Differential Diagnosis for Dysuria

Dysuria, or painful urination, can be caused by a variety of conditions. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Urinary Tract Infection (UTI): This is the most common cause of dysuria, especially in women. UTIs occur when bacteria enter the urinary tract, leading to infection and inflammation. Symptoms include burning sensation while urinating, frequent urination, and sometimes abdominal pain.

• Other Likely Diagnoses

  • Sexually Transmitted Infections (STIs): STIs such as chlamydia, gonorrhea, and herpes can cause dysuria. These infections are transmitted through sexual contact and can lead to symptoms like painful urination, discharge, and genital sores.
  • Urethritis: Inflammation of the urethra, often caused by infection, can lead to dysuria. This condition can result from STIs or other bacterial infections.
  • Vaginitis: Inflammation of the vagina, which can be caused by yeast infections, bacterial vaginosis, or trichomoniasis, may cause dysuria in women due to the proximity of the vaginal opening to the urethral opening.

• Do Not Miss Diagnoses

  • Kidney Stones: While not as common as UTIs, kidney stones can cause severe pain and dysuria. The pain often radiates from the flank to the groin and can be accompanied by nausea and vomiting.
  • Interstitial Cystitis: A chronic condition causing bladder pressure, bladder pain, and sometimes pelvic pain. The symptoms can worsen as the bladder fills and may improve with urination.
  • Tuberculosis of the Urinary Tract: A rare but serious condition that can cause dysuria, among other symptoms like hematuria and flank pain. It's crucial to consider this diagnosis, especially in endemic areas or in individuals with a history of tuberculosis.

• Rare Diagnoses

  • Bladder Cancer: Though rare, bladder cancer can cause dysuria, especially if the tumor is located near the urethral opening. Other symptoms may include hematuria and pelvic pain.
  • Prostatitis: Inflammation of the prostate gland, which can be acute or chronic, may cause dysuria in men. Symptoms can also include pelvic pain, difficulty urinating, and discharge.
  • Urethral Stricture: A narrowing of the urethra, often due to injury, instrumentation, or infection, can lead to obstructive urinary symptoms, including dysuria.

Each of these diagnoses has distinct characteristics and risk factors, and a thorough medical history, physical examination, and diagnostic tests are essential for an accurate diagnosis.