DYSURIA
Assist Prof Microbiology
Dr. Syed Yousaf Kazmi
LEARNING OBJECTIVES
1. Define dysuria
2. Enumerate the major causes of dysuria
3. Discuss common microbiological agents
responsible for dysuria
4. Explain the patho- physiological changes
5. Describe the symptoms and signs of
presentation
6. Discuss the investigations and principles of
management
DYSURIA-DEFINITION
‘Painful or difficult urination’
‘Pain during urination, or
difficulty urinating’
‘Dysuria is the feeling of pain,
burning, or discomfort upon
urination’
DYSURIA- MAJOR CAUSES
A.
B.
C.
D.
CAUSES IN MALE
CAUSES IN FEMALE
CAUSES IN CHILDREN
NON GENDER SPECIFIC CAUSES
A. CAUSES IN MALE
1. URINARY TRACT INFECTION
2.
3.
4.
5.
6.
7.
8.
i.
ii.
Pyelonephritis (Enterobacteriaceae)
Acute Cystitis (Enterobacteriaceae)
i.
ii.
Urethral instrumentation
Prior Gonorrhea infection
URETHRITIS (Gonorrhea and Chlamydia)
PROSTATITIS (Enterobacteriaceae)
EPIDIDYMITIS AND ORCHITIS (Enterobacteriaceae, Mumps)
MEATITIS and URETHRITIS (HSV II infection)
BALANITIS
OBSTRUCTIVE UROPATHY (Nodular hyperplasia prostate)
URETHRAL STRICTURE
9. MISCELLANEOUS CAUSES Prostatitis
2. CAUSES IN FEMALE
1. URINARY TRACT INFECTION
i.
ii.
Acute Cystitis
Pyelonephritis
2. GENITAL HERPES (HSV II)
3. URETHRITIS (Gonorrhea ,Chlamydia )
4. VULVO-VAGINITIS ( Candida, Trichomonas, Atrophic
Vaginitis)
5. URETHRAL SYNDROME (Acute Cystitis symptoms &
normal urine)
6. CONTACT DERMATITIS
Vaginal Douche, Vaginal lubricant, Spermicidal gel,
Contraceptive foams or sponges, Tampons, Perfumed soap,
Toilet paper
3. CAUSES IN CHILDREN
1.URINARY TRACT INFECTION
2.CHEMICAL IRRITANTS (e.g. bubble bath)
3.PHYSICAL IRRITANTS
i. Self exploration
ii. Self-infusion of water into urethra (common in
boys)
4.LOCAL INFECTION (e.g. Pinworms)
NON GENDER SPECIFIC CAUSES
1.
2.
3.
4.
5.
URINARY TRACT INFECTION
NEPHROLITHIASIS
BLADDER CANCER
LOCAL URETHRAL TRAUMA (e.g. Bicycling, catheter)
MEDICATION ADVERSE EFFECTS
i.
Dopamine, Ticarcillin, Penicillin G, Cyclophosphamide
i.
ii.
Saw Palmetto
Pumpkin seeds
i.
ii.
Somatization, Chronic Pain Syndrome , Major Depression
Sexual abuse
6. FOOD AND HERBAL SUPPLEMENT ADVERSE EFFECTS
7. PSYCHOGENIC CAUSES
MICROBIOLOGICAL CAUSES OF
DYSURIA
URINARY TRACT INFECTION
Mainly cystitis
Major pathogens usually intestinal flora
Most common in women in pregnancy
Community acquired:
 E coli (75%), Klebsiella, Proteus, Staph saphrophyticus, other
Enterobacteriaceae
Hospital acquired:
 Enterococcus, Pseudomonas aeruginosa., E coli, Staphylococcus
sp., Candida spp
 Mostly multidrug resistant, catheter related
MICROBIOLOGICAL CAUSES OF
DYSURIA
URETHRITIS
90% symptomatic in
male than female
 Ns. gonorrhea,
Chlamydia trachomatis,
Ureaplasma urealyticum
Trichomonas vaginalis
MICROBIOLOGICAL CAUSES OF
DYSURIA
GENITAL SKIN LESIONS
Genital herpes (HSV 2)
Chancre ( Syphilis)
Candida infection
MICROBIOLOGICAL CAUSES OF
DYSURIA
EPIDIDYMITIS & ORCHITIS
Enterobacteriaceae (E. coli,
Proteus, Klebsiella etc.)
