Dysuria

 

Dysuria is the sensation of pain, burning, or discomfort on urination. It is more common in women than men; approximately 25% of women report one episode of acute dysuria each year. It is most common in sexually active women betwee 25-54. In men, it becomes more prevalent with increasing age.

 

Causes of Dysuria

Infections are the most common cause of dysuria. Non-infectious causes include hormonal conditions, obstruction (BPH, urethral strictures), neoplasms, allergic reactions, chemicals, foreign bodies, or trauma.

 

infection

pathogens

signs and symptoms

emperic treatments

UTI/cystitis

E coli, S. saphrophyticus, Proteus mirabilis, Enterobacter, Klebsiella, Pseudomonas

 

internal dysuria throughout urination; frequency, urgency, incontinence, hematuria, nocturia, back pain, suprapubic discomfort, low grade fever

  

urethritis

C. trachomatis, N. gonorrhea, Trichomonas, Candida, herpes

initial dysuria, urethral/vaginal discharge, history of STI

  

vaginitis

Candida, Gerdnerella, Trichomonas, C. trachomatis, herpes, lichen sclerosis

external dysuria/pain, vaginal discharge, irritation, dyspareunia, abnormal vaginal bleeding

  

prostatitis

E coli, C. trachomatis, S. Saphrophyticus, Proteus mirabilis, Enterobacter, Klebsiella, Pseudomonas

dysuria, fever, chills, urgency, frequency, tender prostate

  

pyelonephritis

E coli, S. Saphrophyticus, Proteus mirabilis, Enterobacter, Klebsiella, Pseudomonas

internal dysuria, fever, chills, flank/groin pain, CVA tenderness, nausea or vomiting

  

 

Investigations

In a history and physical suggesting uncomplicated UTI, emperic treatment can be instituted. Urinalysis can be performed by dipstick or microscopy.

With pyuria, bactiuria, or hematuria, urinalysis and C&S should be carried out.

If vaginal/urethral discharge is present, perform wet mount, Gram stain, KOH test, vaginal pH, culture for yeast and Trichomonas.

Endocervical/urethral swabs can be done for N gonorrhae and C. trachomatis.

In an atypical presentation, radiologic studies should be done.

Renal U/S or voiding cystourethrogram (VCUG) should be done in children with >1 UTI.

 

Management

Pregnant women with bactiuria should be treated, even if asymptomatic. Monthly urine cultures should be done and treated if still infected.

In patients with recurrent UTIs, (ie >3 yearly) consider prophylactic antibiotics.