Some Causes of Dysuria
Cause | Suggestive Findings | Diagnostic Approach |
|---|---|---|
Infectious disorders* | ||
Often cervical discharge History of unprotected intercourse | STI testing | |
Typically urinary frequency and urgency Sometimes bloody or malodorous urine Bladder tenderness | Clinical evaluation with or without urinalysis unless red flags† are present | |
Tender, swollen epididymis | Clinical evaluation | |
Enlarged, tender prostate Often history of obstructive symptoms | Clinical evaluation | |
Usually visible discharge History of unprotected intercourse | STI testing | |
Vaginal discharge Erythema of labia and introitus | Clinical evaluation, urinalysis, and culture to rule out UTI Consideration of catheterization to minimize contamination of specimen | |
Inflammatory disorders | ||
External inflammation Clinical history Family history | Clinical evaluation Urinalysis Imaging of the urinary tract and pelvis | |
Chronic symptoms No other, more common causes found | ||
Spondyloarthropathies (eg, reactive arthritis, Behçet syndrome) | Preceding GI or joint symptoms or both Sometimes skin and mucosal lesions | Clinical evaluation STI testing |
Other disorders | ||
Postmenopausal (including estrogen deficiencies due to medications, surgery, or radiation) Often dyspareunia Atrophy or erythema of vaginal folds | Clinical evaluation | |
Tumors (usually bladder, prostate, or urethral cancer) | Long-standing symptoms Usually hematuria without pyuria or infection | Cystoscopy, urine cytology Possible prostate biopsy or bladder biopsy |
* Common pathogens include nonsexually transmitted bacteria (mostly Escherichia coli, Staphylococcus saphrophyticus, Enterococcus, Klebsiella, and Proteus) and sexually transmitted pathogens (eg, Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum, Trichomonas vaginalis, herpes simplex virus). | ||
† Red flags are fever, flank pain or tenderness, recent instrumentation of the genitourinary tract, immunocompromised state, recurrent episodes, known urologic abnormalities, and male sex. | ||
GI = gastrointestinal; STI = sexually transmitted infection; UTI = urinary tract infection. | ||