Urinary burning or pain most often represents UTI or vaginitis. It is common in middle-aged and/or sexually active women. In men, it is more likely to occur as they grow older (Bremnor and Sadovsky, 2002). Both voiding history and sexual history are essential. Questions regarding vaginal symptoms are important in women. Also, use of medications and personal hygiene products should be reviewed.
Dysuria significantly increases the chance that a patient has a UTI. However, there are many potential causes of dysuria (Box 40-1), and empiric treatment based on this symptom alone leads to unnecessary antibiotic use. Incorporating other symptoms increases the likelihood that a UTI is the
Box 40-1 Differential Diagnosis of Dysuria
Meatal stenosis Medications
Neoplasm—bladder, benign prostate hyperplasia, prostate, penile, vulvovaginal
Trauma—foreign body, mechanical, masturbation, postcoital Urethral syndrome
Modified from Seller RH. Urethral discharge and dysuria. In Differential Diagnosis of Common Complaints, 3rd ed. Philadelphia, Saunders, 1996; and Brenmor JD, Sadovsky R. Evaluation of dysuria in adults. Am Fam Physician 2002;65:1589-1596.
cause (see Urinary Tract Infection) (Bent et al., 2002; McIsaac et al., 2002).
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