Urethritis differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Urethritis}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Urethritis]]
{{CMG}}; {{AE}} {{MehdiP}}
{{CMG}}; {{AE}} {{MehdiP}}
==Overview==
==Overview==
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==Differential Diagnosis==
==Differential Diagnosis==
Urethritis must be differentiated from other diseases that cause lower urinary tract irritation symptoms (e.g., [[dysuria]], urgency and frequency in addition to urethral [[discharge]]); these include '''[[cystitis]]''', '''[[cervicitis]]''', '''[[vaginitis|vulvovaginitis]]''', '''[[Epididymo-orchitis|epididimitis]]''', '''[[prostatitis]]''', and '''[[syphilis]]'''.
Urethritis must be differentiated from other diseases that cause lower [[urinary tract]] irritation symptoms (e.g., [[dysuria]], urgency and frequency in addition to urethral [[discharge]]); these include '''[[cystitis]]''', '''[[cervicitis]]''', '''[[vaginitis|vulvovaginitis]]''', '''[[Epididymo-orchitis|epididymitis]]''', '''[[prostatitis]]''', and '''[[syphilis]]'''.<ref name=":0">{{Cite journal
 
 
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Disease}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Findings}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Cystitis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" | Bladder inflammation, Features with increased frequency and urgency, [[dysuria]], and suprapubic pain. Is more common among women. [[E. coli]] is the most common pathogen.<ref>{{Cite journal
  | author = [[Stephen Bent]], [[Brahmajee K. Nallamothu]], [[David L. Simel]], [[Stephan D. Fihn]] & [[Sanjay Saint]]
  | author = [[Stephen Bent]], [[Brahmajee K. Nallamothu]], [[David L. Simel]], [[Stephan D. Fihn]] & [[Sanjay Saint]]
  | title = Does this woman have an acute uncomplicated urinary tract infection?
  | title = Does this woman have an acute uncomplicated urinary tract infection?
Line 25: Line 16:
  | month = May
  | month = May
  | pmid = 12020306
  | pmid = 12020306
}}</ref><ref>{{Cite journal
}}</ref><ref name=":1">{{Cite journal
  | author = [[W. E. Stamm]]
  | author = [[W. E. Stamm]]
  | title = Etiology and management of the acute urethral syndrome
  | title = Etiology and management of the acute urethral syndrome
Line 35: Line 26:
  | month = July-September
  | month = July-September
  | pmid = 7292216
  | pmid = 7292216
}}</ref><ref>{{Cite journal
}}</ref><ref name=":2">{{Cite journal
  | author = [[W. E. Stamm]], [[K. F. Wagner]], [[R. Amsel]], [[E. R. Alexander]], [[M. Turck]], [[G. W. Counts]] & [[K. K. Holmes]]
  | author = [[W. E. Stamm]], [[K. F. Wagner]], [[R. Amsel]], [[E. R. Alexander]], [[M. Turck]], [[G. W. Counts]] & [[K. K. Holmes]]
  | title = Causes of the acute urethral syndrome in women
  | title = Causes of the acute urethral syndrome in women
Line 46: Line 37:
  | doi = 10.1056/NEJM198008213030801
  | doi = 10.1056/NEJM198008213030801
  | pmid = 6993946
  | pmid = 6993946
}}</ref><ref>{{Cite journal
}}</ref><ref name=":3">{{Cite journal
  | author = [[Leonie G. M. Giesen]], [[Grainne Cousins]], [[Borislav D. Dimitrov]], [[Floris A. van de Laar]] & [[Tom Fahey]]
  | author = [[Leonie G. M. Giesen]], [[Grainne Cousins]], [[Borislav D. Dimitrov]], [[Floris A. van de Laar]] & [[Tom Fahey]]
  | title = Predicting acute uncomplicated urinary tract infection in women: a systematic review of the diagnostic accuracy of symptoms and signs
  | title = Predicting acute uncomplicated urinary tract infection in women: a systematic review of the diagnostic accuracy of symptoms and signs
