Cystitis | Frequency, urgency, may have gross hematuria | Recent sexual intercourse, risk factors present (see Table 2) | 15 to 20% have suprapubic tenderness; no costovertebral angle tenderness | Usually positive for pyuria and sometimes also positive for bacteriuria and nitrite |
Subclinical pyelonephritis | Frequency, urgency, may have gross hematuria | Risk factors present (see Table 5) | May have suprapubic tenderness; no costovertebral angle tenderness | Usually positive for pyuria and sometimes also positive for bacteriuria and nitrite; positive renal cortical scintigraphy, urine culture usually > 105 colony-forming units per mL of urine |
Acute pyelonephritis | Nausea, emesis, fever, sepsis, back/flank pain | May have had concurrent or preceding cystitis symptoms (see Table 5) | Costovertebral angle tenderness, deep right or left upper quadrant tenderness | Pyuria usually present with casts of white blood cells; obtain urine culture and sensitivity |
Interstitial cystitis | Frequency, urgency, gross hematuria (20%) | Often middle-aged; longstanding symptoms with negative cultures | No costovertebral angle tenderness; may have suprapubic tenderness | Urinalysis negative for white blood cells or bacteria; positive for glomerulations on cystoscopy |
Vaginitis | External irritation, vaginal discharge or pruritus, dyspareunia; no hematuria | Premenstrual exaggeration of symptoms; sexual activity or recent antibiotic exposure or post-menopausal and not receiving estrogen replacement therapy | Vaginal discharge, inflamed vaginal mucosa (absent in bacterial vaginosis), inflamed cervix (Trichomonas), vaginal atrophy (postmenopausal) | Positive potassium hydroxide or vaginal saline preparation; elevated pH (bacterial vaginosis or Trichomonas) |
Genital herpes | Dysuria, fever, headache, myalgias, neck pain, vulvar pain, photophobia | Sexually active; may have vaginal discharge | Grouped vesicles usually on cervix or pubic area, but may be vaginal; tender inguinal adenopathy | Viral culture optional |
Urethritis | Usually asymptomatic; if symptoms develop, they are usually delayed (>1 week) | History of unprotected sexual exposure | No suprapubic pain unless associated with pelvic inflammatory disease; rarely, visible urethral discharge | Urethral swab positive for white blood cells; obtain Gram stain to detect intracellular gram-negative diplococci and DNA probe for Chlamydia and gonorrhea |