Does a Painful Stream of Urine Mean That You Have an STD?
It is hard to provide a usual standard per se that only relies on physical examination, but it is possible to give a threshold wherein a urine stream can be considered abnormal – partially depending on the feedback that the patient can provide to the physician. Sure, this could be subject to more factors that could introduce even further variability to the results. Still, pain, after all, is a factor that could only be described by the patient that is experiencing the symptom.
When it comes to sexually transmitted diseases, it is not unknown that changes to the genitalia are ever so possible – resulting in changes not only to the physical structure of the organ but to the way that it functions over time. Some would precipitate immediate changes that could be noticed as soon as they are infected, while some can only be seen years following the instance of infection. Either way, the patient would usually detect any changes in this area, except, of course, when the condition remains asymptomatic or if it mimics other conditions – remaining undiagnosed until it is either resolved on its own or it progresses into a more severe disease that would then provide worse and noticeable symptoms.
In trying to determine whether an STD is causing your painful urination, otherwise known as dysuria, it is essential to identify the distinctive points of each condition – differentiating it from other potential conditions that could likewise cause similar symptoms. Although STDs and non-STDs alike could mimic each other in the aspect of dysuria, they would often have other accompanying manifestations that will provide you with an idea of whether you should employ abstinence and involve your partner in the treatment process.
Of course, this is not saying that abstinence should only be employed when the patient is confirmed to have an STD. It essentially entails that each patient should know the root of their condition for them to address the manifestations – not only to prevent transmission but also to prevent further progression and likewise to narrow down potential testing options that you could employ for your likely disease.
Painful urination or dysuria in medical terms is a symptom that is observed mainly by individuals who have a pre-existing problem either in their urinary tract, urethra, or kidneys – causing blockages or other issues within this pathway that is then restricting the flow of the urine stream, resulting in a painful sensation whenever the patient attempts to urinate.
The standard for dysuria is still a little blurry due to the subjectivity of the entire definition, especially when it comes to the level of pain. Although a threshold has been created to allow patients to describe the pain they are experiencing, it is not essentially a surefire method that can be utilized to conclusively determine the cause of the condition, much less differentiate whether it is an STD or not.
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To provide physicians with a more detailed outlook as to what is causing your condition, they would usually employ microscopic laboratory tests to examine the composition of your urine and detect whether there is a presence of a pathogen in your urine stream. They might also ask you about other symptoms that commonly accompany painful urination, which may include:
Apart from these qualities of the urine, the physician may also ask you a few questions about the quality of the urine stream itself. This may include:
You might also want to recall the specific details about when and how you experienced the symptoms, as these would usually be utilized to determine the progression and severity of the condition. For instance, your physician may ask you the following details:
In determining whether a particular sexually transmitted infection causes your condition or if it is caused by another disease entirely, it might be efficient to examine the plethora of other conditions that would precipitate similar symptoms. They are not necessarily identical, but their highly close manifestation could often be confused with each other, primarily when no physician consultation and pertinent laboratory examination is employed. Once again, although this is not indicative of anything conclusive, knowing what you are currently suffering from provides you with the advantage of knowing what your next steps should be instead of simply depending on the precipitation of more apparent symptoms – a period wherein it might already be too late to address the root cause of the condition.
Urinary tract infections are perhaps the most common cause of dysuria in both genders – resulting from when bacteria enter the urethra, which results in painful urination, cloudy stream, or bloody urine. The infection is more common in women than men due to the proximity of the anus to the vagina and the shorter urethra in the anatomy of females. When the infection likewise reaches the bladder, the infected patient may again experience increased urination frequency – a symptom that often accompanies dysuria in most UTI cases.
The infection is generally mild and can be addressed by a proper course of antibiotics. However, if the bacteria reach the kidneys, the patient may experience systemic symptoms such as fever, general malaise, and back pain. When the condition comes to this point, the patient must be treated immediately to avoid a systemic infection that would be more difficult to address.
Urethral syndrome is nearly parallel with how a UTI works, except that urethritis does not entail any bacterial or viral infection inside the urethra. In this case, the urethra is indeed inflamed, but the cause of this inflammation is not associated with any disease entirely.
Urethral syndrome is known to have been caused by different factors but is all ultimately causing some level of damage or irritation to the urethra when performed. These factors may include:
The inflammation and irritation would usually trigger the constriction of the urethra – precipitating the symptoms commonly observed with this condition, on top of the primary mimicking manifestation of dysuria.
