From the Guidelines
Yes, a candidal infection can cause dysuria (painful urination) in patients with Candida urinary tract infections (UTIs), particularly those with cystitis or pyelonephritis. According to the clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America 1, patients with ascending Candida infections can have symptoms of cystitis or pyelonephritis, which may include dysuria. The guideline notes that diagnostic tests on urine often are not helpful in differentiating colonization from infection, but imaging of the urinary tract by ultrasound or CT scanning can be helpful in defining structural abnormalities, such as hydronephrosis, abscesses, or fungus ball formation.
The treatment for Candida UTI involves addressing the underlying infection, typically with antifungal medications such as fluconazole, which is the drug of choice for treating Candida UTI 1. Fluconazole is effective in eradicating candiduria and is available as an oral formulation, excreted into the urine in its active form, and easily achieves urine levels exceeding the MIC for most Candida isolates. Other treatment options, such as flucytosine and amphotericin B, may be considered in certain cases, but fluconazole remains the preferred choice.
Key points to consider:
- Candida UTIs can cause dysuria, particularly in patients with cystitis or pyelonephritis
- Fluconazole is the drug of choice for treating Candida UTI
- Diagnostic tests on urine may not be helpful in differentiating colonization from infection, but imaging studies can be useful in defining structural abnormalities
- Treatment should be tailored to the individual patient's needs and underlying condition, with fluconazole being the preferred choice for most cases 1.
From the Research
Candidal Infection and Dysuria
- A candidal infection can cause dysuria (painful urination) as it can lead to cystitis, pyelonephritis, prostatitis, epididymo-orchitis, or disseminated candidiasis 2.
- Candiduria, which is the presence of Candida species in the urine, can be symptomatic or asymptomatic, and symptomatic cases can cause dysuria 3, 2.
- The treatment of choice for symptomatic Candida urinary tract infections is fluconazole, which achieves high urine concentrations 3, 2.
Risk Factors and Causes
- Risk factors for candidal urinary tract infections include diabetes mellitus, indwelling urinary catheters, use of broad-spectrum antibiotics, urinary obstruction, and admission to intensive care units 2.
- Candida urinary tract infections can be caused by hematogenous spread following candidemia or retrograde route via the urethra 2.
- Dysuria can also be caused by other factors such as urinary tract infection, sexually transmitted infection, bladder irritants, skin lesions, and chronic pain conditions 4, 5.
Diagnosis and Treatment
- The diagnosis of dysuria involves a targeted history, physical examination, urinalysis, and urine culture 4, 5.
- The treatment of dysuria depends on the underlying cause, and fluconazole is the treatment of choice for symptomatic Candida urinary tract infections 3, 2.
- Other antimicrobial agents such as flucytosine, amphotericin B, and nitroxoline can also be used to treat candiduria 6.