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Dysuria
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Dysuria
, Urethritis
See Also
Urinary Tract Infection
Urinary Tract Infection in Children
Dysuria in Women
Periuretheral Contact Dermatitis in Women
Dysuria in Men
Dysuria in Children
Definition
Burning or stinging of the
Urethra
with voiding
Causes
By Cohort
See
Dysuria in Women
See
Dysuria in Men
See
Dysuria in Children
Causes
Infectious
Urinary Tract Infection
Cyst
itis
Pyelonephritis
Urethritis
Sexually Transmitted Infection
s
White discharge
Neisseria
Gonorrhea
Watery or no discharge
Chlamydia trachomatis
(15-40% of cases)
Gut Flora
(following anal intercourse)
Genital
Herpes Simplex Virus
(
HSV II
)
Mycoplasma
genitalium
Ureaplasma
urealyticum
Trichomonas
vaginalis
Other genitourinary infections
Women
See
Dysuria in Women
Vulvovaginitis
(e.g.
Bacterial Vaginosis
,
Yeast Vaginitis
)
Cervicitis
Men
See
Dysuria in Men
Prostatitis
Epididymitis
or
Orchitis
Causes
Dermatologic
Contact Dermatitis
See
Periuretheral Contact Dermatitis in Women
Spermacidal gel
Topical deodorants
Lichen Sclerosus
Lichen Planus
Psoriasis
Behcet Syndrome
Causes
Medication and food causes of Dysuria
Medications
Dopamine
Cantharidin
Ticarcillin
Penicillin
G
Cyclophosphamide
Opioid
s
Ketamine
Nifedipine
Food and herbal supplement adverse effects
Saw Palmetto
Pumpkin seeds
Causes
Miscellaneous
Urethra
l
Urethra
l stricture
Urethra
l diverticulum
Reiter's Syndrome
Local
Urethral Trauma
(e.g.
Bicycling
, horse back riding)
Bladder
Bladder Cancer
Kidney
Renal Cancer
Nephrolithiasis
Abdomen
and
Pelvis
Lymphoma
Pelvic Irradiation
Genitourinary foreign body (e.g. stent)
Causes
Miscellaneous - Men
See
Dysuria in Men
Prostate
Benign Prostatic Hyperplasia
Prostate Cancer
Causes
Miscellaneous - Women
See
Dysuria in Women
Vulva
and Vagina
Atrophic Vaginitis
Vaginal cancer
Vulvar Cancer
Uterus
Endometriosis
Uterine Fibroid
s (paraurethral)
Causes
Psychogenic and social
Somatization
Chronic Pain Syndrome
(e.g.
Chronic Pelvic Pain
)
Major Depression
Chemical Dependency
Sexual abuse
History
Characteristics of Dysuria
Timing
Start of void:
Urethra
l source
End of void:
Bladder
source
Pain location
Cyst
itis
Bladder
and
Urethra
l pain
Bladder Distention
Suprapubic or retropubic pressure
Vaginitis
External pain distribution
Prostatitis
(or other deeper pelvic source)
Deep perineal pain
Epididymitis
Testicular Pain
History
Associated symptoms and contributing factors
Bladder
and lower urinary tract symptoms
Urinary Frequency
or urinary urgency
Hematuria
Abnormal
Urine Odor
Urinary Incontinence
Nocturia
Kidney
and upper urinary tract symptoms
Flank Pain
Fever
Nausea
or
Vomiting
Past medical history
Pyelonephritis
Nephrolithiasis
Sexually Transmitted Infection
Genitourinary procedures
Genitourinary malignancy
Medications and topical agents
Exposures to possible urinary tract irritants or external
Contact Dermatitis
causes
Additional history in women
Pregnancy, current
Contraception
and
Last Menstrual Period
Vaginal Discharge
or vaginal irritation
Additional history in men
Benign Prostatic Hyperplasia
Testicular Pain
Exam
Abdominal exam
Abdominal tenderness (e.g. suprapubic tenderness)
Flank tenderness (
Costovertebral Angle Tenderness
)
Suprapubic fullness (
Bladder Distention
)
Female genitourinary exam
Vulva
r lesions (e.g. vessicles or ulcerations)
Inguinal Lymphadenopathy
Vaginal Discharge
Vaginal Atrophy
Cervical discharge
Cervical motion tenderness
Male genitourinary exam
Penile discharge
Penile Lesion
s, esp. at meatus (e.g.
Vesicle
s, ulcers)
Inguinal Lymphadenopathy
Epididymal or testicular tenderness
Swollen, tender
Prostate
Skin exam
Localized genitourinary dermatitis (e.g. HSV,
Contact Dermatitis
, chronic inflammatory condition)
Polyarthritis
Gonococcus
(associated with scattered
Pustule
s)
Reiter's Syndrome
(associated with
Conjunctivitis
)
Labs
Urinalysis
Urine Culture
STD Testing for Urethritis
Gonorrhea
PCR
Chlamydia
PCR testing
Wet Prep
Trichomonas
PCR
Also offer
HIV Test
and
Syphilis
Test
Imaging
Bladder
and renal
Ultrasound
(or
Bedside Ultrasound
)
Bladder Distention
(may also be detected with
Bladder
scan or post-void residual catheterization)
Hydronephrosis
CT Abdomen and Pelvis
without contrast
Nephrolithiasis
CT Abdomen and Pelvis
with and without contrast (
CT Urogram
)
Hematuria
evaluation for malignancy
Cyst
oscopy
Hematuria
evaluation for malignancy
Interstitial Cystitis
Management
Urethritis
Treat as
Sexually Transmitted Infection
Ceftriaxone
250 mg IM or IV and
Azithromycin
1 gram orally or
Doxycycline
100 mg orally twice daily for 10 days
Treat
Trichomonas
if present
As noted above, offer other STD testing (e.g.
HIV Test
,
Syphilis
Test)
Treat sexual partners
Management
Persistent Dysuria with unremarkable evaluation
Urge Incontinence
or
Overactive Bladder
Pelvic Floor Exercise
s and
Bladder Training
Exercise
s
Topical or systemic irritants
Discontinue offending agents
' Consider regional pain sources
Endometriosis
Interstitial Cystitis
References
Bremnor (2002) Am Fam Physician 65(8):1589-97 [PubMed]
Michels (2015) Am Fam Physician 92(9): 778-86 [PubMed]
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