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DIFFERENTIAL DIAGNOSA

Condition

Differentiating signs/symptoms

Differentiating investigations

Over-active bladder

Urinary urgency and frequency in the absence of a


UTI.

Negative urine dipstick, microscopic urinalysis


urine culture.

Urothelial carcinoma of
the bladder or upper
urinary tract

Microscopic and/or gross haematuria in the


absence of a UTI.

Positive urine cytology. Tumour seen on cystos


or upper tract imaging.

Non-infectious urethritis

Dysuria, possibly with irritative voiding symptoms,


in the absence of a UTI.

Negative urine dipstick, microscopic urinalysis


urine culture.

Foreign body in bladder

Recurrent or unresolved UTI.

Foreign body (e.g., stone, stitch from prior pelv


surgery) visualised on imaging or cystoscopy.

Vaginitis due to Candida

Presence of vaginal discharge and/or vaginal


irritation.

Negative urine dipstick, microscopic urinalysis


urine culture; positive vaginal cultures.
Direct examination yields budding yeasts and
hyphae - the use of potassium hydroxide (KOH
enhances the recovery of these fungal elemen
yeasts provoke a large white blood cell respon
with a negative amine test. Normal vaginal flo
be present.

Vaginitis due to
trichomonas

Presence of vaginal discharge and/or vaginal


irritation.

Negative urine dipstick, microscopic urinalysis


urine culture; positive vaginal cultures.
Direct examination commonly reveals motile
parasite with its flagella whipping back and for
infection is associated with large numbers of w
cells with a positive amine test and the absenc
normal vaginal flora.

Bacterial vaginosis and


cervicitis due
to Neisseria
gonorrhoeae, Chlamydia
trachomatis, or herpes
simplex

Presence of vaginal discharge and/or vaginal


irritation.

Negative urine dipstick, microscopic urinalysis


urine culture.
Positive vaginal cultures; positive DNA probe a
for gonorrhoea and chlamydia.

Interstitial cystitis
(painful bladder
syndrome)

Pain associated with bladder filling as well as


urinary urgency and frequency in the absence of a
UTI. The course of the disease is usually marked by
flare-ups and remissions.[36]
Dyspareunia and supra-pubic discomfort as well as
anterior vaginal wall tenderness on examination.

Symptoms with negative urine cultures are


characteristic of interstitial cystitis.

Urethral diverticulum

May present with dysuria, dyspareunia, and/or


dribbling.
On physical examination, a fluctuant urethral mass
as well as purulent meatal discharge upon mass
compression may be noted.

Characteristic radiographic findings on voiding


cystourethrography (peri-urethral fluid collecti
T2-weighted MRI (bright image in peri-urethral

Infected Skene gland


cyst

May present with urethral pain, discharge, and/or


urgency and frequency.

May be visualised on MRI.

Pelvic organ prolapse

May present with pelvic fullness or pressure and/or


voiding dysfunction.

Diagnosis is clinical.
No evidence of infection in urine studies.

Urethral cancer

May present with voiding symptoms or haematuria.


Urethral induration may be noted on physical
examination.

A urethral mass can be visualised on cystosco


confirmed by pathological diagnosis of biopsy
specimen.

Radiation cystitis

Hx of pelvic radiation.
May have voiding symptoms and/or haematuria.

Findings on cystoscopy include diffuse erythem


oedema, vascularity, petechiae, and patches o
pallor.

Post-cyclophosphamide

Hx of cyclophosphamide treatment.

Diagnosed by cystoscopy (diffuse erythema,

DIFFERENTIAL DIAGNOSA

Condition

Differentiating signs/symptoms

Differentiating investigations

cystitis

Irritative voiding symptoms.

oedema, vascularity, petechiae, patches of pa


and, possibly, biopsy.

Atypical infections of
lower urinary tract
(fungal, adenovirus, TB)

May present with recurrent voiding symptoms or


sterile pyuria.

Diagnosed by culture of atypical organisms.

Asymptomatic
bacteriuria

This is not considered a UTI, but is present in up to


20% of the older female population, and its
prevalence is even higher in nursing home patients
(25% to 33%). [1]

Bacteria and, occasionally, WBCs in the urine i


absence of urinary symptoms.

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