Urethritis differential diagnosis

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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)