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Urinating is something that we do 5 to 10 times a day without a second thought until there is some irregularity. Burning during urination is a rare problem in males but when a patient presents to the clinical, there are one of two diagnostic paths that all urologists must consider: is it a sexually transmitted disease or just type of bacterial infection in the bladder or kidneys. 

In males aged 15 to 50, it is more common to have some type of sexually transmitted disease that can lead to this penile burning and potential discharge. This condition is termed urethritis and can be caused by common infections like Chlamydia or gonorrhea. Risk factors for this condition would be having unprotected sexual intercourse.

Approximately 11 percent of the population in the United States currently has a gonorrheal infection. When looking at sexually transmitted diseases worldwide, it is believed that there are 1 million new cases of STD infections every day. It is a common condition and physicians will perform a number of rapid tests in order to determine if a patient has a sexually transmitted disease and have a result in minutes. 

With most of these sexually transmitted diseases, the patients are prescribed antibiotics and complete therapy within a week. They will be instructed to make sure they are practicing safe sex. In the event a disease is not treated, there could be more dramatic effects. Men can develop a condition called pyelonephritis and will require an extended stay in the hospital to overcome this condition. This is a condition where the bacteria travel to the kidneys and causes more life-threatening physiological changes. Women who do not treat their STD can develop uterine complications and may have difficulty becoming pregnant. 

While STDs are a distinct and common possibility, not all males with dysuria (pain during urination) will have a history of risky sexual behavior.

Innocent urinary tract infections are possible and should be worked-up when a patient presents to the clinic. It is much more rare for men to develop urinary tract infections compared to females for one very simple reason: the anatomy. Women have much shorter urethra (the tube that connects the bladder to the vaginal opening) compared to men. Because of this shorter tube, women are more likely to contract bacterial infections when they are urinating. Males have longer tubes and it is harder for the bacteria to travel up to the hospitable bladder where they can live in comfort. 

If you find yourself having recurrent episodes of dysuria without a history of risky sexual behavior, irregular anatomy of your urethra may be the cause of your urinary problems. Patients that find themselves in this state will need to be evaluated closer and a small camera will be inserted into the urethra in order to see where the anatomical variation can occur. A micro-surgery would be conducted in this case in order to correct the anatomy. 

As men age, bladder function can decline and patients can become more prone to having urinary infections without anatomical differences. These patients will typically be older than 50 and may have outflow obstructions that could prevent urinary outflow. This may include enlargement of the prostate or kidney stones.  

To recap, younger patients will generally have STD infections or anatomical differences that cause urinary tract infections while older patients may have urinary tract infections secondary to outflow obstructions or chronic conditions like diabetes. 

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