Line 56: Line 47:
  | doi = 10.1186/1471-2296-11-78
  | doi = 10.1186/1471-2296-11-78
  | pmid = 20969801
  | pmid = 20969801
}}</ref>
}}</ref><ref name="pmid8801649">{{cite journal |vauthors=Taylor-Robinson D |title=The history of nongonococcal urethritis. Thomas Parran Award Lecture |journal=Sex Transm Dis |volume=23 |issue=1 |pages=86–91 |year=1996 |pmid=8801649 |doi= |url=}}</ref><ref name=":4">{{cite book |last = Bennett |first = John |title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases |publisher = Elsevier/Saunders |location = Philadelphia, PA |year = 2015 |isbn=9781455748013}}</ref><ref name="pmid20353145">{{cite journal |vauthors=Brill JR |title=Diagnosis and treatment of urethritis in men |journal=Am Fam Physician |volume=81 |issue=7 |pages=873–8 |year=2010 |pmid=20353145 |doi= |url=}}</ref><ref name=":5">{{Cite journal
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Urethritis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Infection of the urethra; causes [[dysuria]] and urethral [[discharge]]<ref name="pmid8801649">{{cite journal |vauthors=Taylor-Robinson D |title=The history of nongonococcal urethritis. Thomas Parran Award Lecture |journal=Sex Transm Dis |volume=23 |issue=1 |pages=86–91 |year=1996 |pmid=8801649 |doi= |url=}}</ref><ref>{{cite book |last = Bennett |first = John |title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases |publisher = Elsevier/Saunders |location = Philadelphia, PA |year = 2015 |isbn=9781455748013}}</ref><ref name="pmid20353145">{{cite journal |vauthors=Brill JR |title=Diagnosis and treatment of urethritis in men |journal=Am Fam Physician |volume=81 |issue=7 |pages=873–8 |year=2010 |pmid=20353145 |doi= |url=}}</ref>
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[vaginitis|Bacterial vulvovaginitis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Presents with dysuria and pruritus, Vaginal discharge and odor are almost always present, caused by [[Gardnerella]] species<ref>{{Cite journal
  | author = [[Daniel V. Landers]], [[Harold C. Wiesenfeld]], [[R. Phillip Heine]], [[Marijane A. Krohn]] & [[Sharon L. Hillier]]
  | author = [[Daniel V. Landers]], [[Harold C. Wiesenfeld]], [[R. Phillip Heine]], [[Marijane A. Krohn]] & [[Sharon L. Hillier]]
  | title = Predictive value of the clinical diagnosis of lower genital tract infection in women
  | title = Predictive value of the clinical diagnosis of lower genital tract infection in women
Line 73: Line 58:
  | doi = 10.1016/j.ajog.2004.02.015
  | doi = 10.1016/j.ajog.2004.02.015
  | pmid = 15118630
  | pmid = 15118630
}}</ref>.
}}</ref><ref name=":7">{{Cite journal
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Cervicitis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Often asymptomatic,some women have an abnormal vaginal discharge and vaginal bleeding (especially after sexual intercourse)<ref>{{Cite journal
| author = [[Kimberly A. Workowski]] & [[Gail A. Bolan]]
| title = Sexually transmitted diseases treatment guidelines, 2015
| journal = [[MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control]]
| volume = 64
| issue = RR-03
| pages = 1–137
| year = 2015
| month = June
| pmid = 26042815
}}</ref>
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Prostatitis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |bacterial infection of the prostate,causes discomfort during ejaculation<ref>{{Cite journal
  | author = [[Felix Millan-Rodriguez]], [[J. Palou]], [[Anna Bujons-Tur]], [[Mireia Musquera-Felip]], [[Carlota Sevilla-Cecilia]], [[Marc Serrallach-Orejas]], [[Carlos Baez-Angles]] & [[Humberto Villavicencio-Mavrich]]