Mumps virus infection
Mycobacterium
tuberculosis
Ns. gonorrhea, Chlamydia
trachomatis
PATHO-PHYSIOLOGICAL CHANGES
 Depends upon causative agent
 Gonorrhea e.g. causes necrosis
of urethral epithelium and
inflammation
 Syphilis causes chancre
formation and dissemination
to other organs
 HSV infection causes
recurrent sores by causing
skin blisters and ulcers
 TB produces granulomatous
reaction in tissue infected
SIGNS & SYMPTOMS
LOWER URINARY TRACT
INFECTION (CYSTITIS)
Frequent urination
An intense urge to urinate
Loss of bladder control
Pain in the lower front portion
of the abdomen
Cloudy urine that may have a
strong odor,
Blood in urine
SIGNS & SYMPTOMS
UPPER URINARY TRACT
INFECTION (PYELONEPHRITIS)
Pain in the upper back
High fever with shaking chills
Nausea and vomiting
Cloudy urine
Frequent micturition
An intense urge to urinate
SIGNS & SYMPTOMS
URETHRITIS
Discharge from the
urethra
Redness at urethral meatus
Frequent urination
Vaginal discharge
Fever
Nausea & vomiting
SIGNS & SYMPTOMS
VAGINITIS
Pain, soreness or itching
in the vagina
An abnormal or foulsmelling vaginal
discharge or odor
Pain or discomfort
during sexual
intercourse
INVESTIGATIONS
URINE ROUTINE EXAMINATION
Color: May be normal, or reddish
color (hematuria)
Smell: Normal to offensive in
certain infections
Turbidity: In UTI, usually turbid
urine
Protein: usually present in UTIs
RBCs: May be present in UTIs, other
infections,
WBCs: Usually >10-20/HPF
URINE ROUTINE EXAMINATION
MICROSCOPY
WBCs, RBCs, in UTIs
Can visualize bacteria,
yeast cells in UTIs and
other infections
Trichomonas vaginalis
motility
RBCs
WBCs
Trichomonas vaginalis in urine
CULTURE OF SPECIMENS
A. URINE CULTURE
Easy way of diagnosing UTI
Antimicrobial sensitivity helpful in
treatment
Helpful in cystitis and pyelonephritis
Negative cultures do not rule out
UTIs(Fastidious org, etc.)
B. DISCHARGE FOR C/S
 Urethral discharge, vaginal
discharge
 Helpful in diagnosing gonorrhea,
and vaginitis
LAB INVESTIGATION OF STIs
A. DARK FIELD MICROSCOPY
For motility of Spirochetes e.g. Treponema
pallidum
B. IMMUNOFLOURESENSCE TEST
For Chlamydia trachomatis from urethral
discharge
C. SEROLOGICAL TESTS FOR SYPHILIS
RPR test, FTA Adsorbed test, TP PA test etc.
MANAGEMENT PROTOCOLS
 Each disease merits its specific treatment
 UTI must be diagnosed by C/S and given antimicrobial
course
 Empiric therapy may be instituted in severe conditions
and amended on report of C/S
 Local antimicrobial susceptibility pattern must be
known to the physicians
 Syphilis, Gonorrhea, Chlamydia etc. needs protocols
like, Penicillin G, Ceftriaxone, oral doxycyclin
respectively
 For Candida vaginitis, local & systemic antifungal
treatment reqd