What is the treatment for dysuria?

Treatment of Dysuria

The most effective treatment for dysuria depends on identifying the underlying cause, with urinary tract infection being the most common etiology requiring appropriate antimicrobial therapy based on suspected pathogens and local resistance patterns. 1, 2

Diagnostic Approach

Initial Assessment

• Obtain a detailed medical history focusing on symptom duration, associated symptoms (frequency, urgency, hematuria), sexual history, and medication use 3, 2
• Perform a focused physical examination, including external genitalia examination and, in men, digital rectal examination to evaluate prostate size and tenderness 4, 5
• Urinalysis should be performed in most patients presenting with dysuria to detect infection, hematuria, or glycosuria 1, 2
• Urine culture is recommended to guide appropriate antibiotic therapy, especially for recurrent or suspected complicated urinary tract infections 1, 2

Age and Gender Considerations

• Younger women more commonly experience dysuria due to greater frequency of sexual activity 3
• Older men have increased incidence of dysuria related to prostatic hyperplasia with accompanying inflammation and infection 3, 6

Treatment Based on Etiology

Urinary Tract Infection

• For uncomplicated UTI with systemic symptoms, recommended empiric treatments include: 1

  • Amoxicillin plus an aminoglycoside
  • A second-generation cephalosporin plus an aminoglycoside
  • An intravenous third-generation cephalosporin

• Only use ciprofloxacin if local resistance rate is <10% and: 1

  • The entire treatment can be given orally
  • The patient does not require hospitalization
  • The patient has anaphylaxis to β-lactam antimicrobials

• Avoid fluoroquinolones for empirical treatment in patients from urology departments or those who have used fluoroquinolones in the last 6 months 1

• Treatment duration: 1

  • 7-14 days for complicated UTIs (14 days for men when prostatitis cannot be excluded)
  • Shorter treatment (7 days) may be considered when the patient is hemodynamically stable and afebrile for at least 48 hours

Sexually Transmitted Infections

• If vaginal discharge is present, investigate for cervicitis and other causes of dysuria beyond UTI 2
• For persistent urethritis or cervicitis with negative initial testing, Mycoplasma genitalium testing is recommended 2, 7
• In younger men, sexually transmitted organisms such as Chlamydia trachomatis are common causes of dysuria 6

Benign Prostatic Hyperplasia (BPH)

• For men with dysuria related to BPH: 1, 5
  • First-line treatment is alpha-blocker therapy (e.g., tamsulosin), with effectiveness typically assessed after 2-4 weeks
  • For enlarged prostates (PSA >1.5 ng/mL), consider combination therapy with an alpha-blocker and 5α-reductase inhibitor
  • Surgical management may be necessary for severe cases with significant obstruction

Non-infectious Causes

• Consider non-infectious inflammation, trauma, neoplasm, calculi, hypoestrogenism, interstitial cystitis, or psychogenic disorders in patients with persistent symptoms despite appropriate initial treatment 3, 8
• Rare conditions like eosinophilic cystitis may present with dysuria and require specific treatment approaches 8

Special Populations

Older Adults with Functional/Cognitive Impairment

• In older patients with bacteriuria and delirium but without local genitourinary symptoms or other systemic signs of infection, assess for other causes rather than immediately treating with antimicrobials 1
• For bacteriuric older patients who experience a fall without local genitourinary symptoms or other systemic signs of infection, assessment for other causes is recommended rather than antimicrobial treatment 1

Children with Dysfunctional Voiding

• For children with dysuria related to dysfunctional voiding, urotherapy (non-surgical, non-pharmacological treatment) is recommended 1
• This includes education, routine hydration, regular optimal voiding regimens, bowel programs, and may include pelvic floor muscle awareness and biofeedback training 1

Follow-up Recommendations

• Patients initiated on pharmacological treatment should be followed up at 2-4 weeks for alpha-blockers and 3 months for 5α-reductase inhibitors 5
• Annual follow-up is recommended for patients with successful treatment to monitor for symptom progression or development of complications 5
• Persistent symptoms after initial evaluation and treatment require further workup for both infectious and non-infectious causes 2

Indications for Specialist Referral

• Referral to a urologist is indicated for treatment failure, persistent symptoms, findings suspicious for prostate cancer, recurrent urinary retention, hematuria, abnormal PSA, or severe obstruction requiring interventional therapy 4, 5