Review Question - QID 211032

A 54-year-old woman comes to the office with increased urinary frequency and dysuria. She goes to the bathroom 6-8 times a day with pain at the end of her urinary stream. She denies fever, abdominal pain, vaginal discharge, or hematuria. Her husband says that they "also don’t have sex as much as we used to.” The patient reports that even when she is “in the mood,” sex is “no longer pleasurable.” She feels guilty about this. The patient’s last menstrual period was 15 months ago. Her medical history is significant for hyperlipidemia and coronary artery disease. She had a non-ST elevation myocardial infarction (NSTEMI) 3 months ago, and she has had multiple urinary tract infections in the past year. She smokes 1 pack of cigarettes a day and denies alcohol or illicit drug use. Her temperature is 98.7°F (37°C), blood pressure is 132/82 mmHg, pulse is 73/min, respirations are 12/min, and oxygen saturation is 98% on room air. Her body mass index is 32 kg/m^2. Pelvic examination reveals vaginal dryness and vulvar tissue thinning. A urinalysis is obtained as shown below:

Urinalysis
Glucose: Negative
WBC: 25/hpf
Bacterial: Many
Leukocyte esterase: Positive
Nitrites: Positive

The patient is prescribed a 5-day course of nitrofurantoin. Which of the following is the most appropriate additional management for the patient’s symptoms?