Abbreviations:
- UA = Urinalysis
- STD = Sexually Transmitted Disease (Gonorrhea, Chlamydia, Mycoplasma genitalium)
- UTI = Urinary Tract Infection (bladder infection from E. coli or other similar bacteria))
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 thereโs โno 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 (itโs 3-4 weeks now)
- Repeat the UA (let’s suppose it’s still negative)
- Reassure โno 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 = โChronic Prostatitisโ)
- Maybe add antibiotic ciprofloxacin to the alpha-blocker
- Promise a Urology referral if it doesnโt work
- Explain that Urology would simply try the same treatment
- Mention that โ6 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.