  | author = [[Felix Millan-Rodriguez]], [[J. Palou]], [[Anna Bujons-Tur]], [[Mireia Musquera-Felip]], [[Carlota Sevilla-Cecilia]], [[Marc Serrallach-Orejas]], [[Carlos Baez-Angles]] & [[Humberto Villavicencio-Mavrich]]
  | title = Acute bacterial prostatitis: two different sub-categories according to a previous manipulation of the lower urinary tract
  | title = Acute bacterial prostatitis: two different sub-categories according to a previous manipulation of the lower urinary tract
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  | pmid = 16437219
  | pmid = 16437219
}}</ref>
}}</ref>
*The following table summarizes the differential diagnosis for urethritis.
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |<small>Diseases</small>
| colspan="5" |<small>'''Symptoms'''
! colspan="4" |<small>Physical Examination</small>
! colspan="3" |<small>Diagnostic tests</small>
! colspan="1" rowspan="2" |<small>Past medical history</small>
! rowspan="2" |<small>Other Findings</small>
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!<small>Hematuria</small>
!<small>Pyuria</small>
!<small>Frequency</small>
!<small>Urgency</small>
!<small>Dysuria</small>
!<small>Fever</small>
!<small>Tenderness</small>
!<small>Discharge</small>
!<small>Inguinal Lymphadenopathy</small>
!<small>Urinalysis</small>
!<small>Urine Culture</small>
!<small>Gold Standard
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Epididymo-orchitis|Epididymitis]]'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Urethritis|'''Urethritis''']]
| style="padding: 5px 5px; background: #F5F5F5;" |Presents with scrotal pain and swelling accompanied by fever and lower urinary tract irritation symptoms([[dysuria]] and frequency)<ref>{{Cite journal
| align="center" style="background:#F5F5F5;" + | –
| author = [[A. Stewart]], [[S. S. Ubee]] & [[H. Davies]]
| align="center" style="background:#F5F5F5;" + | + 
| title = Epididymo-orchitis
| align="center" style="background:#F5F5F5;" + | –
| journal = [[BMJ (Clinical research ed.)]]
| align="center" style="background:#F5F5F5;" + | –
| volume = 342
| align="center" style="background:#F5F5F5;" + | +
| pages = d1543
| align="center" style="background:#F5F5F5;" + | +
| year = 2011
| align="center" style="background:#F5F5F5;" + | –
| month =  
| align="center" style="background:#F5F5F5;" + | [[Urethral discharge]]
| pmid = 21490048
| align="center" style="background:#F5F5F5;" + |  +
}}</ref>.
| align="left" style="background:#F5F5F5;" + |
*Positive [[leukocyte esterase]] test or >10 [[White blood cells|WBCs]]
*Mucous threads in the morning [[urine]]
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | [[Gram stain]] & mucoid or [[purulent]] [[discharge]]
| align="left" style="background:#F5F5F5;" + |
* Prior [[STD]]s
* [[Urinary tract infection|Urinary tract infections]]
* New sexual partner
* Recent intercourse
* Recent [[catheterization]]
| align="left" style="background:#F5F5F5;" + |
*[[Purulent]] [[discharge]] may suggest [[gonorrhoea]]
*Exclusive [[dysuria]] suggest [[Chlamydia]]
*Painful genital [[ulcers]] with [[dysuria]] suggest [[HSV]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pyelonephritis|'''Pyelonephritis''']]
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |  +
| align="center" style="background:#F5F5F5;" + | [[Flank pain|Flank]] or [[costovertebral angle]]
| align="center" style="background:#F5F5F5;" + |  +
| align="center" style="background:#F5F5F5;" + |  +
| align="left" style="background:#F5F5F5;" + |
