What is the next step in the workup for dysuria with a sterile urine culture?

From the Guidelines

Next Steps in Workup for Dysuria with Sterile Urine Culture

The next step in the workup for dysuria with a sterile urine culture would be to consider Chlamydia trachomatis infection as a potential cause, especially in adolescents and young adults, given its association with the acute dysuria-pyuria syndrome or urethral syndrome 1.

• A thorough physical examination and additional diagnostic tests such as:
  • Urinalysis with microscopy
  • Urine Gram stain
  • Cultures for Chlamydia and Gonorrhea should be performed to rule out other sexually transmitted infections.
• If a urinary tract infection is still suspected, a urine PCR (polymerase chain reaction) test may be considered to detect fastidious organisms.
• In female patients, a pelvic exam and wet mount may be performed to evaluate for vaginitis.
• Empiric treatment with a medication such as phenazopyridine 200mg orally three times a day for 2-3 days may be considered to help alleviate symptoms, while awaiting further test results.
• It is important to note that Chlamydia is an uncommon cause of cystitis symptoms among female patients, but it has been an important cause of such symptoms in some groups of young women who have pyuria, but sterile urine cultures 1.

From the FDA Drug Label

The use of Phenazopyridine HCl for relief of symptoms should not delay definitive diagnosis and treatment of causative conditions. The next step in the workup for dysuria with a sterile urine culture is to continue the diagnostic evaluation to determine the underlying cause of the symptoms, as the sterile urine culture does not rule out other conditions that may be causing the dysuria.

• Further testing may be necessary to identify the cause of the symptoms.
• Definitive diagnosis and treatment of the causative condition should be instituted promptly 2.

From the Research

Next Steps in Workup for Dysuria with Sterile Urine Culture

• If a patient presents with dysuria and a sterile urine culture, the next step is to consider other potential causes of dysuria, such as sexually transmitted infections, vaginitis, or urethritis 3, 4, 5.
• A careful history and physical examination are essential to identify risk factors for complicated urinary tract infections and to evaluate for signs of sexually transmitted infections or other noninfectious causes of dysuria 3, 4.
• Laboratory tests, such as vaginal cultures or tests for sexually transmitted infections, may be necessary to determine the cause of dysuria in patients with sterile urine cultures 4, 6.
• Directed imaging studies may also be useful in evaluating patients with dysuria and sterile urine cultures, particularly if there is suspicion of a complicated urinary tract infection or other underlying condition 3.
• It is essential to note that the presence of pyuria or positive nitrite on urinalysis does not necessarily indicate a urinary tract infection, and sterile pyuria is common in patients with sexually transmitted infections 6.
• Clinicians should be cautious when prescribing antibiotics for patients with suspected urinary tract infections, as over-treatment can occur, especially in patients with sterile pyuria and confirmed sexually transmitted infections 6.