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Diagnosis and Treatment |

Diagnostic Decision: Urinalysis and Urine Culture in Women with Dysuria

ANTHONY L. KOMAROFF, M.D.
[+] Article and Author Information

Grant support: in part by grants HS 02063 and HS 04066 from the National Center for Health Services Research.

▸Requests for reprints should be addressed to Anthony L. Komaroff, M.D.; Department of Medicine, Brigham and Women's Hospital, 75 Francis Street; Boston, MA 02115.


Boston, Massachusetts


©1986 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1986;104(2):212-218. doi:10.7326/0003-4819-104-2-212
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In caring for women with acute dysuria, clinicians traditionally have relied on clinical findings to distinguish between acute pyelonephritis and "cystitis"; they have ordered urinalysis and urine culture regularly for patients with suspected acute pyelonephritis and ordered these tests inconsistently for patients with suspected "cystitis." Recent evidence indicates that "cystitis" may actually be any of six different clinical conditions, each of which is managed differently; subclinical pyelonephritis, lower urinary tract bacterial infection, chlamydial urethritis, other forms of urethritis, vaginitis, or dysuria without any urinary tract or vaginal infection. The distinction between these entities is made primarily from clinical findings. Urinalysis is also of great value in symptomatic patients; the presence of pyuria (and possibly indirect quantitation of pyuria by the leukocyte esterase test) is a reliable indicator of treatable infection, and its absence indicates infection is not present. In contrast, urine culture is of clear value only in patients with acute pyelonephritis or subclinical pyelonephritis.

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