*[[Leukocytes]]
*[[Nitrite test|Nitrite]] +ve
| align="center" style="background:#F5F5F5;" + | Identifies causative [[bacteria]]
| align="center" style="background:#F5F5F5;" + | [[Urine culture]]
| align="left" style="background:#F5F5F5;" + |
* History of [[pyelonephritis]]
* Recent history of [[hospitalisation]]
* [[Nephrolithiasis]]
* [[Immunosupression]]
| align="left" style="background:#F5F5F5;" + |
* [[Flank pain|Costovertebral angle tenderness]]
* Patient is in acute distress
* Look for obstructive causes
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Cystitis|'''Cystitis''']]
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |  +
| align="center" style="background:#F5F5F5;" + | Suprapubic
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | +
| align="left" style="background:#F5F5F5;" + |
*[[Nitrite test|Nitrite]] +ve
*[[Leukocyte esterase]] +ve
*[[White blood cells|WBCs]]
*[[RBCs]]
| align="center" style="background:#F5F5F5;" + | >100,000CFU/mL
| align="center" style="background:#F5F5F5;" + | [[Urine culture]]
| align="left" style="background:#F5F5F5;" + |
*Recent catheterisation
*[[Pregnancy]]
*Recent intercourse
*[[Diabetes]]
*Personal or [[family history]] of [[UTI]]
*Known abnormality of the [[urinary tract]]
*[[BPH]]
*[[HIV]]
| align="left" style="background:#F5F5F5;" + |
* Imaging studies help differentiate the various types
* May accompany [[back pain]], [[nausea]], [[vomiting]], and [[chills]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Prostatitis|'''Prostatitis''']]
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | –
| align="left" style="background:#F5F5F5;" + |  
*10–20 [[leukocytes]] for acute and chronic [[bacterial]] subtypes
| align="center" style="background:#F5F5F5;" + | Identifies causative [[bacteria]] (in [[bacterial]] subtypes)
| align="center" style="background:#F5F5F5;" + | [[Urine culture]]
| align="left" style="background:#F5F5F5;" + |
* [[Urogenital]] disorders
* Recent [[catheterization]] or other [[genitourinary]] instrumentation
* History of [[UTI|UTIs]]
| align="left" style="background:#F5F5F5;" + |
*[[Tenderness|Tender]] and [[enlarged prostate]] in [[acute prostatitis]]<sup>[[Prostatitis physical examination|[1][3]]]</sup>
*Tender and soft (boggy) [[prostate]] in chronic [[prostatitis]]<sup>[[Prostatitis physical examination|[1]]]</sup>
* A [[prostate massage]] should never be done in a patient with suspected [[acute prostatitis]], since it may induce [[sepsis]].
|-
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |<small>Diseases</small>
| colspan="5" |<small>'''Symptoms'''
! colspan="4" |<small>Physical Examination</small>
! colspan="3" |<small>Diagnostic tests</small>
! colspan="1" rowspan="2" |<small>Past medical history</small>
! rowspan="2" |<small>Other Findings</small>
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!<small>Hematuria</small>
!<small>Pyuria</small>
!<small>Frequency</small>
!<small>Urgency</small>
!<small>Dysuria</small>
!<small>Fever</small>
!<small>Tenderness</small>
!<small>Discharge</small>
!<small>Inguinal Lymphadenopathy</small>
!<small>Urinalysis</small>
!<small>Urine Culture</small>
!<small>Gold Standard
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Vulvovagintis|'''Vulvovagintis''']]
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + |[[Vaginal discharge]] 
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | [[Gram stain]] & [[culture]] of discharge
| align="left" style="background:#F5F5F5;" + |
* Number and type of sexual partners (new, casual, or regular)
* Prior [[STDs]]
