Ms. D is a 33-year-old woman who complains of dysuria for 4 days.

Ms. D noted the gradual onset of dysuria 4 days ago. She also has increased urinary frequency. She denies flank pain, fever or chills, nausea or vomiting, vaginal discharge, genital rash, or hematuria. Her last menstrual period ended 5 days ago, and she takes an oral contraceptive pill regularly for contraception.

Physical exam demonstrates normal vital signs, normal temperature, and absence of abdominal or CVA tenderness.

A clinical diagnosis of uncomplicated cystitis is made. Urine dipstick is positive for leukocyte esterase only.

No additional testing or urine culture was performed for Ms. D since she had no history of recurrent UTI or other complicating factors. She was given empiric antibiotics of nitrofurantoin 100 mg twice daily for 5 days based on the regional E coli resistance patterns. Her symptoms resolved with treatment.

S :

Ms. D noted the gradual onset of dysuria 4 days ago. She also has increased urinary frequency. She denies flank pain, fever or chills, nausea or vomiting, vaginal discharge, genital rash, or hematuria

O:

Physical exam demonstrates:

–           normal vital signs,

–          normal temperature,

–          absence of abdominal or CVA tenderness.

LMP was 5 days ago

Urine dipstick is positive for leukocyte esterase only.

A:

Because she is using oral contraceptives, we assume she is sexually active, thus putting her at higher risk for uncomplicated cystitis.

A clinical diagnosis of uncomplicated cystitis is made. Urine dipstick is positive for leukocyte esterase only.

P:

No additional testing or urine culture was performed for Ms. D since she had no history of recurrent UTI or other complicating factors.

She was given empiric antibiotics of nitrofurantoin 100 mg twice daily for 5 days based on the regional E coli resistance patterns. If symptoms return or persist after 5 days, she should come back.

Usually patients that have symptoms of dysuria have a UTI. Common symptoms of a UTI are vaginal or penile discharge, flank pain, rectal/perineal pain, nausea or vomiting, fever, hematuria, urinary hesitancy, urinary urgency, nocturia, urinary frequency, and in orthostatic, there is abdominal and costovertebral-angle (CVA) tenderness. The anatomical approach to diagnosing what Ms.D had, which is acute uncomplicated cystitis, would be to examine the bladder. Even though the patient is experiencing dysuria, she denies flank pain, fever or chills, nausea or vomiting, vaginal discharge, genital rash, or hematuria, and she is also sexually active. All these symptoms are consistent with cystitis. These symptoms are very similar to symptoms of vaginitis and pyelonephritis ( a diagnosis that must not be missed). Important test for uncomplicated cystitis include a urine dipstick or urinalysis. Vaginitis symptoms include dysuria with vaginal irritation and discharge (but no hematuria, frequency, or urgency). Important test to be done for Vaginitis include a pelvic exam with discharge examination. In pyelonephritis, symptoms include fever chills, nausea/ vomiting, flank pain, CVA tenderness. Important test for pyelonephritis include urine culture, urinalysis, an ultrasound if lack of clinical response. Risk factors for cystitis include sexual intercourse, use of spermicides (which Ms.D did experience), pervious UTI, and a new sexual partner in the past year. The probability of cystitis is over 90% in women who experience dysuria and frequency without vaginal discharge and irritation. If the urinalysis is negative for both leukocyte esterase and nitrites, then cystitis should be ruled out. Complicated cystitis can occur in pregnant women, men, patients with urinary tract abnormalities, or patients with immunosuppression or chronic kidney disease. Even though uncomplicated cystitis and vaginitis have very similar symptoms, proper lab test need to be taken in order to make the proper differential diagnosis