Dysuria is a common presenting complaint of adolescent girls. Because physicians often assume a bacterial urinary tract infection (UTI) is present, the patient may be treated with antibiotics without thorough evaluation. In previous studies only half of adult women complaining of dysuria had bacteriuria with greater than 105 organisms per milliliter.1,2 Vaginitis,3,4 vulvitis,3 Neisseria gonorrhoeae,5 Chlamydia trachomatis,6-9 and bacteriuria with less than 105 organisms per milliliter1,2,9 are responsible for the symptoms in many of the remaining subjects. A recent study in adult women found that a history of external dysuria (pain felt as the urine passes over the inflamed vaginal labia) suggested vaginal infection, whereas a history of internal dysuria (pain felt inside the body) suggested bacterial UTI.4

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