* Previous history of symptomatic BV in female partner (in [[homosexual]] women)
| align="left" style="background:#F5F5F5;" + |
* Fishy [[odor]] from the [[vagina]] (Whiff test)
* Thin, white/gray homogeneous [[vaginal discharge]]
* [[Microscopy]] (wet prep) and vaginal [[pH]] 
* Clue cells
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Cervicitis|'''Cervicitis''']]
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | Cervical
| align="center" style="background:#F5F5F5;" + | Endocervical exudate
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | [[Culture]] for [[gonococcal]] cervicitis
| align="left" style="background:#F5F5F5;" + |
* Abnormal [[vaginal bleeding]] after intercourse or after [[menopause]]
* Abnormal [[vaginal discharge]]
* Painful sexual intercourse
* Pressure or heaviness in the [[pelvis]]
| align="left" style="background:#F5F5F5;" + |
*[[Purulent]] or [[mucopurulent]] endocervical exudate
*Sustained endocervical [[bleeding]] easily induced by a cotton swab
*>10 [[WBC]] in vaginal fluid, in the absence of [[trichomoniasis]], may indicate endocervical [[inflammation]] caused specifically by ''[[C. trachomatis]]'' or ''[[N. gonorrhea]]''
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Epididymitis|'''Epididymitis''']]
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | [[Testicular]] & suprapubic
| align="center" style="background:#F5F5F5;" + | +/– [[urethral discharge]]
| align="center" style="background:#F5F5F5;" + | +
| align="left" style="background:#F5F5F5;" + |
*[[Hematuria]] may be seen
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | [[Culture]]
| align="left" style="background:#F5F5F5;" + |
*Unilateral, gradual, and [[Localized disease|localized]] [[scrotal pain]] posterior to the [[testis]]
*[[Scrotal swelling]]
*[[Scrotum|Scrotal]] wall [[erythema]]
*Constitutional symptoms: feeling warm, [[chills]], [[nausea and vomiting]]
| align="left" style="background:#F5F5F5;" + |
*[[Ultrasound]] in patients with [[Testicular pain|acute testicular pain]] to assess for [[testicular torsion]]
*If equivocal do surgical exploration
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Syphilis]]'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Syphilis]]'''  
| style="padding: 5px 5px; background: #F5F5F5;" |Presents with generalized systemic [[symptoms]] such as [[malaise]], [[fatigue]], [[headache]] and [[fever]]. [[Skin]] eruptions may be subtle and [[asymptomatic]]. It is classically described as 1) non-pruritic bilateral symmetrical mucocutaneous [[rash]]; 2) non-tender regional [[lymphadenopathy]]; 3) condylomata lata; and 4) patchy [[alopecia]].<ref name="MooreSeward2006">{{cite journal|last1=Moore|first1=Zack S|last2=Seward|first2=Jane F|last3=Lane|first3=J Michael|title=Smallpox|journal=The Lancet|volume=367|issue=9508|year=2006|pages=425–435|issn=01406736|doi=10.1016/S0140-6736(06)68143-9}}</ref>
'''([[STDs|STD]])'''
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | +/–
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | [[Dark field microscopy|Darkfield microscopy]]
| align="left" style="background:#F5F5F5;" + |  
* History of [[STD]]
* [[HIV AIDS|HIV]]
* [[Immunosupression]]
* Previous history of [[chancre]]
| align="left" style="background:#F5F5F5;" + |
* May be asymptomatic
* Painless [[chancre]] in [[primary syphilis]]
* [[Secondary syphilis]] may have generalised features and condylomata lata
* [[Tertiary syphilis]] can have [[neurosyphilis]], [[cardiovascular syphilis]] and gummas
|-
|-
|}
|}
Line 122: Line 318:
{{Reflist|2}}
{{Reflist|2}}


