Urology Book

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Dysuria in Women

Aka: Dysuria in Women, Urethritis in Women
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  1. See Also
    1. Dysuria
    2. Dysuria in Men
    3. Urinary Tract Infection
  2. Causes
    1. See Dysuria for non-gender specific causes
    2. See Periuretheral Contact Dermatitis in Women
    3. Urinary Tract Infection
      1. Acute Cystitis
      2. Pyelonephritis
    4. Genital Herpes (HSV II)
    5. Urethritis
      1. Gonorrhea
      2. Chlamydia
    6. Vulvodynia
    7. Vaginitis
      1. Candidal Vaginitis
      2. TrichomonasVaginitis
      3. Atrophic Vaginitis (post-Menopause)
    8. Interstitial Cystitis
    9. Urethral Syndrome
      1. Acute Cystitis symptoms and normal urine
  3. Symptoms and Signs
    1. See Urinary Tract Infection
    2. See Vaginitis
    3. See Vaginal Discharge
    4. See Dyspareunia
  4. Evaluation
    1. Urine Sample
      1. Urinalysis
      2. Urine Culture
      3. Dysuria with negative Urine Dipstick and culture
        1. 75% Respond to trimethoprim (25% for Placebo)
        2. Richards (2005) BMJ 331:143-6
    2. Vaginitis suspected: Vaginal Discharge examination
      1. KOH Preparation
      2. Saline Preparation (Wet Prep)
    3. Sexually active patient
      1. Routine swab for Gonorrhea and Chlamydia
      2. Consider Gram Stain of cervical discharge
  5. Management: Empiric for Urethritis if testing negative
    1. Consider treating for Ureaplasma
    2. Metronidazole 2 g PO and
    3. Erythromycin
      1. Erythromycin Base 500 mg PO qid for 7 days or
      2. Erythromycin ethylsuccinate 800 mg PO qid for 7 days
  6. References
    1. Kurowski (1998) Am Fam Physician 57(9): 2155-64
    2. Roberts (1999) Am Fam Physician 60(3): 865-72

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