Adenovirus infection is essentially a bridge between UTI and urethral syndrome – causing inflammation or irritation of the urethra due to the colonization of adenoviruses in this particular area. Although adenoviruses are known to be pathogenic and transmissible through close personal contact, it is different from STDs in the way that it is not particularly sexually transmitted – not exclusively, at least.
The manifestation of prostatitis can vary depending on the type of condition experienced by the patient. There are four types of prostatitis in total that could be contracted by a patient – all varying depending on how it was transmitted and how they manifest in the body of an affected individual. According to the Urology Care Foundation, chronic prostatitis is the most common type among the four, but its leading cause is still essentially unknown or vague. On the one hand, acute bacterial prostatitis is a variation of the condition that is often severe when it does manifest. Another variation known as chronic bacterial prostatitis is similar because an underlying infection ultimately causes it, but this tends to develop more slowly, and its symptoms are milder than its acute counterpart. Lastly, much like in any other condition, there is also an asymptomatic variation of the disease – not precipitating any noticeable symptoms but is still very evident upon closer examination.
Prostatitis is essentially caused by the inflammation of the prostate gland – increasing in size and preventing the proper flow of urine to cause a noticeable painful sensation upon attempts at urination.
Cystitis is the inflammation of the cell lining of the urinary bladder – causing some level of pain and tenderness in the pelvic region. The most common variation of this condition is interstitial cystitis, otherwise known as painful bladder syndrome, that precipitates the symptom described in its name.
There are also cases wherein patients exposed to some radiation level would experience inflammation in their bladder region. This is known as radiation cystitis, and this often causes bladder and urinary pain.
Epididymitis is a severe complication in men, especially from those previously infected by an STD that was not immediately resolved and allowed to progress. The epididymitis is mainly isolated in the epididymis, or the region at the back of the testicle that stores and moves the sperm from the testes -aiding ejaculation during intercourse and arousal. Although this condition is relatively rare, especially for particularly healthy individuals, it is likewise a condition that may cause inflammation, resulting in a painful urination process in males.
Pelvic inflammatory disease, similar to epididymitis, is likewise a condition that is considered as a severe complication of a previous STD infection – appearing once an infection is left untreated and is allowed to proceed to its more severe complications. PID would commonly affect other parts of the female reproductive system such as the fallopian tubes, ovaries, cervix, and uterus – causing pain in the abdomen and problems when the affected individual attempts to conceive a baby later.
Obstructive uropathy is a condition wherein the ureter, bladder, or urethra is experiencing some level of blockage, pushing the urine to flow back instead of following its usual stream, and ultimately causing pain during urination as the urine flows back to the kidney. A similar condition known as urethral stricture involves the narrowing of the urethra’s diameter due to inflammation or irritation – causing the same sequence of flow back upon reaching the point of blockage.
Kidney stones are perhaps the most well-known cause of painful urination as it describes precisely what causes the pain – solidified masses of minerals tend to form structures known as “stones” within the kidney, causing pain in the structure of the urinary tract when the patient attempts to release a stream of urine. The friction between the stones and the structure of the vessels would cause excruciating pain – encouraging doctors to either offer to break them in the kidney itself or operate them out if the affected individual is not able to pass them, usually through their urinary tract.
Although medications help ensure that diseases will not progress any further into their more severe complications, you must be likewise aware that medicines may also cause particular symptoms depending on how they are designed and what they are prescribed for. In dysuria, some medications may cause some change in your urine color or stream. You must consult your doctor about the side effects you may experience for the medicines you are prescribed to take.
Similar to what was previously mentioned, painful urination can either be caused by irritation or damage to the urethra, ureter, or bladder – making hygienic products, although they are designed to provide a more soothing presentation of this region, a notorious cause of irritation due to their improper use of overuse by many uninformed individuals.
Chlamydial infections are potentially hazardous due to their ability to progress into more severe manifestations, including ectopic pregnancy, tubal factor infertility, pelvic inflammatory disease, and chronic pelvic pain. The presentations of the condition itself could vary depending on the response of the person’s body to the condition, but what makes it so notorious is its lasting effect that could even impact the person’s fertility and efforts towards conception.
The pathogen Chlamydia trachomatis cause Chlamydia, and it can cause cervicitis in women and urethritis and proctitis in both men and women. A variation of its causative microorganism may also cause lymphogranuloma venereum in developing countries – its transmission mainly being attributed to homosexual intercourse among men.
Chlamydia in itself is notorious for being a “silent infection” – one that does not manifest any immediate symptoms unless the condition itself progresses into its more severe complications. As such, the incubation period of the condition is poorly understood, and there is no one way to determine the actual period wherein its onset could be determined. With such variability, its manifestations and patterns are poorly understood, and relying on symptomatic manifestations alone could be fatal for unaware individuals.
