Diagnostic approach to the adolescent female with dysuria
Diagnostic approach to the adolescent female with dysuria
UTI may coexist with noninfectious etiologies. Unless the cause of dysuria is obvious on physical examination (eg, vulvar ulcers, obvious local trauma, or viral exanthem) a urine specimen for rapid dipstick should be obtained in all patients. Urinalysis and urine culture should also be obtained if the urine dipstick suggests a UTI (refer to UpToDate topics on diagnosis of UTI in children).
PCR: polymerase chain reaction; UTI: urinary tract infection. * In addition to Stevens-Johnson, varicella infection, Behçet syndrome, mycoplasma-induced rash and mucositis, and reactive arthritis with urethritis and conjunctivitis, potential causes include inflammatory bowel disease. Refer to UpToDate topics on vulvar vesicles and bullae. ¶ Testing for Neisseria gonorrhoeae and Chlamydia trachomatis is warranted. Refer to UpToDate topics on vaginitis, cervicitis, and pelvic inflammatory disease. Δ For menstruating females, the urinalysis and culture will be more reliable if obtained by bladder catheterization or by clean catch after placing a tampon. However, a clean catch specimen without tampon placement may have to suffice in some patients who decline. ◊ Refer to UpToDate topics and algorithms on symptomatic microscopic hematuria in children.
