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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}}</ref>
}}</ref>
*The following table summarizes the differential diagnosis for urethritis.
*The following table summarizes the differential diagnosis for urethritis.
<br>
 
<br>
<div style="width: 75%;">
<small>
{|
{|
|-style="background: #DCDCDC; color; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |<small>Diseases</small>
! rowspan="2" |<small>Diseases</small>
| colspan="5" |<small>'''Symptoms'''
! colspan="4" |<small>Physical Examination</small>
! colspan="3" |<small>Diagnostic tests</small>
! colspan="3" |<small>Diagnostic tests</small>
! colspan="4" |<small>Physical Examination</small>
| colspan="5" |<small>'''Symptoms'''</small>
! colspan="1" rowspan="2" |<small>Past medical history</small>
! colspan="1" rowspan="2" |<small>Past medical history</small>
! rowspan="2" |<small>Other Findings</small>
! rowspan="2" |<small>Other Findings</small>
|- style="background: #DCDCDC; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!<small>Urinalysis</small>
!<small>Urine Culture</small>
!<small>Gold Standard
!<small>Fever</small>
!<small>Tenderness</small>
!<small>Discharge</small>
!<small>Inguinal Lymphadenopathy</small>
!<small>Hematuria</small>
!<small>Hematuria</small>
!<small>Pyuria</small>
!<small>Pyuria</small>
Line 96: Line 86:
!<small>Urgency</small>
!<small>Urgency</small>
!<small>Dysuria</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;" |Urethritis
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Urethritis|'''Urethritis''']]
| style="background: #F5F5F5; padding: 5px;" |
| 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;" + | [[Urethral discharge]]
| align="center" style="background:#F5F5F5;" + |  +
| align="left" style="background:#F5F5F5;" + |  
*Positive [[leukocyte esterase]] test or >10 [[White blood cells|WBCs]]
*Positive [[leukocyte esterase]] test or >10 [[White blood cells|WBCs]]
*Mucous threads in the morning [[urine]]
*Mucous threads in the morning [[urine]]
 
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| align="center" style="background:#F5F5F5;" + | [[Gram stain]] & mucoid or [[purulent]] [[discharge]]
| style="background: #F5F5F5; padding: 5px;" |
| align="left" style="background:#F5F5F5;" + |
[[Gram stain]]
&
Mucoid or [[purulent]] [[discharge]]
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px;text-align:center" | -
| style="background: #F5F5F5; padding: 5px;text-align:center" |[[Urethral discharge]]
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Prior [[STD]]s
* Prior [[STD]]s
* [[Urinary tract infection|Urinary tract infections]]
* [[Urinary tract infection|Urinary tract infections]]
Line 122: Line 115:
* Recent intercourse
* Recent intercourse
* Recent [[catheterization]]
* Recent [[catheterization]]
| style="background: #F5F5F5; padding: 5px;" |
| align="left" style="background:#F5F5F5;" + |
*[[Purulent]] [[discharge]] may suggest [[gonorrhoea]]
*[[Purulent]] [[discharge]] may suggest [[gonorrhoea]]
*Exclusive [[dysuria]] suggest [[Chlamydia]]
*Exclusive [[dysuria]] suggest [[Chlamydia]]
*Painful genital [[ulcers]] with [[dysuria]] suggest [[HSV]]
*Painful genital [[ulcers]] with [[dysuria]] suggest [[HSV]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Pyelonephritis
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pyelonephritis|'''Pyelonephritis''']]
| style="background: #F5F5F5; padding: 5px; text-align:center" |
| 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]]
*[[Leukocytes]]
 
