What is the diagnosis for a 20-year-old woman with recurrent cystitis and E. coli urine culture?

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Last updated: April 14, 2025 • View editorial policy

Differential Diagnosis for a 20-year-old Woman with Dysuria

  • Single most likely diagnosis: + Recurrent Uncomplicated Urinary Tract Infections (UTIs): This is the most likely diagnosis given the patient's history of recurrent cystitis, symptoms of dysuria and urinary frequency, and the growth of Escherichia coli in the urine culture. The fact that she has had multiple episodes since becoming sexually active and that her symptoms resolve with antibiotic therapy further supports this diagnosis.
  • Other Likely diagnoses: + Sexually Transmitted Infections (STIs): Although the patient's symptoms and urine culture results are consistent with a UTI, her recent initiation of sexual activity and the presence of dysuria could also suggest an STI such as chlamydia or gonorrhea. However, the absence of other symptoms like abnormal vaginal discharge or pelvic pain makes this less likely. + Interstitial Cystitis: This condition could be considered given the patient's recurrent episodes of dysuria and frequency. However, the lack of other symptoms such as pelvic pain or the presence of hematuria, and the fact that her symptoms resolve with antibiotic therapy, make this diagnosis less likely.
  • Do Not Miss diagnoses: + Pyelonephritis: Although the patient does not have symptoms like fever, flank pain, or costovertebral angle tenderness, pyelonephritis is a serious condition that can arise from untreated or recurrent UTIs. It is crucial to consider this diagnosis, especially if the patient's symptoms worsen or do not improve with treatment. + Kidney Stones: While the patient does not have symptoms like severe pain or hematuria, kidney stones could cause recurrent episodes of dysuria and frequency. This diagnosis should be considered if the patient's symptoms persist or worsen despite appropriate treatment for UTIs.
  • Rare diagnoses: + Tuberculosis of the Urinary Tract: This is a rare condition that could cause recurrent UTI symptoms. However, it would typically be associated with other systemic symptoms like weight loss, fever, or night sweats, which are not present in this patient. + Bladder Cancer: Although extremely rare in a young woman, bladder cancer could cause symptoms like dysuria and frequency. However, it would typically be associated with other symptoms like hematuria, which is not present in this case.

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