Understanding Blood in the Urine (Hematuria)
What Types of STDs Cause Blood in the Urine?

Understanding Blood in the Urine (Hematuria)

The genitalia is a highly intricate organ that is often misunderstood but should always be taken care of. For sure, some people would even cackle at the thought of having even the slightest bit of concern when it comes to your sexual health.

Still, thankfully, most people are slowly getting educated about the importance of this organ in ensuring that an individual is holistically healthy, no matter what aspect is being referred to. A condition involving the genitalia is not always evident, making it hard to discern with utmost accuracy the elements that should have been the tell-tale signs of a particular disease. It is not necessarily a fault from the individual per se due to how difficult it is even for physicians to diagnose such conditions, but it does not mean either that you should not exert the slightest effort in educating yourself regarding the intricacies of these conditions. After all, for most situations that involve such a delicate organ of the body, the urgency of its diagnosis is crucial in ensuring that you will be coming out unscathed from this particular dilemma.

The genitalia can be perceived as an organ that is at high risk for various conditions due to how it functions in the first place. Sure, it is a reproductive organ, but one should take note that it is also in proximity with other excretory organs such as your anus and urethra. With such distance from potentially pathogenic substances, it is not unheard of in many instances for people to contract infections due to something as simple as not maintaining one’s hygiene. Even your wiping motion during defecation may negatively impact your health because you are spreading the pathogenic microbes from your excretion when you clean your private areas improperly.

With these in mind, several conditions could negatively impact your genitalia. These conditions may range from simple superficial irritation to a systemic infection that could even go as far as inducing infertility by causing severe irreversible damage from the lack of an appropriate intervention. However, in this scenario, perhaps it is better to lean more towards the more visible manifestations to allow a more accessible characterization of the conditions you might want to look out for, especially if you are sexually active.

Sexually active individuals are prone to conditions known as STDs/STIs or Sexually Transmitted Conditions. These diseases are often pathogenic and are transmitted through sexual contact, particularly in cases where there is an exchange of bodily fluids or contact between the mucosal tissues of the genitalia and an infected surface. Note that in most cases, the manifestations of sexually transmitted conditions are invisible to the naked eye unless it has already progressed to a more severe disease that can now cause damage and produce exudates – signifying its presence within your genital region.

In this particular characterization of symptoms, perhaps it might be more efficient to focus on a symptom that is a sign of extreme alarm in many, mainly due to how obvious its manifestation and connotation is – the presence of blood in the urine.

The presence of blood in your urine is, by no means, typical, unless there is a particular medication or condition which promotes the sight of blood cells in your urine. However, while this might seem like an instant warning signal for those who even just witnessed its mere presence, one needs first to understand the process behind how this manifestation was possible before jumping to conclusions about what type of life-threatening condition they might have (in some cases, it could even be next to nothing). Sure, it might be harder to stay calm during an actual scenario as compared to just theoretically stating it out, but this is precisely why knowing the related symptoms, mechanisms, and presentations would significantly contribute to ensuring that the scenario is managed correctly, no matter what the underlying condition ultimately is.

What is Hematuria?

The presence of blood in your urine is medically known as “hematuria.” This is usually characterized by either blood cells or visible bloodstains in your urinary excretion, commonly due to an underlying condition that affects your genitalia itself or other organs involved in the excretory pathway of your urine. Hematuria is often a signal for concern due to how significant the presence of blood cells in your urine is. Several underlying reasons might have precipitated such a manifestation, ranging from simple stress to a kidney disease that could progress further into a disorder that could be severely or permanently debilitating. Some specific individuals are more at risk for developing such a manifestation due to their various predisposing factors, but it is essential first to rule out other severe conditions to ensure that the presence of blood in your urine will not progress into something more critical – causing irreversible damage at its wake.

Who are More at Risk for Hematuria?

Several individuals are at a higher risk of developing hematuria due to either the nature of their co-existing condition or the predisposing factors they might have in relation to this manifestation. For instance, individuals with an enlarged prostate, those with urinary stones, taking certain blood thinners, and those who do strenuous exercise are at higher risk of developing this symptom due to how the factors mentioned above interact with the excretory pathway of the urine.

Furthermore, it has also been found that individuals with a bacterial or viral infection, those with a family history of kidney disease, and those with a multi-organ condition could likewise be predisposed to developing such a manifestation along the way.

If, upon close examination, some of the descriptions that have been described in this section correlate with some of your circumstances, then perhaps it might be wise to even know more about hematuria, its intricacies, how it is approached, and the possible interventions for such an alarming manifestation.

