Dysuria - Revision history

Danbot: Strip excess bold

2026-03-22T09:37:04Z

Strip excess bold

← Older revision		Revision as of 09:37, 22 March 2026
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	===Infectious===		===Infectious===
	*~~'''~~[[Cystitis]]~~'''~~ (most common in women)		*[[Cystitis]] (most common in women)
	*~~'''~~[[Pyelonephritis]]~~'''~~ (fever, flank pain, CVA tenderness)		*[[Pyelonephritis]] (fever, flank pain, CVA tenderness)
	*~~'''~~[[Urethritis]]~~'''~~ (STI — gonorrhea, chlamydia)		*[[Urethritis]] (STI — gonorrhea, chlamydia)
	*'''[[Prostatitis]]''' (men — perineal pain, tender prostate)		*'''[[Prostatitis]]''' (men — perineal pain, tender prostate)
	*~~'''~~[[Epididymitis]]~~'''~~ (scrotal pain + dysuria)		*[[Epididymitis]] (scrotal pain + dysuria)
	*~~'''~~Vulvovaginitis~~'''~~ (external dysuria, discharge)		*Vulvovaginitis (external dysuria, discharge)
	*~~'''~~[[HSV]]~~'''~~ (ulcerative lesions, severe dysuria)		*[[HSV]] (ulcerative lesions, severe dysuria)

	===Non-Infectious===		===Non-Infectious===
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	==Evaluation==		==Evaluation==
	*~~'''~~[[Urinalysis]]~~'''~~ ± urine culture		*[[Urinalysis]] ± urine culture
	*GC/CT NAAT (urine or swab) if STI suspected		*GC/CT NAAT (urine or swab) if STI suspected
	*Wet prep if vaginitis suspected		*Wet prep if vaginitis suspected
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	==Management==		==Management==
	*~~'''~~Uncomplicated cystitis~~'''~~ (women): nitrofurantoin 100 mg BID x 5 days OR TMP-SMX DS BID x 3 days OR fosfomycin 3g single dose		*Uncomplicated cystitis (women): nitrofurantoin 100 mg BID x 5 days OR TMP-SMX DS BID x 3 days OR fosfomycin 3g single dose
	*~~'''~~Pyelonephritis~~'''~~: see [[Pyelonephritis]] — outpatient fluoroquinolone or IV antibiotics if admitting		*Pyelonephritis: see [[Pyelonephritis]] — outpatient fluoroquinolone or IV antibiotics if admitting
	*~~'''~~Urethritis (STI)~~'''~~: [[ceftriaxone]] 500 mg IM + [[doxycycline]] 100 mg BID x 7 days (or [[azithromycin]] 1g single dose)		*Urethritis (STI): [[ceftriaxone]] 500 mg IM + [[doxycycline]] 100 mg BID x 7 days (or [[azithromycin]] 1g single dose)
	*'''Prostatitis''': fluoroquinolone or TMP-SMX x 4-6 weeks; see [[Prostatitis]]		*'''Prostatitis''': fluoroquinolone or TMP-SMX x 4-6 weeks; see [[Prostatitis]]
	*~~'''~~Symptomatic relief~~'''~~: phenazopyridine 200 mg TID x 2 days (warn about orange urine)		*Symptomatic relief: phenazopyridine 200 mg TID x 2 days (warn about orange urine)

	==Disposition==		==Disposition==

Danbot: Expanded with concise EM-focused content: cystitis vs STI distinction, red flags, evaluation by sex, antibiotic regimens, disposition

2026-03-21T00:46:12Z

Expanded with concise EM-focused content: cystitis vs STI distinction, red flags, evaluation by sex, antibiotic regimens, disposition

