Pain, burning or discomfort on urination.
Background
- More common in younger women
- Most commonly, but not always, a sign of cystitis/urethritis secondary to a UTI
- Furthermore, the diagnosis of UTI may be secondary to an underlying predisposition e.g. prostatic enlargement in men; anatomical abnormality in children etc
History
- Ask about timing/onset (including when in relation to urination), frequency (how often does it happen), severity, location
- e.g. Pain on initiation suggests urethritis whereas suprapubic pain after micturition is more suggestive of cystitis
- Ask about associated symptoms
- Haematuria
- Urinary frequency, urgency, hesitancy (LUTS); volumes/flow
- Appearance of the urine (e.g. bloody, cloudy; malodourous)
- Discharge
- Flank/abdominal pain/colic
- Fever, rigors, malaise
- Ask about past medical history (particularly any recent urological procedures/conditions; and if they have had this before) and drug history, sexual history (including unprotected sex), social history
- ?possible pregnancy
Examination
- Vital observations
- Temperature; pulse rate
- Abdominal examination
- Looking particularly for any tenderness, specifically suprapubic or loin tenderness
- Examination of the external genitalia
- Any inflammation of the genitals, any discharge, any trauma
- PR exam may be appropriate in men who give a history suggestive of prostatic conditions
Investigations
- Urinalysis and mid-stream urine microscopy/culture & sensitivity are often useful first line tests.
- This may provide enough information to diagnose UTI and warrant the prescription of antibiotics
- First pass urine or high vaginal swabs/endocervical swabs may be useful if sexually transmitted infections are suspected
- Imaging (CT KUB or Renal/Pelvic USS) could be performed if there is suspicion of bladder (or other urological) stones
Causes
- UTI or other infections
- Pyelonephritis
- Cystitis
- STIs: Chlamydia, gonorrhoea, non-gonococcal urethritis; genital herpes simplex;
- Vaginitis
- Prostatitis, epididymitis/epididymo-orchitis
- Kidney/Bladder stones in the urethra
- Obstruction (prostate enlargement)
- Trauma
- Drugs
- Cyclophosphamide, allopurinol, danazol,