Dysuria (women)

A woman presents with acute dysuria.

1.  Dipstick Urinalysis positive for Leukocyte Esterase → Diagnose UTI,   if…
  • No concurrent vaginal discharge
  • Pain is internal, NOT felt on labia
  • Frequency / Urgency present
  • Hematuria strongly suggests UTI (unless menses)
  • No Sx of Pyelo
  • If STD risks, also send urine for GC / Chlamydia
Treat empirically [3-day antibiotic course].  If NOT BETTER:
  • Repeat UA.  If still Leukocyte Esterase  → send for micro
  • C&S (spaced a few days from antibiotics, if possible)
  • Consider Urethritis → Test for GC / Chlamydia
  • If suggestion of “external” pain, consider pelvic exam
2.  Dipstick Urinalysis negative for Leukocyte Esterase → Not UTI
  • Specific Gravity <1.005 → Repeat
  • Careful history for external dysuria
  • Consider pelvic exam
3.  Telephone Call from woman with dysuria  → Treat UTI if:
  • Internal dysuria; AND Frequency / Urgency
  • No Sx Pyelo
  • Non-pregnant, no significant co-morbidites (incl. age)
4.  If Symptoms suggesting Pyelo with positive UA:
  • Obtain C&S
  • Treat empirically (NOT with Nitrofurantoin or Fosfomycin)
  • Give ER precautions if getting worse, or vomits up meds

See our posting Dysuria in Women.