Diagnostic Decision

doi:10.1059/0003-4819-104-2-212

Diagnostic Decision

Urinalysis and Urine Culture in Women with Dysuria

ANTHONY L. KOMAROFF, M.D.

Boston, Massachusetts

Abstract

In caring for women with acute dysuria, clinicians traditionally have relied on clinical findings to distinguish between acute pyelonephritis and "cystitis"; they have ordered urinalysis and urine culture regularly for patients with suspected acute pyelonephritis and ordered these tests inconsistently for patients with suspected "cystitis." Recent evidence indicates that "cystitis" may actually be any of six different clinical conditions, each of which is managed differently; subclinical pyelonephritis, lower urinary tract bacterial infection, chlamydial urethritis, other forms of urethritis, vaginitis, or dysuria without any urinary tract or vaginal infection. The distinction between these entities is made primarily from clinical findings. Urinalysis is also of great value in symptomatic patients; the presence of pyuria (and possibly indirect quantitation of pyuria by the leukocyte esterase test) is a reliable indicator of treatable infection, and its absence indicates infection is not present. In contrast, urine culture is of clear value only in patients with acute pyelonephritis or subclinical pyelonephritis.

Article and Author Information

▸From the Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Boston, Massachusetts.
▸This paper was commissioned by the Blue Cross-Blue Shield Medical Necessity Project, under auspices of the Society for Research and Education in Primary Care Internal Medicine (SREPCIM), and is the second in a series being published in the Diagnosis and Treatment section. Harold C. Sox, Jr., M.D., is the editor for the series, and these papers are also being reviewed by John M. Eisenberg, M.D., and Sankey V. Williams, M.D., our consultants for Diagnostic Decision papers, as well as by selected manuscript consultants. This series will be published in a collective reprint, the availability of which will be announced later. The reprint will include the introductory article by Dr. Sox, which appeared on pages 60-66 in the January issue.—The Editor.
Grant support: in part by grants HS 02063 and HS 04066 from the National Center for Health Services Research.
▸Requests for reprints should be addressed to Anthony L. Komaroff, M.D.; Department of Medicine, Brigham and Women's Hospital, 75 Francis Street; Boston, MA 02115.