A healthy woman under 65 y.o. (or older, if very healthy), not pregnant, has painful urination, urinating small amounts frequently. Possible Diagnoses:
- UTI (bladder infection from E. coli or similar bacteria)
- Sexually Transmitted Disease (STD) โ Gonorrhea, Chlamydia, Mycoplasma genitalium
- Kidney Infection (Pyelonephritis)
- Vaginitis (see topic Vaginal Discharge)
We do a rapid dipstick Urinalysis (UA) in office.
1.ย Urinalysis positive for Leukocyte Esterase โ We diagnose UTI,ย ย ifโฆ
- No vaginal discharge (if present, may need โcomplete UAโ that gets sent to lab)
- Pain is internal, NOT felt on outside skin
- Bloody urine strongly suggests UTI
- No fever, nausea / vomiting (if so, we diagnose Kidney Infection, see #4 below)
- Symptoms present less than a week (if longer, we diagnose Kidney Infection)
- If STD risks, we also test the urine for Gonorrhea & Chlamydia
We give appropriate antibiotics for 3-5 days
If NOT BETTER in 3 days, we:
- Repeat the UA.ย If still positive, we do โcomplete UAโ (lab examines with microscope)
- We order a Culture & Sensitivity (C&S) (spaced a few days from antibiotics, if possible)
- We may test urine for Gonorrhea & Chlamydiaย โ treat if positive
- We clarify the pain.ย If seems to be felt externally, on the skin, we perform a pelvic exam. See topic Vaginal Discharge
- If risks for STD, and tests negative, test or just treat for Mycoplasma genitalium
2. Urinalysis negative for Leukocyte Esterase โ Not a UTI
- If urine very dilute (specific gravity <1.005) โ Repeat the test
- We consider performing a pelvic exam, especially if the pain seems to be felt externally, on the skin
3. Telephone Call from woman with new painful urination โ We Treat for a UTI if:
- Pain is felt internally (in the bladder area above the pubic bone, not on the outside skin) AND ALSO there’s a frequent, urgent need to urinate small amounts
- No fever, nausea / vomiting, or severe mid-back pain (if present, suggest Kidney Infection, needs tests in office)
- Symptoms present less than a week (longer suggests Kidney Infection, needs tests in office)
4. If fever, or nausea / vomiting, suggesting Kidney Infection, and UA is positive, we:
- Obtain Culture & Sensitivity (C&S)
- Treat immediately
- Advise patient to go to an E.R. if getting worse, or if vomits up the medicine
- If results of C&S show we gave wrong antibiotic:
- If symptoms persist, change the antibiotic
- If all better anyway, finish treatment as is
5. Elderly, pregnant, or weak immune system due to other diseases:
- Assume a Kidney Infection, manage as in #4 above
- Hospitalize if any suggestion she feels fairly ill
See Diagram: Urinary System — Anatomy and also Diagram: Female Genital System — Anatomy
See Painful Urination in Women โ Full Text for more in-depth explanations and discussions.