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Dysuria: Evaluation and Differential Diagnosis in Adults

Ariel Hoffman, MD, MPH
Katelyn A. Dolezal, MD
Rob Powell, DO

American Family Physician. 2025;111(1):37-46.

Author disclosure: No relevant financial relationships.

This clinical content conforms to AAFP criteria for CME.

Dysuria, a feeling of pain or discomfort during urination, is often caused by urinary tract infection but can also be due to sexually transmitted infection, bladder irritants, skin lesions, and some chronic pain conditions. History is most often useful for finding signs of sexually transmitted infection, complicated infections, lower urinary symptoms in males, and noninfectious causes. Most patients presenting with dysuria should have a urinalysis performed. Urine culture should be performed for infection to guide appropriate antibiotic use, especially for recurrent or suspected complicated urinary tract infection. Vaginal discharge decreases the likelihood of urinary tract infection, and other causes of dysuria, including cervicitis, should be investigated. If a patient has persistent urethritis or cervicitis with negative initial testing, Mycoplasma genitalium testing is recommended. Clinical decision rules may increase the accuracy of diagnosis with and without laboratory analysis. Evaluation and treatment of dysuria through a virtual encounter without laboratory testing may increase recurrent symptoms and antibiotic courses. Persistent symptoms after initial evaluation and treatment require further workup for infectious and noninfectious causes.

ARIEL HOFFMAN, MD, MPH, is residency faculty at Martin Army Community Hospital, Fort Moore, Georgia, and an assistant professor in the Department of Family Medicine at the Uniformed Services University of the Health Sciences School of Medicine, Bethesda, Maryland.

KATELYN A. DOLEZAL, MD, is the associate program director at Madigan Army Medical Center Family Medicine Residency Program, Tacoma, Washington.

ROB POWELL, DO, is residency faculty at Martin Army Community Hospital, Fort Moore, Georgia.

Address correspondence to Ariel Hoffman, MD, MPH, at arielhoffman716@gmail.com.

Author disclosure: No relevant financial relationships.

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