Dysuria
Cystitis, urethritis or vaginitis? Who needs a culture, who needs STI NAATs, and the 2025 Therapeutic Guidelines order of nitrofurantoin, fosfomycin, then trimethoprim.
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Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Dysuria is pain or burning on passing urine. In a woman with dysuria plus frequency and no vaginal discharge, the chance of cystitis is over 90%.
- The first split is cystitis, urethritis (STI) or vaginitis. Ask every patient a sexual history; an STI can produce the same symptoms as cystitis and a dipstick won't separate them.
- Therapeutic Guidelines (March 2025) made nitrofurantoin first line for uncomplicated cystitis because of trimethoprim resistance in E. coli.
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Sources
- Therapeutic Guidelines: Antibiotic. Urinary tract infectionsAU/NZTherapeutic Guidelines Limited (eTG complete), Major update March 2025 (nitrofurantoin first line for cystitis)
- Australian STI Management Guidelines for Use in Primary Care (urethritis, chlamydia, gonorrhoea)AU/NZAustralasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM), online, accessed November 2026
- IDSA 2025 guideline update on complicated urinary tract infectionsInfectious Diseases Society of America, 2025
- Medicines, Poisons and Therapeutic Goods (Pharmacist Extended Scope of Practice - Urinary Tract Infection) Authorisation 2025 (No 1), including clinical protocolAU/NZACT Government (NI2025-612), 2025
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy