A 23-Year-Old Woman Is Being Evaluated for Recurrent Episodes of Urinary

A 23-year-old woman is being evaluated for recurrent episodes of urinary tract infection.  She has had 5 episodes of cystitis and an episode of pyelonephritis over the past year.  The symptoms tend to occur a few days following sexual intercourse.  The patient has no other medical problems and takes no medications.  Her temperature is 36.7 C (98 F) , blood pressure is 110/70 mm Hg, respirations are 16/min, and pulse is 65/min.  Abdominal and genitourinary examinations are normal.  Which of the following is the most likely predisposing factor for pyelonephritis in this patient?

A) Frequent voiding
B) Hematogenous bacterial spread
C) Suppression of endogenous flora
D) Urethral colonization
E) Vesicoureteral urine reflux

Correct Answer:

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