Differential Diagnosis for Recurrent Dysuria and Absence of White Blood Cells in Urine

Single Most Likely Diagnosis

• Interstitial Cystitis: This condition is characterized by chronic inflammation of the bladder wall, leading to symptoms like dysuria, frequency, and urgency, without the presence of a urinary tract infection (UTI) or significant white blood cells in the urine. The absence of white blood cells and the recurrent nature of dysuria make interstitial cystitis a plausible diagnosis.

Other Likely Diagnoses

• Urethral Syndrome: This condition presents with symptoms similar to a UTI, such as dysuria, but without evidence of infection. It could be due to various factors, including urethral irritation or obstruction.
• Overactive Bladder: While primarily associated with urgency and frequency, some patients with overactive bladder may experience dysuria. The absence of infection or white blood cells in the urine supports this diagnosis.
• Vulvovaginitis: In women, vulvovaginitis can cause dysuria due to external genitalia irritation during urination. The absence of white blood cells in the urine suggests the discomfort is not due to a urinary tract infection.

Do Not Miss Diagnoses

• Tuberculosis of the Urinary Tract: Although rare, tuberculosis can infect the urinary tract and cause chronic symptoms like dysuria. The absence of white blood cells does not rule out this diagnosis, as TB can cause sterile pyuria or minimal inflammatory response.
• Malignancy of the Urinary Tract: Cancers of the bladder or urethra can cause dysuria among other symptoms. Early detection is crucial, making this a "do not miss" diagnosis despite its lower likelihood.
• Sexually Transmitted Infections (STIs): Certain STIs, like chlamydia or gonorrhea, can cause dysuria in the absence of significant white blood cells in the urine, especially in their early stages.

Rare Diagnoses

• Sjögren's Syndrome: This autoimmune disorder can affect exocrine glands, including those in the urinary tract, leading to symptoms like dysuria due to decreased mucin production and potential bladder wall inflammation.
• Eosinophilic Cystitis: A rare condition characterized by eosinophilic infiltration of the bladder wall, which can cause dysuria and other urinary symptoms without the typical presence of white blood cells indicative of bacterial infection.
• Bladder Endometriosis: In women, endometrial tissue in the bladder can cause cyclical dysuria and other symptoms related to the menstrual cycle, without evidence of infection or significant white blood cell presence in the urine.