What is the treatment for dysuria without evidence of Urinary Tract Infection (UTI)?

From the Guidelines

For dysuria without evidence of a urinary tract infection, the most critical step is to consider urethral stricture in the differential diagnosis, as it is a common cause of dysuria in men, and further evaluation with uroflowmetry, ultrasound post-void residual assessment, and potentially urethro-cystoscopy or retrograde urethrography may be necessary 1. When managing dysuria without UTI, it's essential to take a comprehensive approach that includes both symptomatic relief and diagnostic evaluation for underlying causes.

• Increasing fluid intake to dilute urine and reduce irritation is a beneficial first step.
• Over-the-counter pain relievers like ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours) can help manage discomfort.
• Phenazopyridine (Pyridium, 100-200mg three times daily for 2 days) specifically targets urinary tract pain but may turn urine orange-red.
• Avoiding potential bladder irritants such as caffeine, alcohol, spicy foods, and acidic beverages is also recommended.
• Applying warm compresses to the lower abdomen may provide relief. However, given the potential for urethral stricture as an underlying cause, as suggested by the 2023 guideline amendment 1, a thorough diagnostic workup including patient-reported measures, uroflowmetry, and ultrasound post-void residual assessment is crucial for accurate diagnosis and appropriate management. If symptoms persist beyond 3-5 days, worsen, or if the patient develops fever, blood in urine, or flank pain, seeking medical attention is imperative as these could indicate other conditions requiring specific treatment, such as interstitial cystitis, pelvic floor dysfunction, or sexually transmitted infections 1.

From the FDA Drug Label

Phenazopyridine HCl is indicated for the symptomatic relief of pain, burning, urgency, frequency, and other discomforts arising from irritation of the lower urinary tract mucosa caused by infection, trauma, surgery, endoscopic procedures, or the passage of sounds or catheters The treatment for dysuria without evidence of UTI is symptomatic relief using phenazopyridine (PO) for a limited duration, as the cause of pain must be investigated and treated promptly.

• The use of phenazopyridine should not delay definitive diagnosis and treatment of the causative condition.
• Phenazopyridine can be used to relieve pain and discomfort, but it is essential to discontinue its use when symptoms are controlled. 2

From the Research

Treatment of Dysuria without Evidence of UTI

• Dysuria, or painful urination, can be caused by various factors, including urinary tract infections (UTIs), sexually transmitted infections, bladder irritants, and chronic pain conditions 3, 4.
• If a patient presents with dysuria without evidence of UTI, a thorough history and physical examination should be performed to identify potential causes 3, 4.
• A urinalysis and urine culture may be necessary to rule out UTI and guide further treatment 3, 5.
• If the patient has persistent symptoms, further workup for infectious and noninfectious causes may be necessary, including testing for Mycoplasma genitalium 3.
• Treatment should be targeted towards the underlying cause of dysuria, and may include antibiotics, pain management, or other therapies as needed 4, 6, 7.

Differential Diagnosis

• Sexually transmitted infections, such as cervicitis or urethritis, should be considered in patients with dysuria and vaginal discharge or other symptoms 3, 4.
• Bladder irritants, such as certain medications or foods, may cause dysuria and should be identified and avoided 4.
• Chronic pain conditions, such as interstitial cystitis or bladder pain syndrome, may cause dysuria and require specialized treatment 4, 6.

Diagnostic Testing

• Urinalysis and urine culture are essential for diagnosing UTIs and guiding antibiotic treatment 3, 5, 7.
• Dipstick urinalysis may be useful for screening, but results should be interpreted in the context of the patient's symptoms and medical history 5.
• Microscopic urinalysis and bacteriuria testing may be necessary to confirm the diagnosis of UTI 5.