Differential Diagnosis for 20 Week Pregnant Woman with Stinging Urine
Single Most Likely Diagnosis
- Urinary Tract Infection (UTI): The presence of 3+ WCC (white blood cell count) on dipstick testing, which indicates a significant inflammatory response, along with the symptom of stinging urine, strongly suggests a UTI. UTIs are common during pregnancy due to physiological changes that can predispose women to infection.
Other Likely Diagnoses
- Asymptomatic Bacteriuria: This condition is common in pregnancy and can lead to UTIs if not treated. The presence of protein and WCC in the urine could be indicative of an underlying infection that has not yet caused significant symptoms.
- Pregnancy-Induced Hypertension: Although less directly related to stinging urine, protein in the urine (proteinuria) is a hallmark of pregnancy-induced hypertension. The combination of proteinuria and WCC could suggest an early sign of this condition, especially if the patient has other risk factors or symptoms.
Do Not Miss Diagnoses
- Pyelonephritis: An upper urinary tract infection that can be life-threatening if not promptly treated. Symptoms can include flank pain, fever, and chills, in addition to urinary symptoms. The presence of significant WCC in the urine could be an early indicator.
- Septic Abortion or Intrauterine Infection: Although less common, any sign of infection during pregnancy warrants consideration of these potentially life-threatening conditions, especially if there are other symptoms such as fever, abdominal pain, or vaginal bleeding.
Rare Diagnoses
- Interstitial Cystitis: A chronic condition causing bladder pressure, bladder pain, and sometimes pelvic pain. The symptoms can mimic those of a UTI but without the presence of bacteria. It's less likely given the acute presentation and dipstick findings but could be considered if recurrent or persistent symptoms occur without evidence of infection.
- Tuberculosis of the Urinary Tract: A rare condition that can cause chronic urinary symptoms, including frequency, urgency, and pain. It would be an unusual diagnosis to consider initially but might be thought of if standard UTI treatments fail and other symptoms such as weight loss or night sweats are present.