Painful Urination in Men


1.ย  A man has new painful urination.ย  We do a rapid UA by dipstick in the office, and call it “Positive” if there’s Leukocyte Esterase (an enzyme in White Blood Cells, which indicate infection):

  • UA Positive, and man has STD risk  โ†’ Test for Gonorrhea & Chlamydia; Treat for them even before results back
    • If negative and symptoms persist, test or just treat for Mycoplasma
  • UA Positive but no STD risk  โ†’   Tests for Gonorrhea, Chlamydia, and also regular urine Culture & Sensitivity (for a regular UTI).  Give an antibiotic to cover all while results pending.
  • UA Negative, but yes for STD risk   โ†’   Test for STDs, no treatment yet
  • UA Negative, no STD risks   โ†’   Reassure thereโ€™s โ€œno infectionโ€

2.  Patient still has ongoing Painful Urination (above tests, if done, are negative)

  • Repeat the UA (treat as above if positive; let’s suppose it’s still Negative)
  • Examine genitals, genital area, & prostate (let’s suppose they’re normal)
  • Order the STD tests above tests if not yet done
  • Suggest an anti-inflammatory NSAID (ibuprofen, naproxen, etc.)
  • Reassure “no infection!”
  • Follow-up in 2 weeks if not better (if results positive, telephone for treatment)

3.  Pain continues despite the anti-inflammatory, tests are negative (itโ€™s 3-4 weeks now)

  • Repeat the UA (let’s suppose it’s still negative)
  • Reassure โ€œno infection!โ€
  • Prescribe alpha-blocker (see Prostate Medications) for possible Prostate Disease (unlikely if <50 y.o., but try anyway)
  • Return in 2-3 weeks

4.  Pain still persists (now 6 weeks = โ€œChronic Prostatitisโ€)

  • Maybe add antibiotic ciprofloxacin to the alpha-blocker
  • Promise a Urology referral if it doesnโ€™t work
  • Explain that Urology would simply try the same treatment
  • Mention that โ€œ6 weeks of antibiotic is the most anyone should take.โ€
  • Provide psychological support

See Painful Urination in Men โ€” Full Text for more in-depth explanations and discussions.

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