# Dysuria (painful or burning urination) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: IDSA/ESCMID Cystitis 2011 · No dose - assessment step, no medicine given · Phenazopyridine Hydrochloride 100 mg tablets, FDA label sections Indications and Usage and Dosage and Administration (DailyMed set id 860f30ef-cfe3-4c35-8baf-dd788f02ac94) · Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph) · Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph) - Verified date: 2026-08 ## Verified against - IDSA/ESCMID Cystitis 2011 - Phenazopyridine Hydrochloride 100 mg tablets, FDA label sections Indications and Usage and Dosage and Administration (DailyMed set id 860f30ef-cfe3-4c35-8baf-dd788f02ac94) - No dose - assessment step, no medicine given - Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph) - Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph) ## Treatment metadata - No drug therapy in primary care (Assess first) - Nitrofurantoin — 100 mg — oral.solid - Azithromycin — oral.solid - Doxycycline — 100 mg — oral.solid - Ceftriaxone — injection - Phenazopyridine — 100 mg — oral.solid ## Complete treatment card ```text DYSURIA (PAINFUL OR BURNING URINATION) Sources: IDSA/ESCMID Cystitis 2011 · No dose - assessment step, no medicine given · Phenazopyridine Hydrochloride 100 mg tablets, FDA label sections Indications and Usage and Dosage and Administration (DailyMed set id 860f30ef-cfe3-4c35-8baf-dd788f02ac94) · Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph) · Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph) Review status: REVIEWED against 4 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - Pain at the start of urination points to a urethral cause such as urethritis, while pain at the end suggests the bladder or prostate [burning pain] - Dysuria may come with fever, chills, flank or low back pain, nausea, vomiting, joint pain, blood in the urine, or urinary urgency and frequency [back pain · blood in the urine · burning on passing urine · chills · fever · joint pain · nausea · urinary urgency · vomiting] - Dysuria with no other symptoms most often points to chlamydia [burning on passing urine] - Genital ulcers accompanying dysuria suggest herpes simplex virus [burning on passing urine · genital ulcers] - New confusion is often the presenting symptom of a urinary tract infection in an older adult [confusion] SIGNS - what you find (4) - A purulent urethral discharge points toward gonorrhea [pus · urethral discharge] - Exam may show fever, rash, suprapubic bladder tenderness, or joint pain [abdominal pain · fever · joint pain · lower abdominal pain · rash] - Fever with a rapid pulse or low blood pressure alongside dysuria suggests systemic infection [burning on passing urine · fever · hypotension · tachycardia] - Flank pain, blood in the urine, reduced output, and bladder spasms suggest obstruction from a stone or tumor [abdominal pain · blood in the urine · loin pain · spasm] TESTS (8) - Positive nitrites on urinalysis predict a positive urine culture 75% to 95% of the time - Positive leukocyte esterase, more than trace, predicts a positive culture 65% to 85% of the time - Gram-negative diplococci on Gram stain is diagnostic for gonorrhea - 5 or more white blood cells per oil-immersion field on urethral secretions is diagnostic for urethritis - A urine NAAT is the single most sensitive assay for gonorrhea or chlamydia in men - Ultrasound or CT is reserved for complicated dysuria with obstruction, unexplained fever, or suspected stones or tumors - Imaging is unnecessary in most straightforward cases of dysuria - Urine cytology and cystoscopy are used when hematuria or