The diagnosis and management of sexually transmitted infections (STIs), often referred to as STDs, typically begin with a primary care physician or a sexual health clinic. However, urologists frequently play a significant role in both testing and treatment due to their specialized focus on the urinary and male reproductive systems. This specialized focus is important when infections cause specific symptoms or lead to complications within the urogenital tract.
Defining the Field of Urology
Urology is the medical and surgical specialty focused on the urinary tracts of both women and men, as well as the male reproductive system. This anatomical scope includes the kidneys, ureters, bladder, and urethra. In males, the field also encompasses the testes, epididymis, vas deferens, seminal vesicles, prostate gland, and penis.
Because the urethra serves as the exit point for both urine and, in males, semen, it is a common site for sexually transmitted pathogens to enter and cause infection. When an infection or inflammation affects organs like the urethra, bladder, or male reproductive structures, the condition falls directly under the expertise of a urologist. This anatomical overlap between the urinary and reproductive systems links urology to the management of many STDs.
Urologists and STD Screening
Urologists do test for STDs, but their screening is focused and diagnostic rather than general or routine. While a primary care physician may offer comprehensive screening for asymptomatic patients, a urologist is typically consulted when a patient presents with specific, localized symptoms. These symptoms often include painful urination, abnormal discharge from the urethra, or visible lesions on the genitalia.
The diagnostic process involves targeted testing to identify the specific pathogen causing the urogenital complaint. Common tests ordered include nucleic acid amplification tests (NAATs) on urine samples to detect bacterial infections like Chlamydia trachomatis and Neisseria gonorrhoeae. Urologists may also perform blood tests for systemic infections such as HIV and syphilis, or swab tests to analyze fluid from ulcers or lesions for viruses like Herpes Simplex Virus (HSV). If a patient reports symptoms like testicular pain, the diagnostic workup will specifically include ruling out an ascending infection from an STD.
Sexually Transmitted Conditions Treated by Urologists
Urologists are involved in the treatment of STDs, particularly when the infection has caused inflammation or structural damage to the genitourinary tract. A primary focus is treating inflammatory complications in the male reproductive system. For example, bacterial STDs like gonorrhea and chlamydia commonly cause epididymitis, which is the painful inflammation of the coiled tube behind the testicle.
They also treat prostatitis, an inflammation of the prostate gland, which can result from the spread of an STI and causes symptoms like pelvic pain and difficulty urinating. Treating these conditions involves prescribing specific antibiotic regimens, such as combination therapy for chlamydia and gonorrhea, and managing associated pain. If antibiotics fail to resolve the infection or complications arise, the urologist’s surgical training becomes relevant.
Urologists also manage the physical manifestations of viral STDs, most notably Human Papillomavirus (HPV). When HPV causes genital warts, the urologist can treat them using methods such as cryotherapy or surgical excision. Furthermore, untreated or recurrent urethritis, or inflammation of the urethra, can lead to scar tissue formation known as a urethral stricture. Urologists perform procedures like urethroscopy or urethroplasty to surgically repair these strictures, restoring normal urinary flow.
Patient Pathways for Urogenital Health
Deciding whether to see a urologist or a primary care physician for a potential STD depends on the patient’s symptoms and the complexity of the concern. For routine, asymptomatic screening or an uncomplicated, first-time infection like chlamydia, a primary care provider or a sexual health clinic is the appropriate first stop. These settings are well-equipped to perform standard testing and initiate first-line antibiotic treatment.
A urologist is recommended when symptoms are persistent, severe, or suggest a deeper anatomical involvement. Patients should seek a urologist if they experience recurrent urethritis despite treatment, chronic pain in the testicles or perineum, or if the infection has been complicated by abscess formation or urethral strictures. The urologist’s specialized expertise in the anatomy and surgical management of the genitourinary system makes them the appropriate referral for evaluating treatment failures or managing long-term structural consequences of an STI. Effective urogenital health often involves a collaborative approach between different specialists.