Types of Hematuria

When physicians try to distinguish, or rather, elaborate on what type of hematuria you are experiencing, they commonly use two classifications that depend on the characteristics of the symptom, as well as on the results of the lab tests performed on your urine sample.

Gross Hematuria

Gross Hematuria is a condition wherein the manifestation of this symptom is one where the presence of blood is visually observed in the urine sample – making it the type that is commonly more alarming for people, especially those who either did not expect the presence of such a substance in their urine, or those who could not comprehend how blood even appeared in their urinary tract in the first place.

Microscopic Hematuria

On the one hand, microscopic hematuria is a manifestation that is often not determined or identified by a patient unless they could procure a urinalysis to obtain a microscopic examination of their urine. Microscopic Hematuria is a manifestation wherein there is a microscopic presence of blood cells in your urine, but its quantity and composition are insufficient to warrant or precipitate a visible presence. While it is not visible through the naked eye, its presence could still signify the aforementioned potential conditions – making it just as important as observing the presence of actual red blood along with your urine stream.

General Diagnostic Procedure for Hematuria

In determining what the underlying condition is behind your hematuria presentations, physicians would often perform an array of tests that are designed to rule out other conditions – allowing them to construct a better-suited therapy, or rather, more specific to the actual condition that you have rather than providing broad-spectrum interventions only that are more often than not, only palliative in the most basic sense.

In most cases, physicians utilize these four tests in providing you with a concrete diagnosis to start your therapy:

  • A medical history check
  • A physical exam
  • A urinalysis
  • Another confirmatory testing as needed

Medical History

Taking a patient’s medical history is perhaps a no-brainer in the sense that all physicians employ this for every condition imaginable – providing them with the necessary information to grasp the actual situation that you have been through and providing them with the resources to have an educated outlook as to what caused the presence of blood in your urine. Medical history is usually inconclusive as it is used as initiating point for their differential diagnosis, but it often goes a long way in ensuring that every base has been covered and accounted for before they proceed with more sensitive, specific, and possible invasive and expensive tests.

Physical Exam

A physical exam is similar to medical history because they are both general approaches to your condition to provide more details for their differential diagnosis. For instance, your physician may check your pulse, your vital signs, the physical signs related to your kidney function, signs of pain, and other physical manifestations that may have accompanied your hematuria. It is not always conclusive similar to how a simple medical history is not used to provide a concrete diagnosis, but it does narrow down the possible conditions that physicians have to check later on.

  • Digital Rectal Exam – A digital rectal exam is a physical exam performed to examine a male’s prostate and rectum. In this case, the physician would often make the patient bend over, and with a gloved and lubricated hand, insert their digits into the rectum to palpate the surrounding area, including the prostate. In this exam, one might be able to identify whether the prostate is enlarged, inflamed, or injured in any way to cause the leaching of blood towards your urethra.
  • Pelvic Exam – On the one hand, a pelvic exam is similar to a digital rectal exam, but this is performed on females, and the gloved and lubricated digits are inserted into the vaginal area of a female.

Urinalysis

A urinalysis is perhaps the comprehensive test that most physicians aim for, especially when it comes to these foreign objects in areas where it is not supposed to be present. In cases where there is a presence of blood or blood cells in your urine (where it is not supposed to be present in the first place), a urinalysis could determine the presence of other substances that could explain why blood cells are present in your sample. Furthermore, its parameters could likewise be used to rule out certain conditions such as infections, particularly in examining the presence of WBCs and Neutrophils within your sample.

However, please note that certain types of urinalyses, i.e., dipsticks, may result in false-positive results, leading physicians to request another confirmatory test often to solidify the foundation of their diagnosis. In most cases, a simple microscopic analysis of the sample could confirm the presence of blood cells, making this process one of the most commonly ordered tests following a simple laboratory examination of a patient’s sample.

Further Confirmatory Testing

Although the previously identified tests are sometimes sufficient enough to support a physician’s differential diagnosis regarding the underlying condition behind your manifestation, positive test results – especially in cases where the amount of blood cells is staggeringly high – might require additional confirmatory procedures to create a more specific regimen that could immediately address the condition that the patient might have.

Blood Test

Taking a blood test could potentially identify the presence of various parameters such as creatinine levels and products of muscle breakdown that serve as indications of existing kidney disease. Furthermore, it might also identify potential conditions that commonly result in such manifestations as lupus or prostate cancer.