a smoking history over 10 pack-years raises concern for bladder cancer IF NOT THIS - what else fits (12) - Urethral pain syndrome causes dysuria, urinary frequency, and suprapubic discomfort with a negative urine culture - Reactive arthritis presents as the triad of urethritis, conjunctivitis, and arthritis - Infectious causes of dysuria include cystitis, urethritis, pyelonephritis, and other sexually transmitted infections - In women, vulvovaginitis or cervicitis can cause dysuria; in men, prostatitis or epididymo- orchitis can - Dermatologic causes include contact dermatitis, psoriasis, Behcet syndrome, lichen sclerosis and planus, and Stevens-Johnson syndrome - Endocrine causes include atrophic vaginitis and endometriosis - Anatomic causes include benign prostatic hypertrophy and urethral stricture - Neoplastic causes span renal cell, bladder, prostate, penile, vaginal, and vulvar cancer, lymphoma, and metastatic disease - Idiopathic causes include interstitial cystitis and urethral pain syndrome - Drug causes of dysuria include cyclophosphamide and ketamine - Traumatic causes include a foreign body, surgery, urinary tract instrumentation, or pelvic radiation - Noninfectious inflammatory causes include a stone, a urethral or ureteral stent, or pudendal neuralgia Source StatPearls "Dysuria" - disease-level clinical article Status traced to the source above Rx: Main treatment | Gonococcal urethritis - injectable MAIN TREATMENT - choose one, plus any add-on marked below 1. NO DRUG THERAPY IN PRIMARY CARE (ASSESS FIRST) [1st line] Adult Dysuria is a symptom, not a diagnosis. In a non-pregnant woman with frequency and urgency and no vaginal discharge, cystitis is likely enough to treat on the history. Otherwise think again: vaginal discharge points to vaginitis or a sexually transmitted infection, flank pain and fever to pyelonephritis, and in a man dysuria is urethritis or prostatitis until proved otherwise. Ask about pregnancy every time. - Assess, then decide Peds Dysuria in an infant under 3 months, or with fever at any age, needs urgent assessment. Send the urine for culture before starting antibiotics, not after, and remember that urinary infection in a young child warrants thought about reflux. Source No dose - assessment step, no medicine given Why Treating every dysuria as cystitis is how chlamydia is missed in young women and how pyelonephritis gets sent home with a short course of tablets. Caution Pregnancy changes the whole approach: asymptomatic bacteriuria is treated, a culture is always sent, and nitrofurantoin is avoided at term. Fever, rigors, flank pain or vomiting is pyelonephritis, not cystitis. That needs a culture and a different, longer antibiotic course. In a man, and in recurrent infection in a woman, send a urine culture rather than treating blind. Dysuria with a new sexual partner, urethral or vaginal discharge, or pelvic pain: test for chlamydia and gonorrhoea, and treat the partner. Visible blood in the urine that persists after the infection has been treated needs investigating for bladder cancer, particularly in a smoker over 45. Sterile pyuria - white cells with no growth - should raise chlamydia, and in Egypt also urinary tuberculosis and schistosomiasis. RED FLAG - Hematuria accompanying dysuria can signal urological obstruction from a stone or tumor and warrants further evaluation rather than empiric antibiotic treatment alone. 