Differentials
Urinary tract infection
SIGNS / SYMPTOMS
Dysuria is common to both urethritis and urinary tract infection (UTI). However, frequency and urgency characterize UTI, while in urethritis they are typically absent.
INVESTIGATIONS
Urine culture shows growth of bacteria known to cause UTI.
Nucleic acid amplification test is negative for gonorrhea and Chlamydia.
Urine culture in the setting of gonococcal urethritis and nongonococcal urethritis is typically negative, while tests for gonorrhea and chlamydial infection may be positive.
Candida balanitis or vaginitis
SIGNS / SYMPTOMS
No differentiating symptoms.
INVESTIGATIONS
Gram stain, done initially to rule out gonococcal urethritis, may show candidal hyphae.
Potassium hydroxide prep reveals hyphae.
Noninfectious urethritis
SIGNS / SYMPTOMS
A thorough history usually reveals etiology: trauma, instrumentation, foreign body insertion, chemical irritation (e.g., spermicides).
INVESTIGATIONS
Cultures for typical sexually transmitted organisms are negative.
Nephrolithiasis
SIGNS / SYMPTOMS
Intermittent pain with passage of gravel in urine may be present.
INVESTIGATIONS
Serum electrolytes, BUN, and creatinine may show impaired renal function.
Both WBCs and red blood cells may be present in urine.
Microscopic analysis of the urine reveals crystals.
Interstitial cystitis
SIGNS / SYMPTOMS
Pelvic pain, sense of urgency to void, sensation of incomplete bladder emptying, and absence of urethral discharge.
INVESTIGATIONS
Urine cultures and nucleic acid amplification test are negative.
Cystoscopy and biopsy aid diagnosis.
Reactive arthritis
SIGNS / SYMPTOMS
An inflammatory arthritis that occurs after exposure to certain gastrointestinal and genitourinary infections. The classic triad of postinfectious arthritis, nongonococcal urethritis, and conjunctivitis or uveitis is frequently described but found in only a few cases and not required for diagnosis.[39]
Uncomplicated urethritis is not associated with joint symptoms or eye inflammation.
INVESTIGATIONS
Urine culture and sensitivity testing are negative.
Erythrocyte sedimentation rate or c-reactive protein may show nonspecific elevation.
HLA-B27 may be positive.
Chronic prostatitis
SIGNS / SYMPTOMS
Sensation of pain or pressure. No urethral discharge.
INVESTIGATIONS
Urinalysis may reveal WBCs.
Polymerase chain reaction and culture of urine or urethral swab should be performed to rule out Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, and Ureaplasma urealyticum.
A trial of 2 to 4 weeks of antibiotics is recommended. If there is no response, nonbacterial etiologies should be sought.
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