Differentials
Lower urinary tract infection
SIGNS / SYMPTOMS
Dysuria, urgency, and frequency.
Does not display systemic signs or symptoms (e.g., fevers, chills, nausea, vomiting, and back pain).
INVESTIGATIONS
Urine culture and urinalysis.
Cystitis
SIGNS / SYMPTOMS
Does not display systemic signs or symptoms (e.g., fevers, chills, nausea, vomiting, and back pain).
Often associated with a urinary tract infection, manifesting with symptoms of dysuria, urgency, and frequency.
INVESTIGATIONS
No differentiating tests exist.
Acute prostatitis
SIGNS / SYMPTOMS
In men, urinary symptoms along with fever or systemic symptoms may indicate acute prostatitis.[27] Acute prostatitis may present with:[27]
Sudden onset of fever
Low back, suprapubic, perineal, or rectal pain
Symptoms of urinary tract infection (dysuria, frequency, urgency, or retention).
Can be associated with anal intercourse in men. Symptoms may include dysuria, frequency, and blood in the urine, or may be mild and subacute. May recur in patients who are treated for an adequate duration (up to 3 weeks).
Digital rectal examination reveals a tender, often enlarged prostate.
INVESTIGATIONS
Microscopic analysis shows WBCs in urine obtained after prostate massage or by collection of the terminal portion of a urine sample.
Urethritis
SIGNS / SYMPTOMS
Urethral discharge; urethral irritation or itching and dysuria.
INVESTIGATIONS
Gram stain and culture of urethral discharge; nucleic acid amplification test.
Chronic pyelonephritis
SIGNS / SYMPTOMS
Suggested by a relevant history of underlying medical problems, such as anatomical abnormalities that predispose to obstruction (e.g., kidney stones), metabolic factors (e.g., diabetes), or recurrent infections with resistant bacteria that lead to permanent renal damage evident on imaging studies.
INVESTIGATIONS
Imaging studies often show small, irregular, scarred kidneys.
Pelvic inflammatory disease
SIGNS / SYMPTOMS
Determined via a history of sexual intercourse; lower abdominal, pelvic, or low back pain; pain with movements; vaginal discharge; fevers or chills; abdominal or cervical tenderness.
Pelvic examination may show vaginitis, urethral discharge, or herpetic ulcerations.
Cervical examination may show cervicitis.
INVESTIGATIONS
Cervical cultures can identify causative pathogens (e.g., Neisseria gonorrhoeae, Chlamydia trachomatis).
Microscopic examination of vaginal discharge demonstrates neutrophils.
Pelvic pain syndrome
SIGNS / SYMPTOMS
Recurrent symptoms, including dysuria, pain on intercourse, and pelvic pain, occur with negative cultures.
Symptoms that affect primarily the bladder may be associated with a small bladder and frequent voiding.
INVESTIGATIONS
No differentiating tests exist.
Lower lobe pneumonia
SIGNS / SYMPTOMS
Often complain of cough and pleuritic chest pain. Physical examination may show decreased breath sounds, rales, or rhonchi.
INVESTIGATIONS
Chest radiography is useful in making the diagnosis.
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