2. NITROFURANTOIN [1st line] Adult 100 mg BID (monohydrate/macrocrystals) or 50 mg QID x 5 days Peds Specialist use only in children; 5-7 mg/kg/day divided QID Source IDSA/ESCMID Cystitis 2011 Why When the picture is uncomplicated cystitis, this is the first-line antibiotic: it concentrates in the urine, resistance remains low, and it does little to gut flora. Caution Contraindicated if eGFR < 45 mL/min. Take with food to improve absorption and lessen GI upset. It reaches therapeutic levels only in the bladder urine. It does not treat pyelonephritis or prostatitis. Avoid at term in pregnancy and in the neonate - haemolysis risk in G6PD deficiency. Pulmonary toxicity can occur on prolonged use, and urine turns brown. Egypt COLIFURAN 100 MG 20 TABS. KAHIRA 2.40 EGP (0.12/unit) UVAMINE RETARD 100 MG 20 CAPS. MUP > ACINO 47.00 EGP (2.35/unit) MEPAFURAN 100 MG 20 CAPS. MEPACO 54.00 EGP (2.70/unit) MACROFURAN 100 MG 30 CAPS. KAHIRA 82.00 EGP (2.73/unit) 3. AZITHROMYCIN [2nd line] Adult 1 g as a single dose Peds 10-12 mg/kg/dose [child max 500 mg] (Infants, Children, and Adolescents: Oral: 10 to 12 mg/kg/dose once on day 1 (usual maximum dose: 500 mg/dose) followed by 5 to 6 mg/kg once daily (usual maximum dose: 250 mg/dose) for remainder of treatment duration.) 3kg -> 30-36 mg/dose 4kg -> 40-48 mg/dose 5kg -> 50-60 mg/dose 6kg -> 60-72 mg/dose 7kg -> 70-84 mg/dose 8kg -> 80-96 mg/dose 9kg -> 90-108 mg/dose 10kg -> 100-120 mg/dose 11kg -> 110-132 mg/dose 12kg -> 120-144 mg/dose 13kg -> 130-156 mg/dose 14kg -> 140-168 mg/dose 15kg -> 150-180 mg/dose 16kg -> 160-192 mg/dose 17kg -> 170-204 mg/dose 18kg -> 180-216 mg/dose 19kg -> 190-228 mg/dose 20kg -> 200-240 mg/dose 21kg -> 210-252 mg/dose 22kg -> 220-264 mg/dose 23kg -> 230-276 mg/dose 24kg -> 240-288 mg/dose 25kg -> 250-300 mg/dose 26kg -> 260-312 mg/dose 27kg -> 270-324 mg/dose 28kg -> 280-336 mg/dose 29kg -> 290-348 mg/dose 30kg -> 300-360 mg/dose 31kg -> 310-372 mg/dose 32kg -> 320-384 mg/dose 33kg -> 330-396 mg/dose 34kg -> 340-408 mg/dose 35kg -> 350-420 mg/dose 36kg -> 360-432 mg/dose 37kg -> 370-444 mg/dose 38kg -> 380-456 mg/dose 39kg -> 390-468 mg/dose 40kg -> 400-480 mg/dose 41kg -> 410-492 mg/dose 42kg -> 420-500 mg/dose (upper capped) 43kg -> 430-500 mg/dose (upper capped) 44kg -> 440-500 mg/dose (upper capped) 45kg -> 450-500 mg/dose (upper capped) 46kg -> 460-500 mg/dose (upper capped) 47kg -> 470-500 mg/dose (upper capped) 48kg -> 480-500 mg/dose (upper capped) 49kg -> 490-500 mg/dose (upper capped) 50kg -> 500 mg/dose (capped) AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Choice Alternatives. The disease article gives single-dose azithromycin 1 g or doxycycline 100 mg twice daily for 7 days for urethritis; azithromycin stays the printed default as the incumbent and the single-dose option, with doxycycline as the 7-day alternative. Source Egyptian National Drug Formulary - Antimicrobial 2023 Why Single-dose macrolide antibiotic coverage for nongonococcal urethritis causing male dysuria. Caution Rising macrolide resistance - reserve for penicillin allergy. The formulary's general paediatric regimen is 10-12 mg/kg on day 1 (max 500 mg) then 5-6 mg/kg once daily (max 250 mg). The flat five-day course here is the streptococcal- pharyngitis regimen and is deliberately different. Reserve for penicillin allergy due to macrolide resistance. QT prolongation can occur, so use caution with other QT-prolonging drugs. Egypt AZATRIBACT 250MG 6 CAPS. RIVA PHARMA S... 15.00 EGP (2.50/unit) AZOMYCIN 250MG 6 CAPS. PHARCO 25.20 EGP (4.20/unit) AZATRIBACT 500MG 3 CAPS. RIVA PHARMA S... 13.50 EGP (4.50/unit) ZITHROMAX 250MG 6 CAPS. PFIZER 79.00 EGP (13.17/unit) ZITHROPRO 500 MG 6 F.C. TABS. EVA PHARMA 103.00 EGP (17.17/unit) AZROLID 500 MG 3 F.C.TABS. AMRIYA 63.00 EGP (21.00/unit) DISTABCIN 250 MG 6 DISPERSIBLE TABS. EGPI 43.50 EGP DISTABCIN 500 MG 3 DISPERSIBLE TABS. EGPI 43.50 EGP ZITHRODOSE 100MG/5ML SUSP. 15ML EL-OBOUR > AV... 12.00 EGP -> ? strength differs, ? different route - not oral solid ZITHROPHATE 200MG/5ML SUSP. 15ML ORGANO PHARMA... 