[[Category:Needs content]]
[[Category:Medicine]]
[[Category:Disease]]
[[Category:Emergency medicine]]
[[Category:Inflammations]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
[[Category:Primary care]]
[[Category:Urology]]
 
[[Category:Nephrology]]
{{WH}}
{{WS}}

Latest revision as of 00:35, 30 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Overview

Urethritis presents with urinary irritative symptoms and urethral discharge. Differential diagnosis is based on gender and chronicity of symptoms.

Differential Diagnosis

Urethritis must be differentiated from other diseases that cause lower urinary tract irritation symptoms (e.g., dysuria, urgency and frequency in addition to urethral discharge); these include cystitis, cervicitis, vulvovaginitis, epididymitis, prostatitis, and syphilis.[1][2][3][4][5][6][7][8][9]

  • The following table summarizes the differential diagnosis for urethritis.
Diseases Symptoms Physical Examination Diagnostic tests Past medical history Other Findings
Hematuria Pyuria Frequency Urgency Dysuria Fever Tenderness Discharge Inguinal Lymphadenopathy Urinalysis Urine Culture Gold Standard
Urethritis + + + Urethral discharge + Gram stain & mucoid or purulent discharge
Pyelonephritis + + + + Flank or costovertebral angle + + Identifies causative bacteria Urine culture
Cystitis + + + + + + Suprapubic + >100,000CFU/mL Urine culture
Prostatitis + + + + + Identifies causative bacteria (in bacterial subtypes) Urine culture
Diseases Symptoms Physical Examination Diagnostic tests Past medical history Other Findings
Hematuria Pyuria Frequency Urgency Dysuria Fever Tenderness Discharge Inguinal Lymphadenopathy Urinalysis Urine Culture Gold Standard
Vulvovagintis + + Vaginal discharge  + Gram stain & culture of discharge
  • Number and type of sexual partners (new, casual, or regular)
  • Prior STDs
  • Previous history of symptomatic BV in female partner (in homosexual women)
Cervicitis + + + Cervical Endocervical exudate Culture for gonococcal cervicitis
Epididymitis + + + + + Testicular & suprapubic +/– urethral discharge + + Culture
Syphilis

(STD)

+/– + Darkfield microscopy

References

  1. Stephen Bent, Brahmajee K. Nallamothu, David L. Simel, Stephan D. Fihn & Sanjay Saint (2002). "Does this woman have an acute uncomplicated urinary tract infection?". JAMA. 287 (20): 2701–2710. PMID 12020306. Unknown parameter |month= ignored (help)
  2. W. E. Stamm (1981). "Etiology and management of the acute urethral syndrome". Sexually transmitted diseases. 8 (3): 235–238. PMID 7292216. Unknown parameter |month= ignored (help)
  3. W. E. Stamm, K. F. Wagner, R. Amsel, E. R. Alexander, M. Turck, G. W. Counts & K. K. Holmes (1980). "Causes of the acute urethral syndrome in women". The New England journal of medicine. 303 (8): 409–415. doi:10.1056/NEJM198008213030801. PMID 6993946. Unknown parameter |month= ignored (help)
  4. Leonie G. M. Giesen, Grainne Cousins, Borislav D. Dimitrov, Floris A. van de Laar & Tom Fahey (2010). "Predicting acute uncomplicated urinary tract infection in women: a systematic review of the diagnostic accuracy of symptoms and signs". BMC family practice. 11: 78. doi:10.1186/1471-2296-11-78. PMID 20969801.
  5. Taylor-Robinson D (1996). "The history of nongonococcal urethritis. Thomas Parran Award Lecture". Sex Transm Dis. 23 (1): 86–91. PMID 8801649.
  6. Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 9781455748013.
  7. Brill JR (2010). "Diagnosis and treatment of urethritis in men". Am Fam Physician. 81 (7): 873–8. PMID 20353145.
  8. Daniel V. Landers, Harold C. Wiesenfeld, R. Phillip Heine, Marijane A. Krohn & Sharon L. Hillier (2004). "Predictive value of the clinical diagnosis of lower genital tract infection in women". American journal of obstetrics and gynecology. 190 (4): 1004–1010. doi:10.1016/j.ajog.2004.02.015. PMID 15118630. Unknown parameter |month= ignored (help)
  9. Felix Millan-Rodriguez, J. Palou, Anna Bujons-Tur, Mireia Musquera-Felip, Carlota Sevilla-Cecilia, Marc Serrallach-Orejas, Carlos Baez-Angles & Humberto Villavicencio-Mavrich (2006). "Acute bacterial prostatitis: two different sub-categories according to a previous manipulation of the lower urinary tract". World journal of urology. 24 (1): 45–50. doi:10.1007/s00345-005-0040-4. PMID 16437219. Unknown parameter |month= ignored (help)