What medication is used to treat burning during urination in males?

Treatment for Burning During Urination in Males

For males experiencing burning during urination, doxycycline 100 mg orally twice daily for 7 days is the recommended first-line treatment, as it effectively targets the most common causative organisms. 1

Diagnostic Approach

• Burning during urination (dysuria) in males is most commonly caused by urethritis, which is primarily due to sexually transmitted infections 1
• The principal bacterial pathogens in male urethritis are Neisseria gonorrhoeae and Chlamydia trachomatis 1
• In younger men, sexually transmitted organisms like Chlamydia trachomatis are the most common cause, while in men over 35, coliform bacteria predominate 2
• Testing for specific etiology is recommended as both chlamydia and gonorrhea are reportable conditions 1

Treatment Algorithm

First-Line Treatment

• For nongonococcal urethritis (NGU):
  • Doxycycline 100 mg orally twice daily for 7 days 1
• For suspected Mycoplasma genitalium:
  • Azithromycin 1g orally in a single dose 3

Alternative Treatments

• Erythromycin base 500 mg orally 4 times daily for 7 days (if doxycycline cannot be used) 1
• For urinary tract infections caused by E. coli (more common in older men):
  • Trimethoprim/sulfamethoxazole (based on local resistance patterns) 4
  • Note: Azithromycin is ineffective for E. coli UTIs due to inadequate urinary concentrations 5

Special Considerations

• In men over 35 years, consider benign prostatic hyperplasia (BPH) as a contributing factor to urinary symptoms 1, 2
• For prostatitis-related dysuria:
  • Fluoroquinolones (e.g., ciprofloxacin) are first-choice for mild to moderate cases 6
  • For severe cases, ceftriaxone or cefotaxime are recommended 6

Follow-Up Care

• Patients should return for evaluation if symptoms persist or recur after treatment 3
• Abstain from sexual intercourse for 7 days after single-dose therapy or until completion of a 7-day regimen 3
• Partners should be evaluated and treated to prevent reinfection 3

Common Pitfalls and Caveats

• Avoid empiric antibiotic treatment without proper diagnosis, especially in complicated cases 7
• Don't overlook non-infectious causes of dysuria such as renal calculi, genitourinary malignancy, or medication side effects 2
• For persistent symptoms despite appropriate treatment, consider:
  • Alternative infectious causes
  • Anatomical abnormalities
  • Chronic conditions like interstitial cystitis 7
• Sexual dysfunction may occur with urogenital conditions and should be addressed if present 1