A 16 year old girl presents to the clinic with painful urination that has persisted for weeks. She reports she has painful urination multiple times. She does not have any reported abdominal pain but also has an urgency to urinate.

Family History: asthma and atopy

Physical Examination: she looks tired

Head and neck exam: sore throat

Abdomen: palpable mass

Genitourinary exam: no discharge

MSK exam: normal 

The remainder of the physical examination is normal. Urine testing shows UA is positive for white blood cells and STI screen is positive.