*[[Nitrite test|Nitrite]] +ve
*Positive [[Nitrite test|nitrite]]  
| align="center" style="background:#F5F5F5;" + | Identifies causative [[bacteria]]
| style="background: #F5F5F5; padding: 5px;" |Identifies causative [[bacteria]]
| align="center" style="background:#F5F5F5;" + | [[Urine culture]]
| style="background: #F5F5F5; padding: 5px;" |Imaging and culture
| align="left" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |[[Flank pain|Flank]] or [[costovertebral angle]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* History of [[pyelonephritis]]
* History of [[pyelonephritis]]
* Recent history of [[hospitalisation]]
* Recent history of [[hospitalisation]]
* [[Nephrolithiasis]]
* [[Nephrolithiasis]]
* [[Immunosupression]]
* [[Immunosupression]]
| style="background: #F5F5F5; padding: 5px;" |
| align="left" style="background:#F5F5F5;" + |
* [[Flank pain|Costovertebral angle tenderness]]
* [[Flank pain|Costovertebral angle tenderness]]
* Patient is in acute distress
* Patient is in acute distress
* Look for obstructive causes
* Look for obstructive causes
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Cystitis
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Cystitis|'''Cystitis''']]
|style="background: #F5F5F5; padding: 5px;" |
| align="center" style="background:#F5F5F5;" + | +
*Positive [[Nitrite test|nitrite]]
| align="center" style="background:#F5F5F5;" + | +
 
| align="center" style="background:#F5F5F5;" + | +
*[[Leukocyte esterase|Positive leukocyte esterase]]
| 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]]
*[[White blood cells|WBCs]]
*[[RBCs]]
*[[RBCs]]
|style="background: #F5F5F5; padding: 5px; text-align:center"|>100,000CFU/mL
| align="center" style="background:#F5F5F5;" + | >100,000CFU/mL
| style="background: #F5F5F5; padding: 5px;" |[[Urine culture]]
| align="center" style="background:#F5F5F5;" + | [[Urine culture]]
|style="background: #F5F5F5; padding: 5px; text-align:center" | +
| align="left" style="background:#F5F5F5;" + |
|style="background: #F5F5F5; padding: 5px; text-align:center" |Suprapubic
| style="background: #F5F5F5; padding: 5px;text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
|style="background: #F5F5F5; padding: 5px; text-align:center" | +
|style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px;" | +
|style="background: #F5F5F5; padding: 5px;" | +
|style="background: #F5F5F5; padding: 5px;" | +
|style="background: #F5F5F5; padding: 5px;" |
*Recent catheterisation
*Recent catheterisation
*[[Pregnancy]]
*[[Pregnancy]]
*recent intercourse
*Recent intercourse
*[[Diabetes]]
*[[Diabetes]]
*Personal or [[family history]] of [[UTI]]
*Personal or [[family history]] of [[UTI]]
*Known abnormality of the [[urinary tract]]
*Known abnormality of the [[urinary tract]]
*[[BPH]] or [[HIV]]
*[[BPH]]
|style="background: #F5F5F5; padding: 5px;" |
*[[HIV]]
| align="left" style="background:#F5F5F5;" + |
* Imaging studies help differentiate the various types
* Imaging studies help differentiate the various types
* May acompany [[back pain]], [[nausea]], [[vomiting]] and [[chills]]
* May accompany [[back pain]], [[nausea]], [[vomiting]], and [[chills]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Prostatitis
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Prostatitis|'''Prostatitis''']]
| style="background: #F5F5F5; padding: 5px;" |
| align="center" style="background:#F5F5F5;" + |
*10-20 [[leukocytes]] for acute and chronic [[bacterial]] subtypes
| align="center" style="background:#F5F5F5;" + | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | Identifies causative [[bacteria]] (in [[bacterial]] subtypes)
| align="center" style="background:#F5F5F5;" + | +
| style="background: #F5F5F5; padding: 5px;" |  
| align="center" style="background:#F5F5F5;" + | +  
[[Urine culture]]
| align="center" style="background:#F5F5F5;" + | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| align="center" style="background:#F5F5F5;" + | +
| style="background: #F5F5F5; padding: 5px;text-align:center" | -
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px;text-align:center" | -
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px;" | -
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| align="left" style="background:#F5F5F5;" + |  
| style="background: #F5F5F5; padding: 5px;" | +
*10–20 [[leukocytes]] for acute and chronic [[bacterial]] subtypes
| style="background: #F5F5F5; padding: 5px;" | +
| align="center" style="background:#F5F5F5;" + | Identifies causative [[bacteria]] (in [[bacterial]] subtypes)
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| align="center" style="background:#F5F5F5;" + | [[Urine culture]]
| style="background: #F5F5F5; padding: 5px;" | +
| align="left" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px;" |
* [[Urogenital]] disorders
* [[Urogenital]] disorders
* Recent [[catheterization]] or other [[genitourinary]] instrumentation
* Recent [[catheterization]] or other [[genitourinary]] instrumentation
* History of [[UTI|UTIs]]
* History of [[UTI|UTIs]]
| style="background: #F5F5F5; padding: 5px;" |
| align="left" style="background:#F5F5F5;" + |
* In [[acute prostatitis]], [[palpation]] reveals a [[Tenderness|tender]] and [[enlarged prostate]]<sup>[[Prostatitis physical examination|[1][3]]]</sup>
*[[Tenderness|Tender]] and [[enlarged prostate]] in [[acute prostatitis]]<sup>[[Prostatitis physical examination|[1][3]]]</sup>
* In chronic [[prostatitis]], [[palpation]] reveals a tender and soft (boggy) [[prostate]]<sup>[[Prostatitis physical examination|[1]]]</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]]
* A [[prostate massage]] should never be done in a patient with suspected [[acute prostatitis]], since it may induce [[sepsis]].
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Bacterial Vulvovagintis
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
 
