Urethritis differential diagnosis: Difference between revisions

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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|epididymitis]]''', '''[[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" /><ref name=":1" /><ref name=":2" /><ref name=":3" /><ref name="pmid8801649" /><ref name=":4" /><ref name="pmid20353145" /><ref name=":5" /><ref name=":6" /><ref name=":7" /><ref name=":8" /><ref name="MooreSeward2006" />
 


{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
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|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Cystitis]]'''
| 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 causative pathogen.<ref>{{Cite journal
| 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 causative pathogen.<ref name=":0">{{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 24:
  | 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
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  | 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
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  | 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
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|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Urethritis]]'''
| 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: #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 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>
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[vaginitis|Bacterial vulvovaginitis]]'''
| 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
| style="padding: 5px 5px; background: #F5F5F5;" |Presents with [[dysuria]] and [[pruritus]]; vaginal [[discharge]] and odor are almost always present; caused by [[Gardnerella]] species<ref name=":5">{{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
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|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Cervicitis]]'''
| 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
| style="padding: 5px 5px; background: #F5F5F5;" |Often asymptomatic; some women have an abnormal vaginal [[discharge]] and vaginal bleeding (especially after sexual intercourse)<ref name=":6">{{Cite journal
  | author = [[Kimberly A. Workowski]] & [[Gail A. Bolan]]
  | author = [[Kimberly A. Workowski]] & [[Gail A. Bolan]]
  | title = Sexually transmitted diseases treatment guidelines, 2015
  | title = Sexually transmitted diseases treatment guidelines, 2015
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|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Prostatitis]]'''
| 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
| style="padding: 5px 5px; background: #F5F5F5;" |Bacterial infection of the [[prostate]]; causes discomfort during ejaculation<ref name=":7">{{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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|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Epididymo-orchitis|Epididymitis]]'''
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Epididymo-orchitis|Epididymitis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Presents with scrotal pain and swelling accompanied by fever and lower urinary tract irritation symptoms ([[dysuria]] and increased frequency)<ref>{{Cite journal
| style="padding: 5px 5px; background: #F5F5F5;" |Presents with scrotal pain and swelling accompanied by fever and lower urinary tract irritation symptoms ([[dysuria]] and increased frequency)<ref name=":8">{{Cite journal
  | author = [[A. Stewart]], [[S. S. Ubee]] & [[H. Davies]]
  | author = [[A. Stewart]], [[S. S. Ubee]] & [[H. Davies]]
  | title = Epididymo-orchitis
  | title = Epididymo-orchitis
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! colspan="3" |<small>Diagnostic tests</small>
! colspan="3" |<small>Diagnostic tests</small>
! colspan="4" |<small>Physical Examination</small>
! colspan="4" |<small>Physical Examination</small>
| colspan="5" |<small>Symptoms</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>

Revision as of 13:24, 5 April 2017

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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][10][11][12]

Disease Findings
Cystitis Bladder inflammation; features with increased frequency and urgency, dysuria, and suprapubic pain; is more common among women. E. coli is the most common causative pathogen.[1][2][3][4]
Urethritis Infection of the urethra; causes dysuria and urethral discharge[5][6][7]
Bacterial vulvovaginitis Presents with dysuria and pruritus; vaginal discharge and odor are almost always present; caused by Gardnerella species[8]
Cervicitis Often asymptomatic; some women have an abnormal vaginal discharge and vaginal bleeding (especially after sexual intercourse)[9]
Prostatitis Bacterial infection of the prostate; causes discomfort during ejaculation[10]
Epididymitis Presents with scrotal pain and swelling accompanied by fever and lower urinary tract irritation symptoms (dysuria and increased frequency)[11]
Syphilis 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.[12]





Diseases Diagnostic tests Physical Examination Symptoms Past medical history Other Findings
Urinalysis Urine Culture Gold Standard Fever Tenderness Discharge Inguinal Lymphadenopathy Hematuria Pyuria Frequency Urgency Dysuria
Urethritis -

Gram stain & Mucoid or purulent discharge

+ - Urethral discharge + - + - - +
Pyelonephritis Identifies causative bacteria Imaging and culture + Flank or costovertebral angle + + + + - - +
Cystitis >100,000CFU/mL Urine culture + Suprapubic - + + + + + +
Prostatitis Identifies causative bacteria (in bacterial subtypes)

Urine culture

+ - - - - + + + +
Bacterial Vulvovagintis - -

Gram stain & Culture of discharge

+ - Vaginal 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 - - culture for gonococcal cervicitis + Cervical

endocervical exudate

- - + - - +
  • Sustained endocervical bleeding easily induced by a cotton swab
Epididymitis + Culture +

Testicular & Suprapubic

+/- urethral discharge + + - + + +
Syphilis (STD) - - Darkfield microscopy +/- - - + - - - - -

References

  1. ↑ 1.0 1.1 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. ↑ 2.0 2.1 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. ↑ 3.0 3.1 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. ↑ 4.0 4.1 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. ↑ 5.0 5.1 Taylor-Robinson D (1996). "The history of nongonococcal urethritis. Thomas Parran Award Lecture". Sex Transm Dis. 23 (1): 86–91. PMID 8801649.
  6. ↑ 6.0 6.1 Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 9781455748013.
  7. ↑ 7.0 7.1 Brill JR (2010). "Diagnosis and treatment of urethritis in men". Am Fam Physician. 81 (7): 873–8. PMID 20353145.
  8. ↑ 8.0 8.1 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. ↑ 9.0 9.1 Kimberly A. Workowski & Gail A. Bolan (2015). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. PMID 26042815. Unknown parameter |month= ignored (help)
  10. ↑ 10.0 10.1 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)
  11. ↑ 11.0 11.1 A. Stewart, S. S. Ubee & H. Davies (2011). "Epididymo-orchitis". BMJ (Clinical research ed.). 342: d1543. PMID 21490048.
  12. ↑ 12.0 12.1 Moore, Zack S; Seward, Jane F; Lane, J Michael (2006). "Smallpox". The Lancet. 367 (9508): 425–435. doi:10.1016/S0140-6736(06)68143-9. ISSN 0140-6736.

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