Dysuria and Sexual history

Question 1

List 9 causes for female dysuria (pain on urination). What are the symptoms/clinical findings? What will be found on a UA? UC? What other test findings would you expect for each one?

Answer 1

Lower urinary tract bacterial infection (“cystitis”) May have urgency; frequency; hematuria; suprapubic discomfort
Urinalysis (UA): + white blood cells (WBC’s), + bacteria
Urine culture (UC): positive

Acute pyelonephritis Cystitis symptoms plus ill-appearing; fever; flank pain; costo-vertebral angle tenderness
UA: + WBC’s, + bacteria
UC: positive

Chlamydial urethritis/ cervicitis New sexual partner; sexual
partner with recent urethritis; slow onset of symptoms (>7 days); +/- cervical mucopurulent discharge, can progress to PID but symptoms often mild
UA: =+WBC’s, no bacteria
UC: negative
Gram stain of cervical or urethral discharge: + WBC’s with no bacteria
Urine or cervical DNA probe for chlamydia positive

Gonococcal urethritis/ cervicitis New sexual partner, sexual partner with recent urethritis; purulent discharge from urethra; +/- cervical mucopurulent discharge, can progress to PID with fever, chills, and abdominal pain
UA: + WBC’s
UC: negative
Gram stain of cervical or urethral discharge: + WBC’s with gram negative intracellular diplococci
Urine or cervical DNA probe for gonococcus positive

Candidal vaginitis White, curd like discharge; pruritis; antibiotic use
Candida on slide with potassium hydroxide (KOH)

Bacterial vaginosis – (gardnerella) Gray/green discharge; fishy odor “Clue cells” on a slide with saline

Trichomonas vaginitis Yellow/ gray frothy discharge, “strawberry cervix”
Motile trichomonads on a slide with saline

Noninfectious Association with irritants, poor hygiene; trauma; Vulvar erythema
UA: negative
UC: negative

Herpes Vesicular lesions, painful to touch
UA: negative
UC: negative
Herpes DFA (+)

Question 2

What things should be included when taking a history for dysuria?

Answer 2

History of Present Illness:

Time of onset of symptoms, severity of pain, change in color of urine (cloudy or

pink-tinged), feelings of urgency, pain or tenderness over the bladder, back pain

or tenderness, fever

Presence or absence of vaginal discharge, if vaginal discharge present- color,

consistency, estimation of amount, odor, vulvar/ vaginal itching

Vulvar redness, vulvar lesions

Use of douches or other possible vaginal irritants

Social History

Sexual history is of obvious importance