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Dysuria in Women
Aka: Dysuria in Women, Urethritis in Women
- See Also
- Dysuria
- Dysuria in Men
- Urinary Tract Infection
- Periuretheral Contact Dermatitis in Women
- Causes
- See Dysuria for non-gender specific causes
- See Periuretheral Contact Dermatitis in Women
- Urinary Tract Infection
- Acute Cystitis
- Pyelonephritis
- Genital Herpes (HSV II)
- Urethritis
- Gonorrhea
- Chlamydia
- Vulvodynia
- Vaginitis
- Candidal Vaginitis
- TrichomonasVaginitis
- Atrophic Vaginitis (post-Menopause)
- Interstitial Cystitis
- Urethral Syndrome
- Acute Cystitis symptoms and normal urine
- History: Associated symptoms and contributing factors
- See Dysuria
- See Periuretheral Contact Dermatitis in Women
- Pregnancy, current Contraception and Last Menstrual Period
- Vaginal Discharge or vaginal irritation
- Exam
- Abdominal exam
- Abdominal tenderness (e.g. suprapubic tenderness)
- Flank tenderness (Costovertebral Angle Tenderness)
- Suprapubic fullness (Bladder Distention)
- Female genitourinary exam
- Vulvar lesions (e.g. vessicles or ulcerations)
- Inguinal Lymphadenopathy
- Vaginal Discharge
- Vaginal Atrophy
- Cervical discharge
- Cervical motion tenderness
- Skin exam
- Localized genitourinary dermatitis (e.g. HSV, Contact Dermatitis, chronic inflammatory condition)
- Symptoms and Signs
- See Urinary Tract Infection
- See Vaginitis
- See Vaginal Discharge
- See Dyspareunia
- Evaluation
- Urine Sample
- Urinalysis
- Urine Culture
- Vaginitis suspected: Vaginal Discharge examination
- KOH Preparation
- Saline Preparation (Wet Prep)
- Sexually active patient
- Urine Pregnancy Test
- Gonorrhea PCR and Chlamydia PCR
- Consider Gram Stain of cervical discharg
- Management: Persistent Dysuria with unremarkable evaluation
- Consider Topical or systemic irritants
- Discontinue offending agents
- Consider treating for Ureaplasma in sexually active women
- Doxycycline for 7 days or Azithromycin for 5 days
- Consider adding Metronidazole 2 g orally once (covers Trichomonas)
- Consider empiric trimethoprim
- 75% Respond to trimethoprim (25% for Placebo) who had Dysuria with negative UA/UC
- Richards (2005) BMJ 331:143-6 [PubMed]
- Consider Urge Incontinence or Overactive Bladder
- Pelvic Floor Exercises and Bladder TrainingExercises
- ' Consider regional pain sources
- Endometriosis
- Interstitial Cystitis
- Consider imaging or Consultation with urology
- Persistent Microscopic Hematuria not due to Menses
- Sterile pyuria (not due to Vaginitis, STI, dermatitis or other gynecologic cause)
- References
- Kurowski (1998) Am Fam Physician 57(9): 2155-64 [PubMed]
- Michels (2015) Am Fam Physician 92(9): 778-86 [PubMed]
- Roberts (1999) Am Fam Physician 60(3): 865-72 [PubMed]