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==Differential Diagnosis==
==Differential Diagnosis==
Urethritis must be differentiated from other diseases that cause lower [[urinary tract]] irritation symptoms (e.g., [[dysuria]], urgency and frequency in addition to urethral [[discharge]]); these include '''[[cystitis]]''', '''[[cervicitis]]''', '''[[vaginitis|vulvovaginitis]]''', '''[[Epididymo-orchitis|epididymitis]]''', '''[[prostatitis]]''', and '''[[syphilis]]'''.<ref name=":0" /><ref name=":1" /><ref name=":2" /><ref name=":3" /><ref name="pmid8801649" /><ref name=":4" /><ref name="pmid20353145" /><ref name=":5" /><ref name=":6" /><ref name=":7" /><ref name=":8" /><ref name="MooreSeward2006" />
Urethritis must be differentiated from other diseases that cause lower [[urinary tract]] irritation symptoms (e.g., [[dysuria]], urgency and frequency in addition to urethral [[discharge]]); these include '''[[cystitis]]''', '''[[cervicitis]]''', '''[[vaginitis|vulvovaginitis]]''', '''[[Epididymo-orchitis|epididymitis]]''', '''[[prostatitis]]''', and '''[[syphilis]]'''.<ref name=":0">{{Cite journal
 
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Disease}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Findings}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Cystitis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" | [[Bladder]] [[inflammation]]; features with increased frequency and urgency, [[dysuria]], and suprapubic pain; is more common among women. [[E. coli]] is the most common causative pathogen.<ref name=":0">{{Cite journal
  | author = [[Stephen Bent]], [[Brahmajee K. Nallamothu]], [[David L. Simel]], [[Stephan D. Fihn]] & [[Sanjay Saint]]
  | author = [[Stephen Bent]], [[Brahmajee K. Nallamothu]], [[David L. Simel]], [[Stephan D. Fihn]] & [[Sanjay Saint]]
  | title = Does this woman have an acute uncomplicated urinary tract infection?
  | title = Does this woman have an acute uncomplicated urinary tract infection?
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  | doi = 10.1186/1471-2296-11-78
  | doi = 10.1186/1471-2296-11-78
  | pmid = 20969801
  | pmid = 20969801
}}</ref>
}}</ref><ref name="pmid8801649">{{cite journal |vauthors=Taylor-Robinson D |title=The history of nongonococcal urethritis. Thomas Parran Award Lecture |journal=Sex Transm Dis |volume=23 |issue=1 |pages=86–91 |year=1996 |pmid=8801649 |doi= |url=}}</ref><ref name=":4">{{cite book |last = Bennett |first = John |title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases |publisher = Elsevier/Saunders |location = Philadelphia, PA |year = 2015 |isbn=9781455748013}}</ref><ref name="pmid20353145">{{cite journal |vauthors=Brill JR |title=Diagnosis and treatment of urethritis in men |journal=Am Fam Physician |volume=81 |issue=7 |pages=873–8 |year=2010 |pmid=20353145 |doi= |url=}}</ref><ref name=":5">{{Cite journal
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Urethritis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Infection of the urethra; causes [[dysuria]] and urethral [[discharge]]<ref name="pmid8801649">{{cite journal |vauthors=Taylor-Robinson D |title=The history of nongonococcal urethritis. Thomas Parran Award Lecture |journal=Sex Transm Dis |volume=23 |issue=1 |pages=86–91 |year=1996 |pmid=8801649 |doi= |url=}}</ref><ref name=":4">{{cite book |last = Bennett |first = John |title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases |publisher = Elsevier/Saunders |location = Philadelphia, PA |year = 2015 |isbn=9781455748013}}</ref><ref name="pmid20353145">{{cite journal |vauthors=Brill JR |title=Diagnosis and treatment of urethritis in men |journal=Am Fam Physician |volume=81 |issue=7 |pages=873–8 |year=2010 |pmid=20353145 |doi= |url=}}</ref>
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[vaginitis|Bacterial vulvovaginitis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Presents with [[dysuria]] and [[pruritus]]; vaginal [[discharge]] and odor are almost always present; caused by [[Gardnerella]] species<ref name=":5">{{Cite journal
  | author = [[Daniel V. Landers]], [[Harold C. Wiesenfeld]], [[R. Phillip Heine]], [[Marijane A. Krohn]] & [[Sharon L. Hillier]]