! rowspan="2" |<small>Diseases</small>
| style="background: #F5F5F5; padding: 5px;" | -
| colspan="5" |<small>'''Symptoms'''
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
! colspan="4" |<small>Physical Examination</small>
| style="background: #F5F5F5; padding: 5px;" |
! colspan="3" |<small>Diagnostic tests</small>
[[Gram stain]]
! colspan="1" rowspan="2" |<small>Past medical history</small>
&
! rowspan="2" |<small>Other Findings</small>
Culture of discharge
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
!<small>Hematuria</small>
| style="background: #F5F5F5; padding: 5px;text-align:center" | -
!<small>Pyuria</small>
| style="background: #F5F5F5; padding: 5px;text-align:center" | [[Vaginal discharge]] 
!<small>Frequency</small>
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
!<small>Urgency</small>
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
!<small>Dysuria</small>
| style="background: #F5F5F5; padding: 5px;" | -
!<small>Fever</small>
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
!<small>Tenderness</small>
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
!<small>Discharge</small>
| style="background: #F5F5F5; padding: 5px;" | +
!<small>Inguinal Lymphadenopathy</small>
| style="background: #F5F5F5; padding: 5px;" |
!<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)
* Number and type of sexual partners (new, casual, or regular)
* Prior [[STDs]]
* Prior [[STDs]]
* Previous history of symptomatic BV in female partner (in [[homosexual]] women)
* Previous history of symptomatic BV in female partner (in [[homosexual]] women)
| style="background: #F5F5F5; padding: 5px;" |
| align="left" style="background:#F5F5F5;" + |
* Fishy [[odor]] from the [[vagina]] (Whiff test)
* Fishy [[odor]] from the [[vagina]] (Whiff test)
* Thin, white/gray homogeneous [[vaginal discharge]]
* Thin, white/gray homogeneous [[vaginal discharge]]
* [[Microscopy]] (wet prep) and vaginal [[pH]] 
* [[Microscopy]] (wet prep) and vaginal [[pH]] 
* Clue cells
* Clue cells
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Cervicitis
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Cervicitis|'''Cervicitis''']]
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| align="center" style="background:#F5F5F5;" + | +
| style="background: #F5F5F5; padding: 5px; text-align:center" |culture for [[gonococcal]] cervicitis
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px; text-align:center" |Cervical
| align="center" style="background:#F5F5F5;" + | +
| style="background: #F5F5F5; padding: 5px; text-align:center" |
| align="center" style="background:#F5F5F5;" + | +
endocervical exudate
| align="center" style="background:#F5F5F5;" + | Cervical
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| align="center" style="background:#F5F5F5;" + | Endocervical exudate
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px;" | +
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| align="center" style="background:#F5F5F5;" + | [[Culture]] for [[gonococcal]] cervicitis
| style="background: #F5F5F5; padding: 5px;" | +
| align="left" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px; text-align:center" |
* Abnormal [[vaginal bleeding]] after intercourse or after [[menopause]]
* Abnormal [[vaginal bleeding]] after intercourse or after [[menopause]]
* Abnormal [[vaginal discharge]]
* Abnormal [[vaginal discharge]]
* Painful sexual intercourse
* Painful sexual intercourse
* Pressure or heaviness in the [[pelvis]]
* Pressure or heaviness in the [[pelvis]]
| style="background: #F5F5F5; padding: 5px; text-align:center" |
| align="left" style="background:#F5F5F5;" + |
*[[Purulent]] or [[mucopurulent]] endocervical exudate
*[[Purulent]] or [[mucopurulent]] endocervical exudate
 
