My name is Irene and I live in Gikondo with my husband. We’ve been married for four years now. About a month ago, I started feeling pain when I urinate. It actually burns. I get the feeling it might be an STD but I honestly haven’t been fooling around, which leads me to believe that my husband has.

I talked to a friend and she told me that the burning could be gonorrhea or Chlamydia. I have no idea what any of these diseases are like but I do know that I have never had an infection of this sort ever.

To make matters worse, I seem to be getting a strange rash around my lady business. What the hell is going on? I am afraid to talk to my husband as he might turn things on me and I don’t want to sleep with him either lest he sees the rash. What is going on? 

Irene, 33, Gikondo

Dear Irene,

Along with burning pain while urinating, are you passing urine very frequently with a sense of urgency?  If that is so, the underlying cause is infection of the urinary bladder, i.e. cystitis. Gonorrohoea, a sexually transmitted disease, can also cause painful urination. Chlamydia and other sexually transmitted diseases can also cause painful urination. But there may be associated vaginal discharge and or swelling of the inguinal lymph nodes visible as swelling in the groin.  Some of them like Chlamydia may also be without symptoms.

Blood loss during menses in women makes them more susceptible to develop cystitis as blood provides a rich medium for bacteria to grow. The risk for cystitis is also increased due to short length of the tube connecting the bladder to the exterior, i.e. urethra in women, providing easy access to microbes. Poor genital hygiene, an infected sexual partner are other risk factors for acquiring these problems. 

Usually infection of the reproductive and urinary system can co-exist due to close proximity of the two. Similarly, Chlamydia and gonorrhea infections can exist at the same time depending on what type of infection a person is exposed to.  These infections can be easily diagnosed by detecting the causative germs in a swab taken from the cervix (lower part of uterus) or in first morning mid stream sample of urine. The germs can be seen microscopically or grown via culture and then identified. These conditions are easily treatable by suitable antibiotics.

The rash mentioned could be related or unrelated to the present problem. Skin rashes around one’s private parts could be due to fungal infection, genital herpes, allergic dermatitis, psoriasis, scabies and so many reasons. The clinical diagnosis depends on the nature of the rash, its size and presence of associated itching, eruptions or any symptom. It could simply be a rash due to irritation caused by damp sanitary napkins or undergarments, similar to diaper rash in babies.

Prevention of these problems lies in maintaining good hygiene of genital parts. Always keep the parts clean and dry, avoid nylon underpants as they increase risk of causing and aggravating infection. After intercourse, pass urine and wash private parts to remove any contamination. Drinking lots of water (8-10 glasses) everyday helps to flush out infective germs from the urinary system.

Before doubting your husband, you can discuss the problem with him and clearly ask him if he has any problem like painful urination or discharge from his penis. Get a urine sample and genital swab tested to see the underlying causative microbes. Depending on the results antibiotics like azithromycin or ciprofloxacin taken in suitable dose can help in complete cure.

Dr. Rachna Pande is a Specialist in Internal Medicine at Ruhengeri Hospital