Believe it: All pain 'down there' isn't a UTI


I'm gullible. I tend to believe people are honest, but as a result I tend to fall for stupid things. For example, I once believed a person who said "gullible" isn't in the dictionary.

I saw a wall mount of a rabbit with six-point antlers and was told it was a "Jack-a-lope." I wondered about that and researched it, until finally everyone laughed at my foolishness. I believed my staff would all come to my skating exhibition, only to fall on the ice in front of other people– but not my staff.

But when it comes to practicing medicine, I'm skeptical of everything. I question and double-check everything just to make sure I have considered every angle. It's what internists do.

So when women patients call me to request antibiotics for their "UTI" (urinary tract infection, aka bladder infection), I often question if they really do have a UTI. Are women always right about their UTIs?

I had a women recently call me saying, "A UVA nurse friend of mine told me I probably have a UTI and should call in for antibiotics. She said I don't need to see the doctor."

Hmm... I asked her to come in and instead of a UTI, I found a uterine tumor and pelvic infection. Once, while I was on call, I had a woman page me at 6:30am, saying, "I'm going to work in 10 minutes and wondered if you could call in an antibiotic for my UTI so I can pick it up on the way."

Hmm... I asked her to see her primary care physician, and they found out she had a vaginal infection, not a UTI. One woman called me for drugs for her UTI, and instead I diagnosed her with genital herpes.

Though I know antibiotics are treated like candy in some other countries– meaning you don't need a prescription to get them– treatment with antibiotics is not an easy science. Different antibiotics work in different ways, and I hate to say this– gulp– but most non-physicians don't know how they work. (Am I going to be burned in effigy for saying this?)

Dysuria is a fancy-schmancy way of saying, "It hurts to pee. The water coming out feels like Clorox!" Dysuria is pain, tingling, or burning in the perineum while urinating or just afterwards. (Perineum is the medical term for, well, crotch.) Inflammation of the urethra (urinary tract) and bladder or involving the vaginal labia causes dysuria.

Yes, UTI is the number-one reason for dysuria. I can see why a woman who has had many UTIs in the past would want an antibiotic without seeing the doctor– but would you call your dentist and ask for oral antibiotics if your tooth were hurting? Would you ask your optometrist to give you a prescription for contact lenses without seeing her? Would you buy a Jessica Simpson album without first listening to it?

Worse than a UTI is pyelonephritis (kidney infection). The short course of treatment for a UTI won't touch pyelonephritis; it's like UVA trying to beat Tech in football.

STDs like chlamydia (which is not an orchid) can present with dysuria due to urethritis (infection of the urethra). Antibiotics that treat UTIs don't work on chlamydia.

Women after menopause can get vaginal wall thinness, atrophic vaginitis, which can cause dysuria. Spermicides and diaphragms can cause dysuria. Yeast infections, trichomonas, and just plain old-fashioned American sex can cause dysuria.

Egad! It's like a buffet of causes for dysuria! The bottom line is: dysuria doesn't mean you have a classic UTI– and you aren't gullible if you believe this.