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Dysuria in Children

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381. Gonococcal Infections (Overview)

unprotected intercourse with new partners frequently enough to sustain the infection in a community are defined as core transmitters. Neonatal and pediatric gonococcal infection Neonatal gonococcal infection may follow conjunctival infection, which is obtained during passage through the birth canal. In addition, direct infection may occur through the scalp at the sites of fetal monitoring electrodes. In children, infection may occur from sexual abuse by an infected individual or possibly nonsexual contact (...) contraceptives Rates of reported gonorrhea cases by age group and sex, United States, 2016. Courtesy of the Centers for Disease Control and Prevention (CDC). Infection in children is a marker for child sexual abuse and should be reported as such, although a 2007 review provided some support for nonsexual transmission between children and for transmission from adults to children related to poor hand hygiene. [ , ] Gonococcemia remains an important disease in the adolescent and young adult population

2014 eMedicine.com

382. HLA-B27 Syndromes (Overview)

in the treatment of resistant chronic uveitis, including chronic anterior uveitis in children with juvenile rheumatoid uveitis and idiopathic uveitis. This allowed the reduction of both systemic corticosteroids and/or systemic methotrexate. Oral tolerance involves administering an antigen orally to induce a specific peripheral immune tolerance. The mechanisms of oral tolerance are unclear, but it is believed that it involves a specific antigen and the generation of active suppression or clonal anergy dependent (...) in individuals who are HLA-B27 positive; in fact, 60-85% of patients with reactive arthritis are HLA-B27 positive. The disease is most common in persons aged 18-40 years, but it has been known to occur in children and older adults. The sex ratio varies, depending on whether the infection is enteric or venereally acquired. The sex ratio following gastrointestinal infection is 1:1, whereas the genitourinary disease primarily affects males. Prevalence of the disease also is high in homosexual and bisexual men

2014 eMedicine.com

383. Gonococcus (Overview)

partners frequently enough to sustain the infection in a community are defined as core transmitters. Neonatal and pediatric gonococcal infection Neonatal gonococcal infection may follow conjunctival infection, which is obtained during passage through the birth canal. In addition, direct infection may occur through the scalp at the sites of fetal monitoring electrodes. In children, infection may occur from sexual abuse by an infected individual or possibly nonsexual contact in the child's household (...) of reported gonorrhea cases by age group and sex, United States, 2016. Courtesy of the Centers for Disease Control and Prevention (CDC). Infection in children is a marker for child sexual abuse and should be reported as such, although a 2007 review provided some support for nonsexual transmission between children and for transmission from adults to children related to poor hand hygiene. [ , ] Gonococcemia remains an important disease in the adolescent and young adult population, with a peak incidence

2014 eMedicine.com

384. Gonococcemia (Overview)

partners frequently enough to sustain the infection in a community are defined as core transmitters. Neonatal and pediatric gonococcal infection Neonatal gonococcal infection may follow conjunctival infection, which is obtained during passage through the birth canal. In addition, direct infection may occur through the scalp at the sites of fetal monitoring electrodes. In children, infection may occur from sexual abuse by an infected individual or possibly nonsexual contact in the child's household (...) of reported gonorrhea cases by age group and sex, United States, 2016. Courtesy of the Centers for Disease Control and Prevention (CDC). Infection in children is a marker for child sexual abuse and should be reported as such, although a 2007 review provided some support for nonsexual transmission between children and for transmission from adults to children related to poor hand hygiene. [ , ] Gonococcemia remains an important disease in the adolescent and young adult population, with a peak incidence

2014 eMedicine.com

385. Hematopoietic Stem Cell Transplantation (Overview)

hampered by small numbers. [ ] Patients treated with chemotherapy alone have achieved remission, but overall survival has been poor. [ , ] In a comparison allogeneic transplant versus chemotherapy in children with Phl + ALL (UK Medical Research Council trial for childhood ALL [MRC ALL 97] program from 1997-2002), 3-year survival was reported as 60% compared with 36%, respectively. [ ] Children with induction failure (M2 or M3 bone marrow status at the end of 1 mo of therapy) were found to have very (...) Leukocyte adhesion deficiency Indications for HSCT in specific diseases Acute myeloid leukemia Allogeneic HSCT is the treatment of choice for all children with acute myeloid leukemia (AML) with a human leukocyte antigen (HLA) ̶ matched sibling in their first complete remission (CR1). In adults, this is reserved for those with high-risk features in their CR1. In adults with standard or good risk features, stem cell transplantation is reserved for their second complete remission (CR2). HSCT is the only