CT Scan

On the one hand, A CT Scan is an imaging technique that can be used to create visual representations of various organs, particularly the kidney, to rule out obstructions, infections, cysts, tumors, and traumatic injuries.

Cystoscopy

Cystoscopy is a procedure that utilizes an apparatus known as a cystoscope to see the inside of the patient’s bladder and urethra – effectively providing physicians with information regarding potential cancer cases about a patient’s urinary bladder. This procedure is only performed in a physician’s outpatient office, but it may require pain medications due to how invasive the utilization of the apparatus is.

Kidney Biopsy

A kidney biopsy, similar to how other biopsy procedures are performed, involves the collection of a small tissue sample from the kidney to examine the organ's overall health. With such a detailed examination of the organ, a physician could often rule out kidney diseases through this test alone.

MRI Scan

An MRI scan is a similar imaging technique to a CT scan, but it does so differently through magnetic resonance with the soft tissues instead of relying on x-rays to generate the image. This may be performed on a patient with light sedation, and the test results are often used to diagnose problems within individual internal organs such as the bladder or the kidney.

Normal Urine Appearance

In most cases, the appearance of a standard urine sample often ranges from a pale yellow to deep amber, varying depending on the concentration of the urine and the amount of the pigment present known as urochrome within the sample. In addition to that, pigments and medications in ingested foods may likewise affect the color of the urine – with foods like beets, berries, and fava beans as the foods that are most likely to precipitate a change in the urine’s color.

Other Potential Causes of Hematuria

To further determine the exact cause of your hematuria as early as its first detection (a rough educated guess, more or less), knowing the presentations of other conditions that cause hematuria will be crucial in ensuring that the best first-line intervention is provided and applied before it progresses into an even more severe indication.

Trauma

In most cases of trauma-induced hematuria, the patient can be either microscopic or macroscopic/gross, with its degree signifying the extent of damage present within the internal compartments of your urinary tract. It is often due to an intra-abdominal injury, and it may not always be a result of a urinary tract injury.

Vigorous Exercise

Hematuria cases that have been induced by vigorous exercise are often related to the intensity and duration of the activity, as well as the sufficiency of the patient’s hydration throughout the execution of the exercise. In most instances, hematuria is only observed in more prolonged and more intense events, with runners running more than 10km at a time being at an increased risk for such.

Sexual Activity

Studies have shown that over a quarter (25%) of sexually active women may develop microscopic hematuria in response to direct sexual activity.

Menstruation

Although often misunderstood, menstrual fluids may sometimes be washed off along with urination – leading to a false alert in many women, especially when they are particular with the characteristics of their urine at all times. However, it should likewise be known that although some cases are only circumstantial, other urinary tract problems may still cause an actual hematuria case, making it essential for women to be wary of the difference between the presentations of the two.

Endometriosis

Endometriosis is a problem of the ovaries and uterine ligaments wherein recurrent internal bleeding is observed, leading to its name of “chocolate cysts.”

Sexually Transmitted Conditions that Cause Hematuria

After ruling out the various conditions and instances that have been previously mentioned, the following sexually transmitted conditions are the ones that often present with hematuria during its manifestation.

Chlamydia

Symptoms

Chlamydia is a condition that is caused by the pathogen known as Chlamydia trachomatis. This condition is often called the “silent infection” due to its widely asymptomatic presentation in most cases – making it harder to discern, especially when the patient is not as particular in taking care of their sexual health. In addition to that, another difficulty that is associated with Chlamydia infections is the lack of a certain incubation period – making the monitoring timeframe harder to ascertain in this scenario.

In females, the bacteria often affect the cervical area, causing symptoms typical with cervicitis such as mucopurulent endocervical discharge and easily induced endocervical bleeding. In some cases, it might even affect the urethra to cause symptoms akin to urethritis, such as pyuria, dysuria, and urinary frequency. When left unmanaged, it can spread and precipitate what is known as a Pelvic Inflammatory Disease (PID) that is typically observed with abdominal pain, pelvic pain, and cervical motion tenderness.

On the other hand, infected males commonly present with urethritis-like symptoms along with a mucoid or watery urethral discharge. Some males may likewise develop epididymitis, wherein unilateral testicular pain, swelling, and tenderness are observed.

Diagnostic Procedure

Several tests can be performed to diagnose Chlamydia, depending on the availability of resources in the selected institution and the appropriateness of the test with the patient’s situation. Nucleic Acid Amplification Tests or NAATs remain the most sensitive and specific option for C. trachomatis determination, but cell cultures may likewise be used if the test’s accessibility hinders the latter.

