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     There are two groups of people who have painful urination.  One group is older men and women who are not particularly sexually active, and then we have the college students and other non-attached younger group.  It is pretty safe to say that a 20-year-old male or female who is sexually active and has painful urination that came on a few days or week after an indiscretion, unprotected likely has a different cause than a 90-year-old-man in a wheelchair.  Let’s address the younger crowd first.

     Sexually Transmitted Disease, also known as STDs, has to be the number-one concern, if there has been recent unprotected contact.  The time of contact to symptoms can vary, but usually, depending on the organism, within a few days to ten days, though with viral disease like Herpes Simplex type II, it can be longer.

     Years ago, Gonorrhea was one of the more common.  If you have Gonorrhea and you are a male, you will know it.  It will soon burn very badly when you urinate, and pretty soon there will be pus dripping from your penis, staining your underwear.  Women may or may not have as severe of symptoms.  So if you are a male and know whom you got it from, you have an obligation to tell them.  If you don’t, you could risk them unwittingly spreading it, and it could affect their fertility later in life.  So man up and tell them.  If you have these symptoms, you must see your doctor or go to the county health department for testing and treatment.  It will NOT go away on its own.  You will have to get appropriate antibiotics.  Again, females, your symptoms might be milder, so be aware, and if there is any doubt, go get tested.

     Chlamydia is a common STD now.  Unlike Gonorrhea, the symptoms are not usually as severe, but the consequences similar.  If you have had unprotected sexual contact and have some odd sensations urinating, get tested.  If you have a partner, tell him/her as well, so you don’t bounce it back and forth.

     There are other non-viral STDs that have variable symptoms and cause painful urination.  Some are associated with skin lesions down there, and some are not.  Anything that looks funny needs to be looked at by a doctor.  The list is long, and some bugs are resistant to certain antibiotics and anti-protozoan medications, so get tested and treated.  Do not stop the pills when the symptoms go away.  Take all of them.

     Trichomonas is a protozoan infection that can have few symptoms.  It might or might not cause a discharge or funny smell.  If you notice a funny smell, especially if a female, get it checked out.

     Syphilis is an STD that causes a sore first.  The sore might go away, but the disease stays.  It is caused by a spirochete, and latent syphilis can cause many problems, particularly a rash and can affect your nervous system years down the road.  So if you get a sore, called a chancre, get tested and treated, even if the sore goes away.  Syphilis has become much less common than in years past.  Many historians believe Henry the Eighth, King of England, died of syphilis.

     Herpes simplex I and II can cause painful urination during the initial infection, and sometimes later.  Herpes usually forms small blisters around the genitals, but in women can be unseen, because they are more inside and not noticeable.  Herpes has a tendency to come and go and is associated with some pain in the buttocks legs and groin.  It can be very painful.  If you have this, you must see your doctor.  There are blood tests to tell if you have the virus inside of you.  This disease cannot be cured, but it can be treated with suppressive doses of anti-viral medications.  If you have herpes, you can spread it even without having an obvious sore down there.  Suppressive medication does not guarantee your partner will not get it either, so if active, always use a condom and inform your partner of the risks.

     Now, let’s talk about older people who likely don’t have an STD.

     Older men with enlarged prostates can have difficulty urinating, and when the prostate gets infected, it can hurt to urinate.  If men cannot empty their bladders completely, there is an increased likelihood of developing a urinary tract infection.  If that describes you, you will need to see your doctor for a urinalysis and maybe a culture of your urine, because many different types of bacteria can infect your system.   If an infection is present, you will need antibiotics. 

     Older women, and sometimes younger women can get infection of the bladder called cystitis.  This can cause painful urination.  This is usually caused by a bacteria, most commonly E. coli.  This will require antibiotics and is diagnosed with a culture of the urine as well.

     Rarely, in younger people, there is a disease known as Reiter’s Disease that causes painful urination and red, itchy eyes.  This appears to be an autoimmune disease.

     Sometimes, kidney stones, bladder infections and even bladder cancer can cause painful urination in middle-age and older patients.

     Know that there are ample ways to diagnose and treat your cause of painful urination.