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. Bacterial infections, such as those caused by E. coli, are the typical culprits. Symptoms often include frequent urination, urgency, and suprapubic discomfort.

• Other Likely Diagnoses

  • Urethritis: Inflammation of the urethra, often due to sexually transmitted infections (STIs) like gonorrhea or chlamydia, can cause dysuria. It's more common in men and can be accompanied by discharge.
  • Vaginitis: Infections or inflammation of the vagina, such as yeast infections or bacterial vaginosis, can cause dysuria in women, especially if the infection spreads to the urethra.
  • Prostatitis: Inflammation of the prostate gland, which can be acute or chronic, often presents with dysuria, pelvic pain, and sometimes urinary retention or frequency.

• Do Not Miss Diagnoses

  • Kidney Stones: While not always painful, kidney stones can cause severe dysuria, especially if they obstruct the ureter. Other symptoms include flank pain (renal colic), nausea, and vomiting.
  • Interstitial Cystitis: A chronic condition causing bladder pressure, bladder pain, and sometimes pelvic pain. The pain 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, frequent urination, and other systemic symptoms like weight loss and fever.

• Rare Diagnoses

  • Bladder Cancer: Can cause dysuria, especially if the tumor is located near the urethra or bladder neck. Other symptoms include hematuria (blood in the urine) and changes in urinary habits.
  • Schistosomiasis: A parasitic infection that can cause urinary symptoms, including dysuria, hematuria, and bladder obstruction, primarily in endemic areas.
  • Foreign Body in the Urinary Tract: Though rare, the presence of a foreign body (e.g., a urinary catheter fragment, a stone, or an object intentionally inserted) can cause dysuria, infection, and other urinary symptoms.