  | author = [[Daniel V. Landers]], [[Harold C. Wiesenfeld]], [[R. Phillip Heine]], [[Marijane A. Krohn]] & [[Sharon L. Hillier]]
  | title = Predictive value of the clinical diagnosis of lower genital tract infection in women
  | title = Predictive value of the clinical diagnosis of lower genital tract infection in women
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  | doi = 10.1016/j.ajog.2004.02.015
  | doi = 10.1016/j.ajog.2004.02.015
  | pmid = 15118630
  | pmid = 15118630
}}</ref>
}}</ref><ref name=":7">{{Cite journal
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Cervicitis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Often asymptomatic; some women have an abnormal vaginal [[discharge]] and vaginal bleeding (especially after sexual intercourse)<ref name=":6">{{Cite journal
| author = [[Kimberly A. Workowski]] & [[Gail A. Bolan]]
| title = Sexually transmitted diseases treatment guidelines, 2015
| journal = [[MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control]]
| volume = 64
| issue = RR-03
| pages = 1–137
| year = 2015
| month = June
| pmid = 26042815
}}</ref>
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Prostatitis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Bacterial infection of the [[prostate]]; causes discomfort during ejaculation<ref name=":7">{{Cite journal
  | author = [[Felix Millan-Rodriguez]], [[J. Palou]], [[Anna Bujons-Tur]], [[Mireia Musquera-Felip]], [[Carlota Sevilla-Cecilia]], [[Marc Serrallach-Orejas]], [[Carlos Baez-Angles]] & [[Humberto Villavicencio-Mavrich]]
  | author = [[Felix Millan-Rodriguez]], [[J. Palou]], [[Anna Bujons-Tur]], [[Mireia Musquera-Felip]], [[Carlota Sevilla-Cecilia]], [[Marc Serrallach-Orejas]], [[Carlos Baez-Angles]] & [[Humberto Villavicencio-Mavrich]]
  | title = Acute bacterial prostatitis: two different sub-categories according to a previous manipulation of the lower urinary tract
  | title = Acute bacterial prostatitis: two different sub-categories according to a previous manipulation of the lower urinary tract
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  | pmid = 16437219
  | pmid = 16437219
}}</ref>
}}</ref>
|-
*The following table summarizes the differential diagnosis for urethritis.
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Epididymo-orchitis|Epididymitis]]'''
<br>
| style="padding: 5px 5px; background: #F5F5F5;" |Presents with scrotal pain and swelling accompanied by fever and lower urinary tract irritation symptoms ([[dysuria]] and increased frequency)<ref name=":8">{{Cite journal
| author = [[A. Stewart]], [[S. S. Ubee]] & [[H. Davies]]
| title = Epididymo-orchitis
| journal = [[BMJ (Clinical research ed.)]]
| volume = 342
| pages = d1543
| year = 2011
| month =
| pmid = 21490048
}}</ref>
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Syphilis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Presents with generalized systemic [[symptoms]] such as [[malaise]], [[fatigue]], [[headache]] and [[fever]]. [[Skin]] eruptions may be subtle and [[asymptomatic]]. It is classically described as 1) non-pruritic bilateral symmetrical [[mucocutaneous]] [[rash]]; 2) non-tender regional [[lymphadenopathy]]; 3) condylomata lata; and 4) patchy [[alopecia]].<ref name="MooreSeward2006">{{cite journal|last1=Moore|first1=Zack S|last2=Seward|first2=Jane F|last3=Lane|first3=J Michael|title=Smallpox|journal=The Lancet|volume=367|issue=9508|year=2006|pages=425–435|issn=01406736|doi=10.1016/S0140-6736(06)68143-9}}</ref>
|-
|}
 
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<small>
{|
{|
|-style="background: #DCDCDC; color; text-align: center;"
|-style="background: #DCDCDC; color; text-align: center;"
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* [[Tertiary syphilis]] can have [[neurosyphilis]], [[cardiovascular syphilis]] and gummas
* [[Tertiary syphilis]] can have [[neurosyphilis]], [[cardiovascular syphilis]] and gummas
|}
|}
</small>


==References==
==References==

Revision as of 13:41, 5 April 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Overview

Urethritis presents with urinary irritative symptoms and urethral discharge. Differential diagnosis is based on gender and chronicity of symptoms.