12.75 EGP -> ? strength differs, ? different route - not oral solid 4. DOXYCYCLINE [2nd line] Adult 100 to 200 mg/day in 1 to 2 divided doses Peds 2.2 mg/kg/dose [child max 100 mg] (ENDF general paediatric dosing: 2.2 mg/kg/dose every 12 hours, maximum 100 mg/dose.) 3kg -> 6.6 mg/dose 4kg -> 8.8 mg/dose 5kg -> 11 mg/dose 6kg -> 13.2 mg/dose 7kg -> 15.4 mg/dose 8kg -> 17.6 mg/dose 9kg -> 19.8 mg/dose 10kg -> 22 mg/dose 11kg -> 24.2 mg/dose 12kg -> 26.4 mg/dose 13kg -> 28.6 mg/dose 14kg -> 30.8 mg/dose 15kg -> 33 mg/dose 16kg -> 35.2 mg/dose 17kg -> 37.4 mg/dose 18kg -> 39.6 mg/dose 19kg -> 41.8 mg/dose 20kg -> 44 mg/dose 21kg -> 46.2 mg/dose 22kg -> 48.4 mg/dose 23kg -> 50.6 mg/dose 24kg -> 52.8 mg/dose 25kg -> 55 mg/dose 26kg -> 57.2 mg/dose 27kg -> 59.4 mg/dose 28kg -> 61.6 mg/dose 29kg -> 63.8 mg/dose 30kg -> 66 mg/dose 31kg -> 68.2 mg/dose 32kg -> 70.4 mg/dose 33kg -> 72.6 mg/dose 34kg -> 74.8 mg/dose 35kg -> 77 mg/dose 36kg -> 79.2 mg/dose 37kg -> 81.4 mg/dose 38kg -> 83.6 mg/dose 39kg -> 85.8 mg/dose 40kg -> 88 mg/dose 41kg -> 90.2 mg/dose 42kg -> 92.4 mg/dose 43kg -> 94.6 mg/dose 44kg -> 96.8 mg/dose 45kg -> 99 mg/dose 46kg -> 100 mg/dose (capped) 47kg -> 100 mg/dose (capped) 48kg -> 100 mg/dose (capped) 49kg -> 100 mg/dose (capped) 50kg -> 100 mg/dose (capped) Source Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph) Why Dysuria in men is commonly urethritis; the card carried azithromycin only, and the disease article names a tetracycline for the non-gonococcal cause. Caution Hypersensitivity to doxycycline, other tetracyclines, or any component of the formulation Use in children under 8 years should be reserved for severe, potentially life- threatening infections, or when better alternatives are unavailable. The ENDF gives a general dosage range, not a urethritis-specific course - the indication and the need for partner treatment come from the disease article. Egypt FARCODOXIN 100MG 10 CAPS. PHARCO 11.00 EGP (1.10/unit) DOXY M.R.100 MG 10 CAPS. ADWIA 12.00 EGP (1.20/unit) GRANUDOXY 100MG 10 F.C. TAB. GLOBAL NAPI P... 12.00 EGP (1.20/unit) DOXYDOX 100 MG 10 CAPS. EIPICO 23.00 EGP (2.30/unit) DOXYMYCIN 100 MG 10 CAPS. EL NILE. 30.00 EGP (3.00/unit) TABOCINE 100MG 10 CAPS. TABUK PHARMAC... 46.00 EGP (4.60/unit) VIBRAMYCIN 100MG 10 CAPS. PFIZER 65.00 EGP (6.50/unit) 5. PHENAZOPYRIDINE [add-on - not a substitute] Adult 200 mg (two 100 mg tablets) three times daily after meals x 2 days maximum when given alongside an antibiotic Peds Not used in young children in primary care. The label's dosing applies to adults and children 12 years and over. Source Phenazopyridine Hydrochloride 100 mg tablets, FDA label sections Indications and Usage and Dosage and Administration (DailyMed set id 860f30ef-cfe3-4c35-8baf-dd788f02ac94) Why A urinary mucosal analgesic that takes the edge off the burning in the first day or two while the antibiotic works. It treats nothing, and because it turns the urine bright orange it masks both the dipstick and visible blood - which is why the label caps it at two days. Caution Do not give in G6PD deficiency without deliberate thought - it can cause haemolysis, and G6PD deficiency is common enough in Egypt for this to matter in practice. Two days maximum alongside an antibiotic. The label states there is no evidence that longer adds anything. Warn the patient the urine will turn reddish-orange, and that it stains clothing and permanently stains soft contact lenses. A yellow tinge to the skin