Management Strategy

Chlamydia is generally resolved using a standard regimen of antibiotics to clear out the infection from the infected individual's body. However, one should note that it is highly advised for infected individuals to abstain from sexual activity seven days after completing a single-dose antibiotic course or during the 7-day course of antibiotics to ensure that no transmission will occur while the bacteria are still viable. In addition to that, any sexual partners within 60 days from the onset of symptoms should likewise be assessed and provided with a prophylactic source of antibiotics to ensure their safety.

Gonorrhea

Symptoms

Gonorrhea is widely known as a “discharge-causing STD” caused by the microorganism Neisseria gonorrhoeae. It primarily targets the mucus membrane of the reproductive area – including the uterus cervix, and even the fallopian tubes in females, and including even the urethra in males. For most cases, gonorrhea remains asymptomatic until an exacerbating stimulus weakens the individual's immune system, or the condition surpasses its incubation period to progress into a more advanced disease with multiple complications finally.

In cases where the condition is symptomatic, the most common symptoms are dysuria and either a white, yellow, or green urethral discharge 14 days after the presumed time of exposure. As it progresses, other symptoms that might be observed could include that characterize epididymitis, such as testicular and scrotal pain.

On the other hand, gonorrheal infections in women are often mistaken for a bladder or vaginal infection. This may include dysuria, increased vaginal discharge, or vaginal bleeding between menstrual periods.

Rectal infections can then be characterized by symptoms such as discharge, anal itching, soreness, bleeding, or painful bowel movements. Sore throat, on the one hand, is particular in cases of pharyngeal gonorrhea infections.

Diagnostic Procedure

For urogenital infections that primarily involve the genital area in both males and females, urine samples, urethral swabs, or endocervical samples are often used in Nucleic Acid Amplification Tests or NAATs to provide a conclusive diagnosis for an infected patient. Some institutions might use a culturing technique, but this would ultimately still entail the collection of necessary swab samples.

Management Strategy

The Centers for Disease Control and Prevention recommends administering 500mg IM Ceftriaxone to address Gonorrhea infections, but alternative regimens are likewise available in cases where the patient may not tolerate Ceftriaxone or if the necessary medication is unavailable for immediate use.

A test of cure is likewise required to determine if the infection is being tackled effectively by the medication – indicating whether the patient would require a different treatment regimen depending on how the pathogen responded to the previous therapy administered.

Testing Options Available for a Potential STD

In cases where you are slowly suspecting that the hematuria case that you have been experiencing is caused by a sexually transmitted condition (recently sexually active), perhaps the following testing options will provide a more streamlined option that you could select from depending on its availability within your area.

Laboratory

Chlamydia

Gonorrhea

Package Prices

What it Offers

STD Check Labs

Yes

Yes

Starts at $99.00 for Chlamydia + Gonorrhea Test

  • Obtain result in as early as 2 days
  • No need to collect sample at home
  • On-site testing and sample collection

myLAB Box

Yes

Yes

Starts at $89.00 for Chlamydia + Gonorrhea Test

  • Obtain results in as early as 2 days
  • Collecting samples is performed at the convenience of your own home
  • At-home testing kit
  • Complete anonymity

HealthLabs

Yes

Yes

Starts at $99.00 for Chlamydia + Gonorrhea Test

  • Obtain results in as early as 3 days
  • Orders performed by phone or online

GetTested (CDC)

Yes

Yes

Free to use

  • Free search engine that can be used to obtain information regarding laboratory availabilities

Note: All testing options are not currently covered by insurance plans as it would nullify the confidentiality feature of these testing options

Frequently Asked Questions (FAQs)

How long does it usually take for the kidney to heal after a biopsy?

Your physician would normally advise you to avoid any strenuous activity in the next 2 to 3 days as the area will be sore while healing during this period.

Can blood from your menstrual cycle mess up a urinalysis?

Yes, a sample of your blood in your urine will produce false-positive results for hematuria.

What is antimicrobial resistance?

It is the tendency of bacteria and pathogens to adapt to the antimicrobials’ mechanism – making them immune and resistant to the action of the drug and thus rendering them ineffective.

How long does it take before symptoms appear in chlamydia infections?

One to three weeks is the common incubation period for chlamydia.

Is it possible to be reinfected with chlamydia?

Yes. It is possible to be reinfected with chlamydia when you come into contact with infected individuals.

Further Reading

Pan American Health Organization

National Center for Biotechnology Information

Union for International Cancer Control

References

Mark Riegel, MD

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