*Sustained endocervical [[bleeding]] easily induced by a cotton swab  
*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]]''
 
*>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
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Epididymitis|'''Epididymitis''']]
| style="background: #F5F5F5; padding: 5px;" |
| 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
*[[Hematuria]] may be seen
| style="background: #F5F5F5; padding: 5px;" |+
| align="center" style="background:#F5F5F5;" + | +
| style="background: #F5F5F5; padding: 5px;" | Culture
| align="center" style="background:#F5F5F5;" + | [[Culture]]
| style="background: #F5F5F5; padding: 5px;" |+
| align="left" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px;text-align:center" |
*Unilateral, gradual, and [[Localized disease|localized]] [[scrotal pain]] posterior to the [[testis]]
[[Testicular]]
&
Suprapubic
| style="background: #F5F5F5; padding: 5px;" | +/- [[urethral discharge]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |  
*[[Scrotal pain]]:  starts gradually, is usually unilateral and [[Localized disease|localized]] posterior to the testis
*[[Scrotal swelling]]
*[[Scrotal swelling]]
*[[Scrotum|Scrotal]] wall [[erythema]]
*[[Scrotum|Scrotal]] wall [[erythema]]
*Constitutional symptoms: feeling warm, [[chills]], [[nausea and vomiting]]
*Constitutional symptoms: feeling warm, [[chills]], [[nausea and vomiting]]
 
| align="left" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px;" |
*[[Ultrasound]] in patients with [[Testicular pain|acute testicular pain]] to assess for [[testicular torsion]]
*[[Ultrasound]] in patients with [[Testicular pain|acute testicular pain]] to assess for [[testicular torsion]]
*If equivocal do surgical exploration
*If equivocal do surgical exploration
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Syphilis]] ([[STDs|STD]])
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Syphilis]]'''
| style="background: #F5F5F5; padding: 5px;" | -
'''([[STDs|STD]])'''
| style="background: #F5F5F5; padding: 5px;" | -
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px;" |[[Dark field microscopy|Darkfield microscopy]]
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px;" | +/-
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px;" | -
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px;" | -
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px;" | +
| align="center" style="background:#F5F5F5;" + | +/–
| style="background: #F5F5F5; padding: 5px;" | -
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px;" | -
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px;" | -
| align="center" style="background:#F5F5F5;" + | +
| style="background: #F5F5F5; padding: 5px;" | -
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px;" | -
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px;" |
| align="center" style="background:#F5F5F5;" + | [[Dark field microscopy|Darkfield microscopy]]
| align="left" style="background:#F5F5F5;" + |  
* History of [[STD]]
* History of [[STD]]
* [[HIV AIDS|HIV]]
* [[HIV AIDS|HIV]]
* [[Immunosupression]]
* [[Immunosupression]]
* Previous history of [[chancre]]
* Previous history of [[chancre]]
| style="background: #F5F5F5; padding: 5px;" |
| align="left" style="background:#F5F5F5;" + |  
* May be asymptomatic
* May be asymptomatic
* Painless [[chancre]] in [[primary syphilis]]
* Painless [[chancre]] in [[primary syphilis]]
* [[Secondary syphilis]] may have generalised features and condylomata lata
* [[Secondary syphilis]] may have generalised features and condylomata lata
* [[Tertiary syphilis]] can have [[neurosyphilis]], [[cardiovascular syphilis]] and gummas
* [[Tertiary syphilis]] can have [[neurosyphilis]], [[cardiovascular syphilis]] and gummas
|-
|}
|}
</small>


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Medicine]]
[[Category:Medicine]]
[[Category:Primary care]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date]]

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)