical history:NoPoorly controlled diabetesMild 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:NoNephrotic colic by lithiasis (stone) < 1 year.Vesicoureteral refluxNeurogenic 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 yearUrine infection with associated stonesCarry bladder catheterProstatitisStricture (narrowing) in the urethraUrine infection in the last month:NoYes, but I did not receive treatmentYes. 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 completelyI was partially symptomaticI did not get the symptomsTime of reappearance of the symptoms of new infection in the case of having presented an infection in the last month:I did not haveNew symptoms in less than 1 week New symptoms in more than 1 weekWhich are your current symptoms:Pain or itching when you urinateFeeling of having to run to the toilet and urinate littleUrinating many times and fewPain, discomfort or heaviness or discomfort in the suprapubic zone (under the belly)Blood in the urineTurbid and / or smelly urineFeverLumbar 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 rednessAltered vaginal discharge (malodorous, thick, greenish)Perineal pain (between anus and genitals)Anal painLow back painTesticular painReactive strip (Optional)Nitrites: Positive NegativeLeukocytes: 0 1+ 2+ 3+ 4+Hematíes: 0 1+ 2+ 3+ 4+I accept the privacy conditions of this form.