| Presenting features of UTI | Differential diagnosis | Characteristic and/or distinguishing features |
Cystitis symptoms: - Dysuria
- Urinary urgency
- Urinary frequency
- Suprapubic pain
| Urethritis | - Dysuria is often the primary symptom
- Urethral discharge or pruritus variably occur
- Pyuria can be present on urinalysis
- Bacteriuria is typically absent on urinalysis or urine culture
- Should be a diagnostic consideration in sexually active individuals with dysuria who do not respond to cystitis treatment
|
| Interstitial cystitis/bladder pain syndrome | - Presents with same symptoms as infectious cystitis; fever is absent
- Symptoms persist for weeks despite antimicrobial therapy
- Diagnosis of exclusion
- Bacteriuria is typically absent on urinalysis or urine culture
|
| Vaginitis | - Can be associated with dysuria
- Predominant features include vaginal discharge, odor, or pruritus
- Urinary frequency or urgency is generally absent
- Pyuria and bacteriuria are typically absent on urine studies of a properly collected specimen
|
| Pelvic inflammatory disease | - Can be associated with dysuria
- Predominant features include lower abdominal or pelvic pain
- Suggested by cervical motion, uterine, and/or adnexal tenderness on pelvic examination; mucopurulent endocervical discharge may be present
- Bacteriuria is typically absent on urinalysis or urine culture
|
| Bacterial prostatitis | - Presents with same symptoms as cystitis
- Acute prostatitis is associated with fevers and signs of systemic illness
- Also associated with pelvic or perineal pain
- Digital rectal examination demonstrates tender prostate
- Pyuria and bacteriuria are commonly present in urine studies
|
| Benign prostatic hyperplasia | - Can be associated with lower urinary tract storage symptoms (frequency, urgency, nocturia, incontinence) and voiding symptoms (slow stream, hesitancy, terminal dribbling)
- Digital rectal examination demonstrates non-tender, enlarged prostate
- Pyuria and bacteriuria are typically absent on urine studies
|
Pyelonephritis symptoms: - Flank pain
- Fever
- Nausea/vomiting
- Costovertebral angle tenderness
| Nephrolithiasis | - Kidney and upper ureteral stones can cause flank pain and associated nausea/vomiting
- Can occur concomitantly with UTI
- Fever is uncommon without superimposed infection
- Pyuria can be present on urinalysis
- Bacteriuria is typically absent on urinalysis or urine culture without superimposed infection
|
| Renal infarct | - Can present with acute flank or abdominal pain and associated nausea/vomiting
- Fever is less common
- A history of atrial fibrillation increases likelihood of renal infarct
- Costovertebral angle tenderness is uncommon
- Pyuria and bacteriuria are typically absent on urine studies
|
| Herpes zoster | - If affecting lower thoracic/upper lumbar dermatomes, can present with flank pain that precedes typical vesicular lesions by a few days, although lesions are not always seen
- Pyuria and bacteriuria are typically absent on urine studies
|
Intraabdominal processes: - Appendicitis
- Cholecystitis/biliary colic
- Pancreatitis
| - Can occasionally be associated with flank pain in addition to generalized abdominal pain, nausea, and vomiting, with or without fevers
- Pyuria and bacteriuria are typically absent on urine studies
|
| Signs of systemic infection (eg, fever) in the setting of pyuria and bacteriuria | Other common infection with coincident bacteriuria: - Upper or lower respiratory tract infection (including influenza)
- Skin/soft tissue infection
- Intraabdominal infection
- Primary bloodstream or intravascular-catheter-associated infection
| - In the absence of symptoms localized to the urinary tract, the possibility of other infections should be considered before attributing pyuria and bacteriuria to UTI
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