2014 eMedicine.com

386. Genital Herpes in Pregnancy (Overview)

of Obstetrics and Gynecologists (Washington, DC) for speaking and teaching; Received honoraria from National Institute of Child Health and Human Development Pediatric and Adolescent Gynecology Research Thi. Chief Editor Ronald M Ramus, MD Professor of Obstetrics and Gynecology, Director, Division of Maternal-Fetal Medicine, Virginia Commonwealth University School of Medicine Ronald M Ramus, MD is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Additional Contributors (...) to herpes simplex virus 2 (HSV-2). Approximately 22% of pregnant women are infected with HSV-2 and 2% of women acquire genital herpes in pregnancy. Approximately 1500-2000 new cases of neonatal HSV infection are diagnosed each year. The incidence of neonatal herpes varies considerably in international studies (about 1:3,200 births in the US and 1:60,000 in the UK). Approximately 80% of infected infants are born to mothers with no reported history of HSV infection. [ ] Untreated neonatal HSV infection

2014 eMedicine.com

387. Dermatologic Diseases of the Male Genitalia: Nonmalignant (Overview)

(HPV) and Zoon balanitis has been identified. Clinical presentation/diagnosis Although the mean age at presentation is 53 years, patients aged 18-88 years are described in two series, and presentation in children as young as 12 years has been described. The men are uncircumcised in most series. Patients present with a solitary, glistening, sharply demarcated, large (2-3 cm), erythematous, speckled patch on the glans or inner prepuce. Rarely, multiple patches can erode and ulcerate. Clinical (...) is recommended, with application to the entire skin surface below the chin. The cream should be left on for 8-14 hours (overnight) and then washed off. Second-line therapy includes the use of 1% lotion/cream or oral . Ivermectin may be repeated in 2 weeks. Lindane is not recommended for pregnant women or children younger than 2 years. Use lindane as a single dose (do not repeat). [ ] Antipruritic agents may be helpful in reducing discomfort related to pruritus. All household members and close contacts must

2014 eMedicine.com

388. Tuberculosis (Overview)

to coma over a period of days to weeks Low-grade or absent fever Symptoms of skeletal TB may include the following: Back pain or stiffness Lower-extremity paralysis, in as many as half of patients with undiagnosed Tuberculous arthritis, usually involving only 1 joint (most often the hip or knee, followed by the ankle, elbow, wrist, and shoulder) Symptoms of genitourinary TB may include the following: Flank pain Dysuria Frequent urination In men, a painful scrotal mass, prostatitis, orchitis (...) considerations for drug therapy in children include the following: Most children with TB can be treated with isoniazid and rifampin for 6 months, along with pyrazinamide for the first 2 months if the culture from the source case is fully susceptible. For postnatal TB, the treatment duration may be increased to 9 or 12 months Ethambutol is often avoided in young children Special considerations for drug therapy in HIV-infected patients include the following: Dose adjustments may be necessary [ , ] Rifampin

2014 eMedicine.com

389. Tuberculosis (Overview)

to coma over a period of days to weeks Low-grade or absent fever Symptoms of skeletal TB may include the following: Back pain or stiffness Lower-extremity paralysis, in as many as half of patients with undiagnosed Tuberculous arthritis, usually involving only 1 joint (most often the hip or knee, followed by the ankle, elbow, wrist, and shoulder) Symptoms of genitourinary TB may include the following: Flank pain Dysuria Frequent urination In men, a painful scrotal mass, prostatitis, orchitis (...) considerations for drug therapy in children include the following: Most children with TB can be treated with isoniazid and rifampin for 6 months, along with pyrazinamide for the first 2 months if the culture from the source case is fully susceptible. For postnatal TB, the treatment duration may be increased to 9 or 12 months Ethambutol is often avoided in young children Special considerations for drug therapy in HIV-infected patients include the following: Dose adjustments may be necessary [ , ] Rifampin

2014 eMedicine.com

390. Urinary Tract Obstruction (Overview)

obstruction is usually indolent and may be asymptomatic. When infection is present, the patient may experience fever, chills, and dysuria. Hematuria may also be present. When bilateral obstruction or unilateral obstruction in a solitary kidney is severe and renal failure has occurred, uremia can be present. Uremia symptoms include weakness, peripheral edema, mental status changes, and pallor. If hydronephrosis is severe, the kidney may be palpable on physical examination, especially in children. In cases (...) . In men, hydronephrosis is most likely after age 60 years secondary to prostatic obstruction. Hydronephrosis is found in 2-2.5% of children. Previous Next: Etiology Obstruction of urinary flow can occur anywhere from the kidneys to the urethral meatus. Dividing the urinary tract into the upper urinary tract, defined as the kidney and ureter to the hiatus with the bladder, and the lower urinary tract, defined as the bladder and urethra to the urethral meatus, allows for further delineation of the cause

