From the Guidelines
Adolescent dysuria is most effectively managed by empiric treatment with antibiotics like nitrofurantoin 100mg twice daily for 5 days or trimethoprim-sulfamethoxazole (TMP-SMX) 160/800mg twice daily for 3 days, alongside testing for sexually transmitted infections (STIs) and counseling on safe sex practices, as supported by the most recent guidelines and studies 1.
Causes and Symptoms
Adolescent dysuria, or painful urination in teenagers, can be caused by various factors including urinary tract infections (UTIs), STIs, or irritation from soaps or hygiene products. Symptoms may include dysuria, increased urinary urgency and frequency, hematuria, and new or worsening incontinence.
- Dysuria is a central symptom in the diagnosis of UTI, with more than 90% accuracy for UTI in young women in the absence of concomitant vaginal irritation or increased vaginal discharge 1.
- Other symptoms may be variably present, and their chronicity is an important consideration when the diagnosis of UTI is in doubt.
Diagnosis and Treatment
For suspected UTIs, empiric treatment with antibiotics is appropriate after obtaining a urine culture.
- Nitrofurantoin 100mg twice daily for 5 days or trimethoprim-sulfamethoxazole (TMP-SMX) 160/800mg twice daily for 3 days are commonly recommended antibiotic regimens 1.
- For STIs, testing for gonorrhea and chlamydia is essential, with treatment based on results - typically ceftriaxone 500mg IM once for gonorrhea and doxycycline 100mg twice daily for 7 days for chlamydia.
- Adolescents should increase fluid intake, avoid irritating products, and complete the full course of antibiotics.
Prevention and Counseling
Sexually active teens should be counseled on safe sex practices and offered STI screening.
- Persistent symptoms warrant further evaluation for other causes like interstitial cystitis, urethritis, or pelvic inflammatory disease.
- The approach should be sensitive to adolescents' privacy concerns while ensuring appropriate treatment of the underlying cause to prevent complications like pyelonephritis or PID 1.
From the Research
Causes of Adolescent Dysuria
- Vulvovaginitis is the most common cause of dysuria in adolescent girls, rather than urinary tract infection 2
- Sexually transmitted infections, such as urethritis, can also cause dysuria in adolescent females, even if they do not report a history of sexual activity 3
Evaluation of Adolescent Dysuria
- A thorough history and physical examination, including examination of the genital area, are necessary for proper evaluation of dysuria in adolescent girls 2
- Assessment of associated symptoms, concomitant conditions, and use of contraceptive or feminine hygiene products that may cause irritation is also essential 2
- Providers should ask questions about their patients' past and present sexual activity and consider the possibility of sexually transmitted diseases in young women presenting with dysuria 3
Treatment of Urinary Tract Infections
- Trimethoprim-sulfamethoxazole, nitrofurantoin, and fosfomycin are appropriate first-line therapies for uncomplicated cystitis in women 4, 5, 6
- Fluoroquinolones are effective for clinical outcomes but should be reserved for more invasive infections 4
- Immediate antimicrobial therapy is recommended rather than delayed treatment or symptom management with ibuprofen alone 4