Urethritis differential diagnosis: Difference between revisions

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!<small>Gold Standard
!<small>Gold Standard
|-
|-
| colspan="15" |'''Differentiating amongst different types of urinary tract infections:'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Urethritis|'''Urethritis''']]
| 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]]
*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''']]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pyelonephritis|'''Pyelonephritis''']]
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* Imaging studies help differentiate the various types
* Imaging studies help differentiate the various types
* May accompany [[back pain]], [[nausea]], [[vomiting]], and [[chills]]
* May accompany [[back pain]], [[nausea]], [[vomiting]], and [[chills]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Urethritis|'''Urethritis''']]
| 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]]
*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;" |[[Prostatitis|'''Prostatitis''']]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Prostatitis|'''Prostatitis''']]
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!<small>Urine Culture</small>
!<small>Urine Culture</small>
!<small>Gold Standard
!<small>Gold Standard
|-
| colspan="15" |'''Differentiating UTIs from other diseases:'''
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Vulvovagintis|'''Vulvovagintis''']]
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Vulvovagintis|'''Vulvovagintis''']]
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* [[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
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[BPH|'''BPH''']]
| 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;" + |
*[[Hematuria]] may be seen
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | [[Digital rectal examination|DRE]]
&
Serum [[PSA]]
| align="left" style="background:#F5F5F5;" + |
* Sudden inability to [[urinate]]
* [[Urinary tract infection|Urinary tract infections]]
* [[Urinary stone|Urinary stones]]
* Damage to the [[Kidney|kidneys]]
| align="left" style="background:#F5F5F5;" + |
* Involves mainly central or transitional zone
* [[Hyperplasia]] rather than [[Organ hypertrophy|hypertrophy]]
* [[Obstruction]] of the [[urethra]]
* [[Nocturia]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Neoplasms'''
| 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;" + |
*[[Hematuria]] may be seen
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | [[Imaging]] and [[biopsy]]
| align="left" style="background:#F5F5F5;" + |
* Sudden inability to [[urinate]]
* Recurrent [[Urinary tract infection|urinary tract infections]]
* [[Weight loss]] and other constitutional symptoms
| align="left" style="background:#F5F5F5;" + |
* [[Cachexia]]
* Gradual progression
|- 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
|-
|-
|}
|}

Revision as of 18:32, 24 July 2018

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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]

  • 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)