2014 eMedicine.com

391. Urinary Tract Infections in Pregnancy (Overview)

mucosal vaccine for urinary tract infections. J Urol . 2003 Sep. 170(3):867-9. . Mann JR, McDermott S. Are Maternal Genitourinary Infection and Pre-Eclampsia Associated With ADHD in School Aged Children?. J Atten Disord . 2010 Sep 13. . Sun Y, Vestergaard M, Christensen J, Nahmias AJ, Olsen J. Prenatal exposure to maternal infections and epilepsy in childhood: a population-based cohort study. Pediatrics . 2008 May. 121(5):e1100-7. . Kazemier BM, Koningstein FN, Schneeberger C, Ott A, Bossuyt PM, de (...) and childhood neurologic consequences. For patient education information, see the and , as well as , , , and . Definitions of key terms Urinary tract infection UTI is defined as the presence of at least 100,000 organisms per milliliter of urine in an asymptomatic patient, or as more than 100 organisms/mL of urine with accompanying pyuria (> 7 white blood cells [WBCs]/mL) in a symptomatic patient. A diagnosis of UTI should be supported by a positive culture for a uropathogen, particularly in patients

2014 eMedicine.com

392. Urethritis (Overview)

, including approximately 25% of those with NGU, are asymptomatic and present to a clinician following partner screening. [ ] Up to 75% of women with Chlamydia trachomatis infection are asymptomatic. Signs and symptoms in patients with urethritis may include the following: Urethral discharge: May be yellow, green, brown, or tinged with blood; production unrelated to sexual activity Dysuria (in men): Usually localized to the meatus or distal penis, worst during the first morning void, and made worse (...) is highest in the summer months. International Worldwide, approximately 62 million new cases of gonococcal urethritis and 89 million new cases of NGU are reported each year. Previous Next: Mortality/Morbidity Approximately 10%-40% of women with urethritis eventually develop (PID), which may subsequently cause and ectopic pregnancy secondary to postinflammatory scar formation in the fallopian tubes. PID can occur even in women with asymptomatic infections. Children born to mothers with Chlamydia infection

2014 eMedicine.com

393. Urinary Tract Infection, Females (Overview)

of estrogen with attendant changes in vaginal flora (notably, loss of lactobacilli), which allows periurethral colonization with gram-negative aerobes, such as E coli; and higher likelihood of concomitant medical illness, such as diabetes. Of neonates, boys are slightly more likely than girls to present with UTI as part of a gram-negative sepsis syndrome. The incidence in preschool-aged children is approximately 2% and is 10 times more common in girls. UTI occurs in 5% of school-aged girls, but it is rare (...) infection) represents the majority of these infections (see the image below). Related terms include pyelonephritis, which refers to upper urinary tract infection; bacteriuria, which describes bacteria in the urine; and candiduria, which describes yeast in the urine. Plain radiograph in a 63-year-old patient with poorly controlled type 2 diabetes mellitus shows emphysematous cystitis. Signs and symptoms Symptoms and signs of UTI in the adult are as follows: Dysuria Urinary urgency and frequency

2014 eMedicine.com

394. Uric Acid Nephropathy (Overview)

practice, the prognosis for persons with acute renal failure from acute urate nephropathy is excellent. The morbidity of uric acid nephrolithiasis arises from the manifestations of stones, obstruction, and crystalluria and is often accompanied by dysuria and hematuria. [ ] Secondary bacteriuria and pyelonephritis also can occur. However, life-threatening complications are rare. Race See the list below: A number of different malignancies cause a predisposition to acute uric acid nephropathy, making (...) demographics for this entity difficult to characterize. Sex See the list below: Uric acid nephrolithiasis occurs most frequently in those with underlying hyperuricemia or gout, which occurs in men more frequently than women by a male-to-female ratio of 4:1. In the United States, the prevalence rate is 4-9% in men and 1.7-4.1% in women. Age See the list below: Uric acid nephropathy has been well documented in the pediatric and adult populations. It may occur more often in pediatric patients because

2014 eMedicine.com

395. Urinary Tract Infection, Males (Overview)

to the normal male urinary tract’s many natural defenses to infection, many experts consider UTIs in males, by definition, to be complicated (ie, more likely to be associated with anatomic abnormalities, requiring surgical intervention to prevent sequelae). Signs and symptoms Dysuria is the most frequent chief complaint in men with UTI. The combination of dysuria, urinary frequency, and urinary urgency is about 75% predictive for UTI, whereas the acute onset of hesitancy, urinary dribbling, and slow stream (...) organisms can retard ureteral peristalsis. E coli is responsible for approximately 25% of cases in males, with and causing many remaining infections; , Pseudomonas , , and are less frequent. Bacterial cystitis Bacterial cystitis without concomitant infection in other portions of the genitourinary tract is believed to be a rare event in males. The abrupt onset of irritative voiding symptoms (eg, frequency, urgency, nocturia, dysuria) and suprapubic pain are clinically diagnostic. Most cases of bacterial