In women, the symptomatic presentations of the condition may include signs and symptoms of cervicitis and urethritis (pyuria, dysuria). An increased urinary frequency may likewise be observed along with cervical motion tenderness and uterine tenderness upon examination.
On the one hand, infected men would usually present symptoms of urethritis – experiencing a mucoid or water discharge along with cases of dysuria during urination. Testicular pain may likewise be observed for those who develop epididymitis throughout the condition’s duration.
Similar to how other conditions are diagnosed, Chlamydia cases require appropriate laboratory tests to determine the causative organism behind the symptoms experienced by the patient. Among these tests, nucleic acid amplification tests are the most sensitive, but vaginal swabs and cell cultures may likewise be employed depending on the availability of resources.
The management method for Chlamydia is often composed of a seven-day course of antibiotics. Throughout this duration, or for seven days following the intake of a single-dose formulation, the infected patient is advised to employ abstinence as the transmission is still possible and evident according to the data obtained by the Centers for Disease Control and Prevention. It is also important to note that reinfection is possible, and immunity from the condition is not developed despite being exposed to the pathogen.
Gonorrhea is a prevalent sexually transmitted disease in the United States – averaging at around 1.6. million new cases in the country in 2018 alone, according to the reports received by the Centers for Disease Control and Prevention. Most patients remain asymptomatic despite this number, making it apparent that the actual number of infections could still be significantly more than what was reported to various health institutions.
The condition itself is caused by the pathogen known as Neisseria gonorrhoeae. It is a microorganism that mainly targets the mucous membranes of various organs, enabling it to infect not only the genitalia but also the mouth, throat, eyes, and rectum.
It is known to be transmitted through sexual contact, but it is also evident that ejaculation is not necessary for the pathogen to be transmitted. Contact with the infected mucus membranes is considered the primary path of transmission – allowing the vertical transmission to the baby when a pregnant mother undergoes labor while infected.
For most men and women, the condition mainly remains asymptomatic – varying depending on the response of the patient’s body to the infection caused by the pathogen mentioned above. In men, the symptomatic manifestations of the condition may include dysuria coupled with an abnormal discharge and epididymitis that could result in testicular pain as the infection reaches the epididymis.
On the one hand, women would usually experience dysuria, increased vaginal discharge, and vaginal bleeding between periods if they are symptomatic. However, due to the low intensity and mild manifestation of these symptoms, the presentations are often confused with other conditions, mainly attributed to urinary tract infections instead of sexually transmitted ones.
Using a nucleic acid amplification test (NAAT), both men and women potentially infected by the pathogen N. gonorrhoeae would be required to provide a urine, urethral, endocervical, or vaginal sample to the pertinent laboratory to determine whether these particular bacterial species precipitate the condition. Rectal and oral diagnostic tests may also be used for clinical use, but NAATs are still preferred for a more conclusive analysis of the patient’s status.
The recommended treatment for gonorrhea, according to the Centers for Disease Control and Prevention, is a single dose of 500mg Ceftriaxone administered intramuscularly. However, the CDC reminds infected individuals that even though the medication can address the presence of the pathogen in the system, it is not able to, in any way, resolve the pre-existing damages to the structure of the genitalia that were caused by the infection. Any impairments related to proper function and fertility could no longer be addressed by the antibiotic treatment and are only resolved through other more complex means, depending on the clinical judgment of the physician in charge.
Trichomoniasis is a sexually transmitted condition that is caused by a protozoan parasite known as Trichomonas vaginalis. The situation is considered the most curable STD in the United States by the CDC. Still, the majorly asymptomatic behavior of the condition makes it more challenging to employ the proper management strategies, much less the appropriate diagnostic procedures for the difficulties that the patient is experiencing.
Considering its classification, the parasite is transferred from one individual to another through sexual contact – invading the lower urinary tract in women while mainly infecting the urethra in men. According to the reports received by the CDC, it is apparent that the condition’s transmission is not unidirectional and can be transmitted from male to female ad vice versa. Homosexual female intercourse may likewise transmit the disease between vaginas.
Despite its mainly asymptomatic reputation, there is still a significant portion of the population that experiences symptomatic manifestations. However, the CDC maintains that the rationale behind this variation is still unknown and is still subject to further studies.
For infected men, they may experience symptoms which may include:
On the one hand, infected women may experience symptoms which may include:
Similar to how other conditions are provided with their respective conclusive diagnoses, trichomoniasis is likewise diagnosed using appropriate laboratory tests that could be used to accurately determine the causative pathogen that is developing a colony within your system. Although some tests would be arguably more accurate and sensitive than others, the availability of the tests and the accessibility of various facilities may affect the physician's clinical decision when it comes to the test that should be employed for your testing. It is also important to note that a physical examination alone will not conclusively determine the presence of T. vaginalis, especially considering that its manifestations are primarily asymptomatic.