Differential Diagnosis

Urethritis must be differentiated from other diseases that cause lower urinary tract irritation symptoms (e.g., dysuria, urgency and frequency in addition to urethral discharge); these include cystitis, cervicitis, vulvovaginitis, epididymitis, prostatitis, and syphilis.[1][2][3][4][5][6][7][8][9]

  • The following table summarizes the differential diagnosis for urethritis.



Diseases Diagnostic tests Physical Examination Symptoms Past medical history Other Findings
Urinalysis Urine Culture Gold Standard Fever Tenderness Discharge Inguinal Lymphadenopathy Hematuria Pyuria Frequency Urgency Dysuria
Urethritis -

Gram stain & Mucoid or purulent discharge

+ - Urethral discharge + - + - - +
Pyelonephritis Identifies causative bacteria Imaging and culture + Flank or costovertebral angle + + + + - - +
Cystitis >100,000CFU/mL Urine culture + Suprapubic - + + + + + +
Prostatitis Identifies causative bacteria (in bacterial subtypes)

Urine culture

+ - - - - + + + +
Bacterial Vulvovagintis - -

Gram stain & Culture of discharge

+ - Vaginal discharge  + - - - - +
  • Number and type of sexual partners (new, casual, or regular)
  • Prior STDs
  • Previous history of symptomatic BV in female partner (in homosexual women)
Cervicitis - - culture for gonococcal cervicitis + Cervical

endocervical exudate

- - + - - +
  • Sustained endocervical bleeding easily induced by a cotton swab
Epididymitis + Culture +

Testicular & Suprapubic

+/- urethral discharge + + - + + +
Syphilis (STD) - - Darkfield microscopy +/- - - + - - - - -

References

  1. ↑ Stephen Bent, Brahmajee K. Nallamothu, David L. Simel, Stephan D. Fihn & Sanjay Saint (2002). "Does this woman have an acute uncomplicated urinary tract infection?". JAMA. 287 (20): 2701–2710. PMID 12020306. Unknown parameter |month= ignored (help)
  2. ↑ W. E. Stamm (1981). "Etiology and management of the acute urethral syndrome". Sexually transmitted diseases. 8 (3): 235–238. PMID 7292216. Unknown parameter |month= ignored (help)
  3. ↑ W. E. Stamm, K. F. Wagner, R. Amsel, E. R. Alexander, M. Turck, G. W. Counts & K. K. Holmes (1980). "Causes of the acute urethral syndrome in women". The New England journal of medicine. 303 (8): 409–415. doi:10.1056/NEJM198008213030801. PMID 6993946. Unknown parameter |month= ignored (help)
  4. ↑ Leonie G. M. Giesen, Grainne Cousins, Borislav D. Dimitrov, Floris A. van de Laar & Tom Fahey (2010). "Predicting acute uncomplicated urinary tract infection in women: a systematic review of the diagnostic accuracy of symptoms and signs". BMC family practice. 11: 78. doi:10.1186/1471-2296-11-78. PMID 20969801.
  5. ↑ Taylor-Robinson D (1996). "The history of nongonococcal urethritis. Thomas Parran Award Lecture". Sex Transm Dis. 23 (1): 86–91. PMID 8801649.
  6. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 9781455748013.
  7. ↑ Brill JR (2010). "Diagnosis and treatment of urethritis in men". Am Fam Physician. 81 (7): 873–8. PMID 20353145.
  8. ↑ Daniel V. Landers, Harold C. Wiesenfeld, R. Phillip Heine, Marijane A. Krohn & Sharon L. Hillier (2004). "Predictive value of the clinical diagnosis of lower genital tract infection in women". American journal of obstetrics and gynecology. 190 (4): 1004–1010. doi:10.1016/j.ajog.2004.02.015. PMID 15118630. Unknown parameter |month= ignored (help)
  9. ↑ Felix Millan-Rodriguez, J. Palou, Anna Bujons-Tur, Mireia Musquera-Felip, Carlota Sevilla-Cecilia, Marc Serrallach-Orejas, Carlos Baez-Angles & Humberto Villavicencio-Mavrich (2006). "Acute bacterial prostatitis: two different sub-categories according to a previous manipulation of the lower urinary tract". World journal of urology. 24 (1): 45–50. doi:10.1007/s00345-005-0040-4. PMID 16437219. Unknown parameter |month= ignored (help)

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