2014 eMedicine.com

396. Urethral Syndrome (Overview)

Updated: Jun 23, 2017 Author: Martha K Terris, MD, FACS; Chief Editor: Edward David Kim, MD, FACS Share Email Print Feedback Close Sections Sections Urethral Syndrome Overview Practice Essentials Urethral syndrome is characterized by urinary frequency, dysuria, and suprapubic discomfort without any objective finding of urological abnormalities. It is also characterized by sterile urine culture results and urinary frequency that is typically worse during the day than during the night. The dysuria (...) syndrome is to relieve the discomfort and urinary frequency. This often involves a trial-and-error approach that uses behavioral, dietary, and medical therapy. See and . Next: Background Urethral syndrome was originally described as urinary frequency and dysuria without demonstrable infection. As a diagnosis, urethral syndrome (also known as frequency-dysuria syndrome) is controversial, and the term (coined by Powell and Powell in 1949) may be outdated, partially because of the lack of consensus

2014 eMedicine.com

397. Urethral Prolapse (Overview)

is predominantly asymptomatic. Often, urethral prolapse is an incidental finding during routine examination. The most common presentation is vaginal bleeding associated with a periurethral mass. [ ] Symptomatic children present with bloody spotting on their underwear or diapers. is uncommon. Until urethral prolapse is definitively diagnosed, the presence of blood in the genital area should raise suspicion of and warrant ruling out this possibility. Voiding disturbances are typically rare in the pediatric (...) population, but when they are present, patients may report dysuria, urinary frequency, or introital pain. Again, hematuria is uncommon. Children may report genital pain if the prolapsed mucosa becomes very large or if thrombosis and necrosis have developed. Furthermore, although reportedly a nonobstructive lesion, acute urinary retention secondary to urethral prolapse has been reported. [ ] In contrast, patients with postmenopausal urethral prolapse are often symptomatic. Vaginal bleeding associated

2014 eMedicine.com

398. Urethral Diverticula (Overview)

been identified with increasing frequency over the past several decades because of increased physician awareness of the condition. The most common symptoms associated with urethral diverticula include urinary frequency, urgency, and dysuria. In some cases, and calculi are also present. Despite the increased awareness in recent years, this entity continues to be overlooked during routine evaluation of women with voiding problems. Accurate diagnosis and treatment of urethral diverticula require (...) . Congenital urethral diverticula are rare; however, urethral diverticula in children have been used to support the congenital origin theory. Congenital urethral diverticula have been postulated to arise from the following: Remnant of Gartner duct Faulty union of primordial folds Cell rests Vaginal wall cysts of müllerian origin Congenital dilatation of periurethral cysts Association with blind-ending ureters Acquired diverticula may originate from repeated urinary tract infections obstructing

2014 eMedicine.com

399. Urethral Caruncle (Overview)

. Cases of urethral melanoma, [ ] , [ , ] intestinal ectopia, lymphoma, [ , ] and urethral leiomyoma [ ] masquerading as urethral caruncle have been reported; however, reports of these associations are rare. Intraepithelial squamous cell carcinoma arising within a urethral caruncle has been reported in two patients. [ ] Additionally, urethral caruncles have been reported to occur rarely in the premenopausal patient and may enlarge during pregnancy. Urethral polyps are the pediatric equivalent (...) of urethral caruncles and manifest in a similar fashion. Previous Next: Presentation Most urethral caruncles are asymptomatic and are incidentally noted on pelvic examination; however, some may be painful and others may be associated with dysuria. Many individuals with a urethral caruncle present with bleeding or, more commonly, with the patient noticing blood on undergarments. Urethral caruncles are unlikely to explain voiding or storage symptoms in women. In fact, a comparison of lower urinary tract

2014 eMedicine.com

400. Tuberculosis of the Genitourinary System (Overview)

, golf-hole appearance) with . Severe cases involve the entire bladder wall, where deep layers of muscle are eventually replaced by fibrous tissue, thus producing a thick fibrous bladder. Tubercles are rare in the bladder; if present, they usually appear at the ureteral orifice. Malignancy should be considered with any isolated tubercles away from the ureteral orifices. Epididymal and testicular TB The higher frequency of isolated epididymal TB lesions in children favors the possibility (...) order of frequency, include increased frequency of urination (during the day initially but at night later in the disease course), dysuria, frank pain, suprapubic pain, blood or pus in the urine, and fever. Urinary urgency is relatively uncommon unless the bladder is extensively involved. Patients with GUTB may also present with a painful testicular swelling, perianal sinus, or genital ulcer. Unexplained infertility in both men and women is sometimes attributable to GUTB. [ ] Physicians have also

2014 eMedicine.com

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