QuestionSBA
QuestionChoice
There is no indication for an ultrasound of the kidneys at present
32000
c
Ultrasound of kidneys
QuestionChoice
This is only indicated if there is protein in the urine, which there is not
32002
e
Send urine for PCR
QuestionChoice
There is no need to send this urine for culture if it is negative for nitrites and leukocytes, it is unlikely to be due to an infection
32001
d
Urine culture
QuestionChoice
This is correct. This is a simple test to investigate the next most common cause of dysuria in a young female patient
31998
a
Sexually transmitted disease (STD) screen
QuestionChoice
Simpler investigations should first be carried out before referral for consideration of cystoscopy
31999
b
Refer for cystoscopy
Concept
Chapter
# Candidiasis 


The most common cause of Candidiasis is Candida Albicans. This is the causative organism in 85-90% of cases. Candida infection is associated with pregnancy, antibiotic use and immunosuppression. The method of transmission is generally non-sexual.


- Symptoms in women include: itching, white curdy discharge, sour milk odour, dysuria, superficial dyspareunia


- Examination in women: redness, fissuring, swelling, intertrigo, thick white discharge


- Symptoms in men: soreness, pruritis, redness


- Examination in men: dry, dull, red glazed plaques and papules


# Bacterial Vaginosis 


Bacterial Vaginosis is a bacterial overgrowth, leading to vaginal discharge with an associated fishy odour. This is associated with UPSI and menstruation


In order to diagnose Bacterial Vaginosis, the Amstel criteria are used. Three out of four features are needed to confer a diagnosis:


- Vaginal pH >4.5
- Homogenous grey discharge
- Whiff test - 10% potassium hydroxide produces fishy odour
- Clue cells present on wet mount


The treatment of choice is Metronidazole or Clindamycin. The treatment used in pregnancy is Metronidazole.


# Trichomoniasis 


Trichomonas infection is caused by Trichomonas Vaginalis, a flagellated protozoan. Transmission is usually sexual, with an incubation period of around 7 days.


- Symptoms in women: can be asymptomatic, but classically profuse, frothy, yellow vaginal discharge. There can also be vulval irritation and dyspareunia present.


- Symptoms in men: can cause non gonococcal urethritis, can be asymptomatic


- On examination:commonly normal, strawberry cervix is a rare sign


- Diagnosis: Direct microscopy and culture


- Treatment: Metronidazole (PO state or BD for 7 days), follow up in one week, screen sexual contacts.


# Chlamydia 


Chlamydia trachomatis is an obligate intracellular bacterium, responsible for the infection of 1/10 women in the UK. Incubation is less than 4 weeks for men


- Asymptomatic infections are common. The most common symptoms in men are urethral discharge and dysuria, with the main symptoms in women being dysuria, inter menstrual bleeding and vaginal discharge. Neonates can be affected with pneumonia and conjunctivitis.


- Diagnosis is made by collecting endocervical swab and analysing using the NAAT test, the current investigation of choice. In males, urine and urethral swabs can be collected and analysed in a similar manner.


- Treatment is either by using Doxycycline BD for 7 days or Azithromycin 1g single dose. There is no need for a test of cure.


# Gonorrhoea 


Neisseria Gonorrhoeae is a gram-negative diplococcus.


- Symptoms in men: asymptomatic, discharge, dysuria, tender inguinal nodes.


- Symptoms in women: discharge, dysuria, abnormal bleeding.


- Examination may show discharge from the os, Skene's gland or Bartholin's gland.


- There can be extra-genital complications,including pharyngitis, rectal pain and discharge and disseminated infection.


- Diagnosis is made by microscopy and successful culture.


- The current guidance on treatment recommends treatment with both Ceftriaxone and Azithromycin to cover possible Chlamydia co-infection. A test of cure is recommended.
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Common genito-urinary infections
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Genitourinary medicine
Video
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Common genito-urinary infections
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Quesmed Tutorial: Genitourinary medicine and HIV SBAs
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Common genito-urinary infections
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Common genito-urinary infections 2
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Common genito-urinary infections
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Common genito-urinary infections 1
6400
In young women with dysuria and negative urine dipstick results, consider screening for sexually transmitted infections as a common underlying cause.
A 30 year old woman presents to her general practice with dysuria for the last 3 days. She denies blood in her urine, urinary frequency, or abdominal pain and her last period started 10 days ago, and has now finished.

A urine dipstick test is performed:

- Glucose: none
- Bilirubin: none
- Ketones: none
- Specific gravity: 1.020 (1.002-1.035mOsm/kg)
- pH 5 (4.5-8)
- Blood: none
- Protein: none
- Nitrites: none
- Leukocytes: none

What is the next best step to investigate this patient's dysuria?
a