Chapter 22 Dysuria
ETIOLOGY AND PATHOGENESIS
Causes: Infection and inflammation in the urethra and suburethral tissues. Most urinary tract infections in women ascend from contamination of the vulva and meatus acquired via instrumentation, trauma, or sexual intercourse. (A history of intercourse within the proceeding 24 to 48 hours is present in up to 75% of patients with acute urinary tract infection.) Coliform organisms, especially Escherichia coli, are the most common organisms responsible for asymptomatic bacteriuria, cystitis, and pyelonephritis. Ninety percent of first infections and 80% of recurrent infections are caused by E. coli, with between 10% and 20% resulting from Staphylococcus saprophyticus. Infection with other pathogens such as Klebsiella species (5%) and Proteus species (2%) account for most of the remaining infections. Infection with Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma, and Ureaplasma should all be considered when urethritis is suspected. Chemical irritation, allergic reactions, or vulvitis may all produce symptoms of dysuria.