or the whites of the eyes means it is accumulating - stop it and check renal function. Avoid in renal impairment. It relieves the symptom and hides the signs. It is never a substitute for treating the infection, and never a reason to delay a culture. Egypt URISEPT 100 MG 20 SUGAR C.TABS. KAHIRA 5.00 EGP GONOCOCCAL URETHRITIS - INJECTABLE 6. CEFTRIAXONE [2nd line] Adult IV or IM: 1 to 2 g once daily, or divided twice daily Peds 50-75 mg/kg/dose [child max 1000 mg] (ENDF: mild to moderate infection, 50 to 75 mg/kg/dose once daily; maximum daily dose 1,000 mg/day.) 3kg -> 150-225 mg/dose 4kg -> 200-300 mg/dose 5kg -> 250-375 mg/dose 6kg -> 300-450 mg/dose 7kg -> 350-525 mg/dose 8kg -> 400-600 mg/dose 9kg -> 450-675 mg/dose 10kg -> 500-750 mg/dose 11kg -> 550-825 mg/dose 12kg -> 600-900 mg/dose 13kg -> 650-975 mg/dose 14kg -> 700-1000 mg/dose (upper capped) 15kg -> 750-1000 mg/dose (upper capped) 16kg -> 800-1000 mg/dose (upper capped) 17kg -> 850-1000 mg/dose (upper capped) 18kg -> 900-1000 mg/dose (upper capped) 19kg -> 950-1000 mg/dose (upper capped) 20kg -> 1000 mg/dose (capped) 21kg -> 1000 mg/dose (capped) 22kg -> 1000 mg/dose (capped) 23kg -> 1000 mg/dose (capped) 24kg -> 1000 mg/dose (capped) 25kg -> 1000 mg/dose (capped) 26kg -> 1000 mg/dose (capped) 27kg -> 1000 mg/dose (capped) 28kg -> 1000 mg/dose (capped) 29kg -> 1000 mg/dose (capped) 30kg -> 1000 mg/dose (capped) 31kg -> 1000 mg/dose (capped) 32kg -> 1000 mg/dose (capped) 33kg -> 1000 mg/dose (capped) 34kg -> 1000 mg/dose (capped) 35kg -> 1000 mg/dose (capped) 36kg -> 1000 mg/dose (capped) 37kg -> 1000 mg/dose (capped) 38kg -> 1000 mg/dose (capped) 39kg -> 1000 mg/dose (capped) 40kg -> 1000 mg/dose (capped) 41kg -> 1000 mg/dose (capped) 42kg -> 1000 mg/dose (capped) 43kg -> 1000 mg/dose (capped) 44kg -> 1000 mg/dose (capped) 45kg -> 1000 mg/dose (capped) 46kg -> 1000 mg/dose (capped) 47kg -> 1000 mg/dose (capped) 48kg -> 1000 mg/dose (capped) 49kg -> 1000 mg/dose (capped) 50kg -> 1000 mg/dose (capped) AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph) Why The app's own assessment text names urethritis as the presumed cause of dysuria in men, but the card carried no agent active against N. gonorrhoeae - nitrofurantoin is a cystitis drug and azithromycin covers the chlamydial partner organism. The ENDF lists uncomplicated gonococcal infection (cervical/urethral, rectal, and pharyngeal) as a ceftriaxone indication. Caution Hypersensitivity to ceftriaxone, any component of the formulation, or other cephalosporins Do not use in hyperbilirubinaemic neonates, particularly those who are premature, since ceftriaxone is reported to displace bilirubin from albumin binding sites. Do not give with intravenous calcium-containing solutions in neonates 28 days or younger. The ENDF gives a general adult dose and lists uncomplicated gonococcal infection as an indication, but states no gonorrhoea-specific figure - the indication comes from the disease article, the dose from the monograph's general adult range. Treat the sexual partner and test for co-infection; this is a disease-article instruction, not an ENDF dosing statement. Egypt CEFAXONE 250MG I.V. VIAL. PHARCO B 15.00 EGP CEFOTRIX 250MG I.V.VIAL (U.S.P.23) UP PHARMA 15.00 EGP TRIXOMASH 500MG VIAL FOR I.V. INJ. RAMEDA > MASH PREMIERE 16.50 EGP TRIAXONE 500MG VIAL FOR I.M. INJ. TABUK PHARMACEUTICAL MANUFACTURING COM... 36.00 EGP WINTRIAXONE 1 GM PD. FOR I.M INJ. SANOFI 48.00 EGP CEFTRIAXONE-SANDOZ 500 MG I.M. VIAL PHARCO B > SANDOZ 62.00 EGP TRIAXONE 1 GM I.M. VIAL TABUK PHARMAC... 106.00 EGP TRIAXONE 1 GM I.V VIAL TABUK PHARMAC... 106.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)