Lyme Disease

C.J. is a 33-year-old White female referred to infectious disease as a new patient for chronic, complicated UTI. She recalls her first UTI about 18 months ago and has since received multiple oral antibiotic courses, including ciprofloxacin (Cipro®), cephalexin (Keflex®), cefdinir, nitrofurantoin (Macrobid®), and fosfomycin; she cannot swallow pills and requires crushed or liquid formulations. She reports weeks-to-months of persistent flank/low back aching with dysuria and urinary frequency, along with chronic fatigue. She denies fever, chills, weakness, shortness of breath, chest/abdominal/pelvic pain, myalgias/arthralgias, hematuria, or passing visible stones. She continues to work full-time and has not missed work, though she feels long hours and infrequent bathroom breaks may be contributing.