← Older revision		Revision as of 00:46, 21 March 2026
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	==Background==		==Background==
	*Painful urination		*Painful or burning urination — one of the most common ED complaints
	**~~due~~ to ~~inflammation of urethra~~, ~~bladder~~, ~~or prostate~~		*Most commonly caused by [[UTI]] (cystitis) in women and [[urethritis]]/[[STI]] in young men
	*Dysuria is uncommonly used to describe difficult urination		*The EM goal is to identify the cause and rule out complications (pyelonephritis, sepsis, urinary retention)

	==Clinical Features==		==Clinical Features==
	*~~Pain with urination~~		===History===
	*~~Additional features dependent on underlying cause~~		*Internal dysuria (urethral burning) vs. external dysuria (urine contacting irritated skin — vulvovaginitis)
			*Frequency, urgency, hematuria (cystitis)
			*Flank pain, fever, nausea/vomiting (pyelonephritis)
			*Vaginal/penile discharge (STI, vaginitis)
			*New sexual partner, unprotected sex (STI risk)
			*Urinary retention, hesitancy, poor stream (prostatic obstruction)
			*Recent catheterization or instrumentation

			===Red Flags===
			*Fever + dysuria = [[pyelonephritis]] or complicated UTI
			*Suprapubic mass / urinary retention = obstruction
			*Dysuria in men <50 = STI until proven otherwise

	==Differential Diagnosis==		==Differential Diagnosis==
	{{Dysuria DDX}}		{{Dysuria DDX}}

			===Infectious===
			*'''[[Cystitis]]''' (most common in women)
			*'''[[Pyelonephritis]]''' (fever, flank pain, CVA tenderness)
			*'''[[Urethritis]]''' (STI — gonorrhea, chlamydia)
			*'''[[Prostatitis]]''' (men — perineal pain, tender prostate)
			*'''[[Epididymitis]]''' (scrotal pain + dysuria)
			*'''Vulvovaginitis''' (external dysuria, discharge)
			*'''[[HSV]]''' (ulcerative lesions, severe dysuria)

			===Non-Infectious===
			*[[Kidney stones\|Nephrolithiasis]]
			*Interstitial cystitis
			*Urethral trauma / foreign body
			*Atrophic vaginitis (postmenopausal)
			*Medication-related (cyclophosphamide → hemorrhagic cystitis)

	==Evaluation==		==Evaluation==
	*[[UA]]		*'''[[Urinalysis]]''' ± urine culture
			*GC/CT NAAT (urine or swab) if STI suspected
	~~===Men===~~		*Wet prep if vaginitis suspected
	*~~Men <50 yr: symptoms usually due to~~ [[~~STI~~]]		*[[BMP]] if pyelonephritis or concern for renal impairment
	*Men >50 yr: ~~incidence of [[acute~~ cystitis~~]] rises dramatically due to~~ prostatic obstruction		*Blood cultures if systemic signs of infection
			*Consider imaging (CT or renal US) if complicated UTI, obstruction, or abscess suspected
			*Men <50: STI testing first-line; men >50: UA/culture for cystitis (prostatic obstruction increases UTI risk)

	==Management==		==Management==
			*'''Uncomplicated cystitis''' (women): nitrofurantoin 100 mg BID x 5 days OR TMP-SMX DS BID x 3 days OR fosfomycin 3g single dose
			*'''Pyelonephritis''': see [[Pyelonephritis]] — outpatient fluoroquinolone or IV antibiotics if admitting
			*'''Urethritis (STI)''': [[ceftriaxone]] 500 mg IM + [[doxycycline]] 100 mg BID x 7 days (or [[azithromycin]] 1g single dose)
			*'''Prostatitis''': fluoroquinolone or TMP-SMX x 4-6 weeks; see [[Prostatitis]]
			*'''Symptomatic relief''': phenazopyridine 200 mg TID x 2 days (warn about orange urine)

	==Disposition==		==Disposition==
			*Discharge: uncomplicated cystitis, mild urethritis, stable prostatitis
			*Admit: pyelonephritis with sepsis or intractable vomiting, urinary obstruction, prostatic abscess
			*Return precautions: fever, flank pain, inability to urinate, worsening symptoms

