Can STD exposure cause dysuria and hematuria?

STDs Can Cause Dysuria and Hematuria

Yes, sexually transmitted diseases (STDs) can definitely cause both dysuria (painful urination) and hematuria (blood in urine). Several STDs are known to cause urinary symptoms, with some being among the most common causes of these symptoms, particularly in sexually active individuals.

STDs That Commonly Cause Dysuria and Hematuria

Chlamydia

• Most common bacterial STD that causes urinary symptoms 1
• Often presents with dysuria and sometimes microscopic hematuria
• Frequently asymptomatic, especially in women (75% of cases)
• When symptomatic, causes urethritis with burning urination 1
• May cause mucopurulent cervicitis in women

Gonorrhea

• Frequently causes dysuria, particularly in men
• Can cause urethral discharge and painful urination
• Often co-exists with chlamydial infection 1
• May cause hematuria in some cases

Mycoplasma genitalium

• Emerging as an important cause of urethritis and dysuria
• Studies show 24% of women presenting with dysuria may have M. genitalium 2
• Often responds better to azithromycin than doxycycline 1
• May be misdiagnosed as a urinary tract infection

Trichomoniasis

• Can cause dysuria and urinary frequency
• May cause microscopic hematuria
• Often presents with vaginal discharge in women
• Can co-infect with other STDs 2

Diagnostic Considerations

When evaluating dysuria and hematuria potentially related to STDs:

1. Risk assessment is crucial:

   • Recent sexual activity with new or multiple partners
   • Inconsistent condom use
   • Previous STD history
   • Age (highest prevalence in adolescents and young adults) 1

2. Testing approach:

   • Nucleic acid amplification tests (NAATs) from urine or vaginal specimens are preferred for gonorrhea and chlamydia 1
   • NAAT vaginal specimens for trichomoniasis 1
   • Consider testing for multiple STDs simultaneously as co-infections are common 2

3. Differential diagnosis:

   • Urinary tract infection (most common non-STD cause)
   • Interstitial cystitis
   • Urolithiasis
   • Trauma
   • Medication effects
   • Urethral anatomic abnormalities 3

Treatment Considerations

If an STD is suspected or confirmed as the cause of dysuria and hematuria:

• For chlamydia: Azithromycin 1g orally in a single dose OR doxycycline 100mg orally twice daily for 7 days 1
• For gonorrhea: Ceftriaxone 250mg IM single dose PLUS treatment for chlamydia 4
• For M. genitalium: Azithromycin is preferred 1, 2
• For trichomoniasis: Metronidazole 2g orally in a single dose OR tinidazole 2g orally in a single dose 1

Important Clinical Pearls

1. Don't assume UTI: Many women with dysuria are empirically treated for UTI when they actually have an STD 2

2. Partner notification: All sexual partners within 60 days should be evaluated and treated 4

3. Follow-up: Symptoms should improve within 3 days of starting appropriate treatment 4

4. Recurrent symptoms: May indicate reinfection from untreated partners, antimicrobial resistance, or non-STD etiology 5

5. Prevention: Consistent condom use provides 80-90% protection against STI transmission 4

Special Populations

• Adolescents: Higher prevalence of asymptomatic STDs; lower threshold for testing recommended 1
• Pregnant women: Require prompt treatment to prevent complications 1
• HIV-positive patients: Same treatment regimens but higher suspicion for atypical pathogens 4

Remember that many STDs can be asymptomatic despite causing inflammation in the urogenital tract. Testing should be considered in high-risk individuals even without symptoms to prevent complications and further transmission.