Differential Diagnosis for Dysuria in Male with Negative Urinalysis
Single Most Likely Diagnosis
- Urethritis: This is often caused by sexually transmitted infections (STIs) such as gonorrhea or chlamydia. A negative urinalysis does not rule out urethritis, as the infection may not always result in the presence of leukocyte esterase, nitrites, or blood in the urine.
Other Likely Diagnoses
- Prostatitis: Inflammation of the prostate gland can cause dysuria, and it may not always be associated with a positive urinalysis. Chronic prostatitis/chronic pelvic pain syndrome is a common condition that can present with dysuria.
- Urethral stricture: Narrowing of the urethra can cause obstructive symptoms including dysuria. This condition may not be detected by a standard urinalysis.
- Overactive bladder: Symptoms can include urgency, frequency, and dysuria, even in the absence of a urinary tract infection.
Do Not Miss Diagnoses
- Kidney stones: Although a negative urinalysis decreases the likelihood, it does not completely rule out the presence of a kidney stone, especially if it is small or not causing significant obstruction or inflammation.
- Tuberculosis of the urinary tract: This is a rare condition but can present with chronic dysuria and a negative standard urinalysis. It's crucial to consider in patients with risk factors or exposure history.
- Interstitial cystitis: A condition causing bladder pressure, bladder pain, and sometimes pelvic pain. The symptoms can mimic a urinary tract infection but without the positive urinalysis findings.
Rare Diagnoses
- Bladder cancer: Although rare, especially in younger males, it can present with irritative voiding symptoms including dysuria. A negative urinalysis does not rule out this diagnosis, especially in smokers or those with other risk factors.
- Schistosomiasis: In endemic areas, this parasitic infection can cause urinary symptoms including dysuria. It's a rare consideration in most clinical practices but important in travelers or immigrants from certain regions.
- Sjögren's syndrome: An autoimmune disorder that can affect exocrine glands, including those in the urinary tract, leading to symptoms that might mimic a urinary tract infection without the typical laboratory findings.