Condition: Dysuria
Brief Overview: Dysuria is pain, burning, or discomfort with urination. It is a symptom commonly due to infection or irritation of the lower urinary tract but may reflect gynecologic, dermatologic, urologic, or systemic causes.
Etiology: Many possible etiologies, including, but not limited to:
- Infectious
- Cystitis/UTI (most common in females)
- Urethritis (STIs): Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis
- Prostatitis (men)
- Vaginitis: vulvovaginal candidiasis, bacterial vaginosis, trichomoniasis
- Herpes simplex virus (external lesions cause pain with voids)
- Noninfectious
- Irritants/trauma: spermicides, perfumed products, bubble baths, soaps; catheter/instrumentation; tight clothing
- Stones (ureteral/vesical), foreign body
- Interstitial cystitis/bladder pain syndrome (IC/BPS)
- Atrophic vaginitis/Genitourinary syndrome of menopause
- Dermatologic: lichen sclerosus, contact dermatitis
- Obstruction: BPH, urethral stricture
- Systemic: reactive arthritis
Common Medications: Treatment guided by cause of symptom
Common Labs, Imaging, and Tests:
- Urine testing
- STI testing
- Pelvic exam
- Imaging – ultrasound, CT, MRI
- Post-void residual testing (PVR)
Common Symptoms:
- Burning, itching, stinging with urination
- Can be after urination or at the start of urination
Common Treatments:
- Medication, as directed by the cause of dysuria
- Adequate hydration
- Adequate hygiene
General Health and Lifestyle Guidance:
- Maintain adequate hydration; avoid bladder irritants (caffeine, alcohol, carbonated/sugary drinks, spicy foods) during flares
- Urinate after intercourse; consider condom use; avoid spermicides/fragranced products if sensitive
- Front-to-back wiping, breathable underwear; avoid tight garments
- Keep a symptom/trigger diary if IC/BPS suspected
- Complete full antibiotic courses when prescribed; abstain from sex until STI treatment complete and partners treated, or as directed by healthcare provider
Suggested Questions to Ask Patients:
- Onset and character of pain/burning? Any fever, flank pain, nausea?
- Urinary symptoms: frequency, urgency, hematuria, weak stream, retention?
- Vaginal or urethral discharge, genital lesions, pelvic pain, dyspareunia?
- Recent new sexual partner, unprotected intercourse, prior STIs?
- Prior UTIs, kidney stones, or similar episodes? Response to past meds?
- Medications/irritants (new soaps, spermicides), hydration/caffeine habits?
Suggested Talking Points:
- Dysuria is common
- Your healthcare provider with base treatment on your symptoms and test results
- If tests suggest an STI, your partner(s) should be treated to prevent reinfection.
- Always ask your healthcare provider for specific advice on when to call to report symptoms, and when to seek urgent/emergency care.
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