	==See Also==		==See Also==
			*[[UTI]]
			*[[Pyelonephritis]]
			*[[Urethritis]]
			*[[STI]]
			*[[Prostatitis]]

	==References==		==References==
	<references/>		<references/>


	[[Category:Urology]]		[[Category:Urology]]
			[[Category:Symptoms]]

ClaireLewis at 21:05, 4 October 2016

2016-10-04T21:05:02Z

← Older revision		Revision as of 21:05, 4 October 2016
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	==Background==		==Background==
			*Painful urination
			**due to inflammation of urethra, bladder, or prostate
			*Dysuria is uncommonly used to describe difficult urination

	==Clinical Features==		==Clinical Features==
	*~~Painful~~ urination		*Pain with urination
	*~~Less commonly used to describe difficult urination~~		*Additional features dependent on underlying cause

	==Differential Diagnosis==		==Differential Diagnosis==

ClaireLewis: /* Clinical Features */

2016-10-04T21:00:27Z

Clinical Features

← Older revision		Revision as of 21:00, 4 October 2016
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	==Clinical Features==		==Clinical Features==
	*Painful or difficult urination		*Painful urination
			*Less commonly used to describe difficult urination

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1 at 01:23, 29 September 2016

2016-09-29T01:23:24Z

← Older revision		Revision as of 01:23, 29 September 2016
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			==Background==

			==Clinical Features==
			*Painful or difficult urination

			==Differential Diagnosis==
			{{Dysuria DDX}}

	==Evaluation==		==Evaluation==
			*[[UA]]

	===Men===		===Men===
	*Men <50 yr: symptoms usually due to [[STI]]		*Men <50 yr: symptoms usually due to [[STI]]
	*Men >50 yr: incidence of [[acute cystitis]] rises dramatically due to prostatic obstruction		*Men >50 yr: incidence of [[acute cystitis]] rises dramatically due to prostatic obstruction

	==~~Differential Diagnosis~~==		==Management==
	~~{{Dysuria DDX}}~~
			==Disposition==

			==See Also==

	==References==		==References==

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-23T23:49:58Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 23:49, 23 July 2016
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	==~~Diagnosis~~==		==Evaluation==
	===Men===		===Men===
	*Men <50 yr: symptoms usually due to [[STI]]		*Men <50 yr: symptoms usually due to [[STI]]

Neil.m.young: Text replacement - "Tintinalli" to ""

2016-06-28T01:39:52Z

Text replacement - "Tintinalli" to ""

← Older revision		Revision as of 01:39, 28 June 2016
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	==References==		==References==
	<references/>		<references/>
	~~Tintinalli~~

	[[Category:Urology]]		[[Category:Urology]]

Neil.m.young: Text replacement - "==Source==" to "==References== "

2016-06-27T17:37:09Z

Text replacement - "==Source==" to "==References== <references/>"

← Older revision		Revision as of 17:37, 27 June 2016
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	{{Dysuria DDX}}		{{Dysuria DDX}}

	==~~Source~~==		==References==
			<references/>
	Tintinalli		Tintinalli

	[[Category:Urology]]		[[Category:Urology]]

Ostermayer: Text replacement - "Category:GU" to "Category:Urology"

2016-03-22T17:01:09Z

Text replacement - "Category:GU" to "Category:Urology"

← Older revision		Revision as of 17:01, 22 March 2016
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	Tintinalli		Tintinalli

	[[Category:GU]]		[[Category:Urology]]

Rossdonaldson1 at 20:58, 22 February 2015

2015-02-22T20:58:06Z

← Older revision		Revision as of 20:58, 22 February 2015
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			==Diagnosis==
			===Men===
			*Men <50 yr: symptoms usually due to [[STI]]
			*Men >50 yr: incidence of [[acute cystitis]] rises dramatically due to prostatic obstruction

	==Differential Diagnosis==		==Differential Diagnosis==
	{{Dysuria DDX}}		{{Dysuria DDX}}