What is the treatment for dysuria (painful urination) and burning sensation of the penis, also known as urethral burning sensation?

From the Guidelines

For a burning sensation in the penis, I recommend first trying over-the-counter remedies like warm sitz baths for 10-15 minutes twice daily and applying petroleum jelly to soothe the area, as this approach can help alleviate symptoms and improve quality of life. Avoid irritants such as harsh soaps, tight clothing, and sexual activity until symptoms improve. If these measures don't help within 2-3 days, see a healthcare provider as the sensation may indicate an infection requiring specific treatment, such as urethritis, which can be caused by infectious agents like N. gonorrhoeae and C. trachomatis 1.

Causes and Treatment

The burning sensation can be caused by various factors, including urinary tract infections, sexually transmitted infections, and yeast infections. For urinary tract infections, antibiotics like nitrofurantoin (100mg twice daily for 5-7 days) or trimethoprim-sulfamethoxazole (160/800mg twice daily for 3 days) may be prescribed. For sexually transmitted infections, treatment depends on the specific diagnosis - chlamydia typically requires doxycycline (100mg twice daily for 7 days) or azithromycin (1g single dose) 1. Yeast infections may need antifungal creams like clotrimazole applied twice daily for 7-14 days.

Recent Guidelines

According to the most recent guidelines from the European Association of Urology in 2024, it is crucial to differentiate between gonococcal urethritis (GU) and non-gonococcal urethritis (NGU), and to evaluate and treat all at-risk sexual partners while upholding patient confidentiality 1. The guidelines also emphasize the importance of nucleic acid amplification tests in diagnosing urethral infections.

Recommendations

• Try over-the-counter remedies like warm sitz baths and petroleum jelly to soothe the area
• Avoid irritants like harsh soaps, tight clothing, and sexual activity until symptoms improve
• See a healthcare provider if symptoms persist or worsen over time
• Follow the recommended treatment for the specific diagnosis, whether it's a urinary tract infection, sexually transmitted infection, or yeast infection
• Stay hydrated by drinking 8-10 glasses of water daily to help flush irritants from the urinary tract and speed recovery.

From the FDA Drug Label

Adults: The usual dose of oral doxycycline is 200 mg on the first day of treatment (administered 100 mg every 12 hours) followed by a maintenance dose of 100 mg/day Uncomplicated urethral, endocervical, or rectal infection in adults caused by Chlamydia trachomatis: 100 mg, by mouth, twice a day for 7 days. Nongonococcal urethritis (NGU) caused by C. trachomatis or U. urealyticum: 100 mg, by mouth, twice a day for 7 days.

The treatment for a burning sensation of the penis may be related to urinary tract infections or sexually transmitted infections.

• The dosage of doxycycline for uncomplicated urethral infections is 100 mg, by mouth, twice a day for 7 days 2.
• The dosage of doxycycline for nongonococcal urethritis is 100 mg, by mouth, twice a day for 7 days 2. However, the burning sensation is not explicitly mentioned in the drug label, and the treatment should be guided by the underlying cause of the symptom.

From the Research

Treatment Options for Burning Sensation of Penis

• The burning sensation of the penis can be a symptom of various sexually transmitted infections, including genital herpes simplex virus infections 3, 4, 5, 6.
• Treatment for genital herpes simplex virus infections is not curative, but rather serves to shorten the duration of symptoms and improve quality of life 3.
• Current therapies for genital herpes simplex virus infections include episodic treatment and chronic suppressive therapy, and are generally well tolerated and effective 3.
• Antiviral medications such as acyclovir, valacyclovir, and famciclovir have been shown to provide clinical benefit in the treatment of genital herpes 4, 6.
• Valacyclovir and famciclovir are not yet recommended for use during pregnancy 4.

Clinical Characteristics of Herpes Simplex Virus Urethritis

• Men with herpes simplex virus urethritis are significantly more likely to report severe dysuria or constitutional symptoms compared to those with chlamydial urethritis 5.
• Men with herpes simplex virus urethritis are also more likely to have meatitis, genital ulceration, or inguinal lymphadenopathy, but less likely to have urethral discharge 5.
• The clinical presentation of herpes simplex virus urethritis in men may differ from those of chlamydial urethritis and guide testing for herpes simplex virus in men presenting with non-gonococcal urethritis 5.

Evidence-Based Review of Herpes Simplex Infections Treatment

• The treatment of herpes simplex infections can be confusing due to competing clinical approaches to therapy, evolving dosing schedules, and dissimilar regimens for oral and genital infections 6.
• The physician must choose an approach to treatment based on defined clinical characteristics and patient preference, and then select an evidence-based dosing regimen 6.