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Urologic evaluation, including cystoscopy, should also be performed in those with persistent hematuria after infection has been eradicated.Clinical ReasoningDifferential of Dysuria, Urinary Frequency, and HematuriaMost Likely DiagnosesGonorrheaSeveral sexually transmitted infections, such as chlamydia, gonorrhea, trichomoniasis, and herpes simplex virus can causeurethritis and dysuria similar to that seen here.Symptoms that occur gradually over several weeks are more likely with a sexually transmitted urethritis.CystitisCystitis is an inflammation of the bladder caused most commonly by bacterial infection.A non-specific term often used interchangeably with cystitis is "urinary tract infection". Urinary tract infection can denoteinfection of any portion of the urinary tract including the kidneys (pyelonephritis) or urethra (urethritis).Hematuria, urinary frequency, and dysuria are all common features of cystitis.Urinary frequency and dysuria can also be seen with urethritis, but hematuria is rarely seen with that condition. Thepresence of hematuria points to cystitis rather than urethritis in this patient.Note that fever is not seen with cystitis. When fever is present in the setting of urinary symptoms, pyelonephritis should beconsidered.PelvicinflammatorydiseasePelvic inflammatory disease, often called PID, is the name for a spectrum of disorders of the upper female genital tract,including endometritis, tubo-ovarian abscess and salpingitis.Often sexually transmitted infections are the source of PID, which can lead to infertility if not treated.Women with PID may have subtle symptoms, and physical exam findings of cervical motion tenderness, and uterine oradnexal tenderness are important diagnostic features of PID.In addition to vaginal discharge, abdominal and pelvic pain are common in PID-more so than with the other diagnoses.Fever is variably present in PID, and is more likely in severe cases.Less Likely DiagnosesPyelonephritisPyelonephritis is an infection of the kidney, or upper urinary tract.Dysuria may be present, but is rarely the only symptom.Symptoms that suggest the diagnosis of pyelonephritis are flank pain, fever, chills, nausea, vomiting, and prostration none ofwhich are present here.Fever is usually present with pyelonephritis, but not always, so a lack of fever argues against this diagnosis.CandidiasisCandidiasis is an often-neglected cause of dysuria, and is perceived as pain or burning when urine comes in contact with aninflamed perineum or labia.A vaginal yeast infection may cause inflammation of the perineum and the urethral orifice, called "vaginitis" that leads todysuria. This so-called "external dysuria" is most common with candida and trichomonas vaginitis, but is also present inpatients with genital ulcers from herpes simplex, and in irritant vaginitis from soaps, hygiene products, condoms, andspermicides.
BacterialvaginosisBacterial vaginosisis a condition marked increased malodorous vaginal discharge.