ok
but i need help how can i approach this case
??
First, you should get a history and do a physical. I am assuming that the information you gave us is all we can get. Then come up with a differential. With dysuria I come up with UTI (urethritis,cystitis, pyelonephritis). STD's make the list, with gonorhea and/or chlamydia urethritis. Interstitial cystitis can be on the list, but is pretty low on the likelihood scale.
We don't have much information, in terms of history and physical, so work out with what you have. It sounds like acute onset of dysuria, without systemic findings I(such as fever), or any other associated symptoms. Given the honeymoon, and the high likelihood of recent intercourse, "honeymoon cystitis" (which is actually a urethritis) is very, very high on my list.
Next would be the work up. Urinalysis and urine culture would be appropriate, and would be the extent of what is appropriate, if there are no other history or physical findings that would lead us to have reasonable suspision of another disease process. If there is some purulent discharge from the urethra, get a GC/CZ culture as well. Ulcerated lesions, consider herpes culture and/or titers. Maybe do a wet prep/KOH if there is a lot of discharge or vulvar irritation.
Treatment would be based on the suspected pathogen. Classically, "honeymoon cystitis" is secondary to E. coli or Staph saprophyticus. Treat with antibiotics, several of which are effective, including bactrim, cipro, macrobid and keflex.
Clinical problem solving involves gathering information (from cheif complaint, H&P), developing a differential diagnosis based on those findings, performing further studies to confirm or disconfirm the diagnosis, and treatment which is either presumptive or based upon definitive studies (such as culture results)
Hope this helps.
