Help It Burns When I Pee!

Hey there guys,

Today I thought I would cover a fairly common symptom seen in my office, pain or discomfort with passing urine.

In sexually active men the most common cause of pain with urination is infection of the urethra, the tube that drains the bladder through the prostate and out the penis. Commonly this is a sexually transmitted infection (STI) with gonorrhoea and chlamydia causing the majority of cases.

Occasionally pain with urination can be caused by infection of the prostate or infection of the testes, however even in these situations it is the same two bugs that cause majority of the infections. For this reason let’s discuss these two bugs in a little more detail.

What is gonorrhoea?

Gonorrhoea is a common STI caused by a bacteria called Neisseria gonorrhoeae.

Gonorrhoea has a preference to grow in warm moist areas such as the urethra (the tube that drains the bladder via the penis), however it can also happily grow in the mouth, throat, anus or eyes.

Most commonly gonorrhoea presents with pain when passing urine and a creamy discharge from the penis. While it’s fairly obvious when present in the urethra, gonorrohea in the throat may present as a sore throat or cough or pain when opening in your bowels if it’s in the anus. For these reasons gonorrhoea in the throat or the anus can sometimes be missed as the symptoms can be difficult to interpret if present at all.

Gonorrhoea will normally become symptomatic 2-5 days after initial exposure. Some strains of gonorrhoea can take longer but the research shows that most people will be showing symptoms two weeks after exposure.

If not treated gonorrhoea infection of the urethra can travel upwards, infecting the prostate, epididymus and testicles.

Gonorrhoea is easily tested for by taking a sample of urine. This test check for the gonorrhoea DNA. For the best chance of catching it the very first part of urine that leaves the body is the best. If there is discharge from the penis this can be swabbed and also tested.

Throat swabs are suggested if you have had oral sex and a swab of the rectum can also be taken if you have had any anal play which includes fingers and toys as well as cocks.

The good news is that if your doctor has a strong suspicion that you may have gonorrhoea you do not need to wait for the test results to start treatment. Because of resistant strains being present in Australia, the current recommendation is for an injection of an antibiotic into the buttock.

As chlamydia is sometimes present your doctor may suggest adding antibiotic tablets as well to cover this as well.

What is chlamydia?

Chlamydia is one of the most common bacterial STI’s. Caused by the bacterium Chlamydia trachomatis it is very easily spread via sexual contact. Like gonorrhoea it grows easily in the urethra but can also grow in the throat and anus.

Chlamydia infections can show symptoms as early as 2 days after exposure however it’s important to remember that it can take up to 35 days before signs show and some people never actually have any symptoms.

For guys the most common symptom is pain when passing urine and a sore throat and anus if the bug has settled there. People can have discharge from the infected area however it is not as frequent as when infected with gonorrhoea. Some people can be infected and not even know it.

Testing for chlamydia is similar to testing for gonorrhoea; a sample of the first part of your urine and swabs can be taken from the anus.

Treatment for chlamydia can be started before results are back and is simply two tablets of an antibiotic taken at the same time.

What is NSU?

In some cases no bugs are discovered via testing yet discomfort may continue. In these cases we need to consider the diagnosis of NSU otherwise known as “non-specific urethritis”. NSU can be caused by either damage to the urethra from vigorous sex or sounding, or from more unusual bugs that are sometimes very difficult to test for.

Either way if you still have pain after completing treatment for both gonorrhoea and chlamydia your doctor will probably suggest a longer course of antibiotics with tablets twice a day for a week.

One final cause of pain when passing urine may be herpes infection of the penis. If you notice a reddened area with small blisters that is burning or painful this may be herpes. This can be tested with a swab after examination and discussion with your doctor.

What do I do if I have been treated?

If you have been diagnosed with gonorrhoea, chlamyida or NSU it’s important you let your sexual partner or partners know. They are going to need treatment as well.

Because this can be a rather sensitive topic to bring up you may wish to use the notification service at the Drama Down Under website. From their website you can send an anonymous sms or email to notify your partners allowing them to get tested and treated.
This service can be accessed in Australia here -> The Drama Down Under Notification Service 

Having completed your treatment, whether that be tablets or injection, it’s important not to have sex for one week afterwards. This ensures full removal of the bugs from your system. If you are not able to wait that long it’s best to use a condom to protect your partner(s) from potential infection. If you still have symptoms be sure to return to see your doctor to make sure you do not have any other issues going on.

Why is treatment important?

Treatment of these infections is important for a number of reasons.

If not treated infections like gonorrhoea and chlamydia can lead to more significant infections of the prostate, epididymus and testes. As I mentioned in my post about prostate health, untreated prostate infections can end with significant illness and rarely death so getting treated early will save a lot of pain and heartache.

Another significant issue is the way that untreated gonorrhoea and chlamydia impacts on the risks of HIV infection. If a person is HIV positive, infection with chlamydia or gonorrhoea can increase viral load which has a great impact on treatment and health. Because these STI’s can cause inflammation of the area infected there is a greater chance of HIV being able to enter the body and lead to infection.

Perhaps the greatest risk is chlamydia or gonorrohea infection where there are no symptoms. A Melbourne study from 2006 was able to demonstrate that there were many men infected despite no obvious symptoms. During this study swabs were taken of the mouth and anus and urine was tested. While tests of the the urine had low positive results (around 1 in 500 testing postive), rectal and throat swabs came back positive more frequently, about 1 in 50 which clearly shows that infections on these areas are less likely to show symptoms and are missed when it comes to testing.

So what testing should I have done?

Currently AFAO (The Australian Federation of AIDS Organisations) recommends the following testing on an annual basis for all gay men.

  • A throat swab for gonorrhoea
  • An anal swab for chlamydia and gonorrhoea
  • Urine testing for chlamydia and gonorrhoea
  • A blood test for HIV and syphilis
  • If you have injected drugs, a blood test for Hepatitis C
  • It is worth also having Hepatitis A and B checked and to consider immunisation

If you have had more then 10 sex partners in a year, gone to a sex club or picked up online they recommend having this testing done every 3-6 months depending on how active you have been.
You can download a great summary from their website here.

So what is the take home message?

  • If you notice burning, stinging or pus when you pee there is a good chance you have been infected with an STI. It’s important to see your doctor to get testing organised and to start treatment straight away.
  • While chlamydia is more prevalent, there is also a risk of gonorrhoea, so your doctor may wish to treat you for both.
  • While these diseases are fairly obvious when in the penis, they can also grow in the throat and anus where it may not be noticed. If untreated these infections can lead to serious illness, can increase risk of infection with HIV and can alter your viral load if you are HIV positive. Having a regular sexual health checkup can reduce the chance of having these infections unnoticed.
  • If you have been told by your doctor you may have gonorrhoea, chlamydia or NSU it’s important to firstly get treatment, let your sexual partners know so they can be treated and finally to not have sex for one week after treatment to help avoid reinfection.

Guys, I hope you have found this post helpful. While chlamydia and gonorrhoea is quite common the good news is that it’s easy to detect and treat if looked for.

If you have any questions please feel free to drop a comment below, send me an email or feel free to make an appointment for a one on one consult.

Yours in good health.

Dr George

PS Please help look after your friends. Simply hitting the like button below can help get the word out about this important message. Thanks!

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