A course of antiprotozoal medication is commonly administered to the patient who was conclusively diagnosed with the condition. In most cases, the drug is taken orally and is safe to consume for pregnant women, but always consult with your doctor regarding the possible side effects of your medications to be aware of what to look out for during this treatment period. It is also imperative that a physician appropriately prescribes your treatment to avoid medication error and the improper use of sensitive treatment options. Do not self-medicate.
Primarily attributed to two variations of a single virus, genital herpes is caused by the virus known as Herpes Simplex Virus – a pathogen with two subtypes, Type 1 and Type 2, causing varying manifestations depending on the infected region and the presentation of the condition within the individual. Oral HSV-1 infections were previously found to be more dominant in childhood, but genital HSV-1 infections are likewise increasing in number according to the 2018 data of the CDC regarding the number of herpes cases in the United States alone.
The condition itself is transmitted through contact with infected lesions and mucosal surfaces. However, it is also important to note that contracting the disease from normal-looking genitalia and skin surfaces devoid of any lesions or indicative abnormalities is still possible due to the risk of viral shedding. In addition to that, although patients are mainly found to contract oral infections from the HSV-1 subtype, receiving oral sex from someone infected with HSV-1 oral herpes may put you at risk of developing an HSV-1 genital herpes infection.
For most cases of genital herpes infection, the condition remains either asymptomatic or mild – allowing individuals to confuse it with some other disease or simply a matter of personal hygiene. However, its symptomatic manifestations are relatively evident due to lesions, vesicles, or blisters around the genitalia, mouth, or rectum, depending on the point of contact with the infected tissue. The incubation period may range from 2 to 12 days following exposure, and the lesions may take around 2 to 4 weeks to heal despite the lack of a proper management method completely.
However, it is essential to note that recurrence is possible in herpes infections – providing another set of lesions and subsequent healing that could then be defined as a single “outbreak.” Prodromal symptoms for recurrent outbreaks are possible, including fever, body pain, swollen lymph nodes, and headache.
HSV NAATs are mainly employed to diagnose genital herpes infections as it is considered the most sensitive type of test that can be utilized for this specific condition. However, it is essential to note that recurrent or healing lesions may cause viral shedding to become intermittent - resulting in false-negative results in particular periods of the infection.
On the one hand, type-specific virologic tests may also be performed when a patient has no confirmatory NAAT test yet, if they are experiencing recurrent lesions, or if they already have a culture result that is subject to confirmation using a more conclusive testing option. However, a confirmatory second method may still be required to provide a more definitive analysis of the patient’s infection status.
As of this writing, there is no definitive and approved cure for herpes as it is considered a chronic condition despite antiviral medications. Although antiviral drugs are not necessarily regarded as the cure that could ultimately eradicate the pathogen from the body, they can limit and control the number of outbreaks to prevent further transmission and allow the affected individual to return to their previous quality of life.
Over-the-counter pain medications can help relieve the pain as the stones pass through with your urine, but a proper consultation with your physician is the only guaranteed way to resolve the condition with certainty and safety.
Foods like nut products, peanuts, legumes, rhubarb, spinach, and wheat bran should be avoided as they are high in oxalate – one of the components of kidney stones (calcium oxalate).
Due to their tendency to block the pathway, you may acquire infections, loss of kidney function, and debilitating pain as the stones get stuck within crevices and tubes.
Yes. Viral shedding allows the transmission of the virus even from normal-looking genitalia.
It depends on whether the virus is symptomatic or not. The virus would remain latent in most cases, but symptomatic cases would often appear 2 to 10 days following exposure.
You may drink as much water as possible, employ a proper urination habit, use probiotics, wipe from front to back for women when defecating or urinating, and practice good hygiene in the genital region.
Ideally, immediately. Otherwise, do so as soon as possible, especially when the pain is radiates towards your back and you are experiencing fever.
It can, but it does not necessarily mean that it always will. Always have your UTI treated immediately, as it could result in a systemic infection that will be much harder to resolve.
You could take several steps to resolve dysuria if you are convinced that you do not have an infection. Some of these may include drinking more water and taking over-the-counter medications that could address these symptoms. Pain relievers may also be helpful in this instance.
National Institute of Diabetes and Digestive and Kidney Diseases
American Family Physician
Centers for Disease Control and Prevention
Written by Mark Riegel, MD
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