Urinary Discomfort / Dysuria

If men got UTIs as often as women, there’d be antibiotic vending machines.

Very little that I do seems to spread more relief (sometimes sheer joy), than the destruction of UTIs. And unlike for the common cold, patients in this case are usually right… “I just need an antibiotic!” Nobody leaves feeling ripped off by a diagnosis of “viral UTI.”

Dysuria means painful urination. Sometimes the problem is complex, but much more often the problem is easily and rapidly solved. Urinary tract infection is frequently caused by bacteria like E. coli. Less frequently STDs like chlamydia or gonorrhea are the culprits. Sometimes there are mechanical causes as well for dysuria, like exiting kidney stones, or fissures that sting with the passage of urine. Rare causes of dysuria include bladder or prostate pathologies including a variety of cancers.

However, the large large majority of patients with dysuria in my world suffer the simple UTI, which is a pleasure to treat. Only rarely are urine cultures required. Actually, it’s borderline embarrassing, given that patients usually know exactly their diagnosis and treatment. “I’m on my honeymoon, and I get UTIs about once a year that always get better with Bactrim. And can you please include Diflucan to treat the yeast infection I may get after the antibiotic?” Patients who call me at 7pm are often ecstatic to receive their first antibiotic dose along with Pyridium for discomfort before bed, without having to pace in an urgent care or ER.

Red Flags:

• Fever
• Back pain
• Vomiting/dehydration
• Diabetes
• Pregnancy
• Past infected kidney stones
• Past antibiotic resistant UTIs
• Structural anomalies like ureteral/urethral strictures
• Kidney transplant
• Ureteral stent
• Indwelling catheter

Happy Words

• Symptoms just started
• Infrequent
• “I’m on my honeymoon” (honeymoon cystitis)
• “I have never had a UTI with bacterial resistance.”
• “Macrobid, Bactrim, Keflex, Cipro all work just fine.”
• “No I don’t want to wait for urine culture results, I want an antibiotic!”

Hydration is important. OTCs like “Azo” take the edge off. And cranberry juice should probably be standard at every wedding.

If this NPR article “Should Women Be Able To Treat Bladder Infections Themselves?” foretells the future, Pre-R will definitely lose value across California. But the world will be a happier place. (Uncertain what will happen to bacterial resistance, however.)

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