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DYSURIA: WHO NEEDS A PELVIC EXAMINATION?

Studies in populations where infections of the genital tract (GTI) are more prevalent than those of the urinary tract (UTI) suggest that pelvic examinations must be included in the evaluation of all women presenting with dysuria. In these populations, symptom information and general physical findings alone do not adequately distinguish between the two sites of infection. However, in populations where UTI are more prevalent, practitioners frequently omit pelvic exams and make management decisions on the basis of clinical findings. Empirical evidence to support this practice is lacking. Our study was designed to determine whether clinical findings can discriminate between UTI and GTI in a population with a high prevalence of UTI. We evaluated 118 women presenting to a College Health Service with dysuria. For each patient, data on GU symptoms, medical, and sexual history were obtained; a physical and pelvic exam, and standard laboratory evaluation were performed. Based on microbiological results, a diagnosis was established for 72.5% of cases: 33.7% pure UTI, 18.4% pure GTI and 20.4% mixed UTI-GTI. Clinical data for the three groups were compared using standard univariate statistics. Significant differences (p<.05) between pure UTI and pure GTI were obtained for vaginal discharge, itching, hematuria, and pyuria. No differences were found between pure UTI and mixed UTI-GTI. These data suggest that traditional clinical data alons cannot adequately discriminate between pure UTI and other GU infections. Even in populations with a high prevalence of UTI, pelvic exams may be important in evaluating dysuria.