Health Matters | A community pharmacist’s guide
Men are not always comfortable discussing problems involving their urinary or genital health. A burning sensation when passing urine, redness around the penis, an unusual discharge or an unpleasant smell can cause embarrassment, and some men may prefer to buy a cream from the pharmacy rather than speak to a doctor.
But these symptoms deserve attention. They can be caused by several different conditions, and the correct treatment depends on identifying the underlying problem.
In Malaysia, where community pharmacies are an accessible source of healthcare advice, pharmacists can help men understand their symptoms, use appropriate treatments safely and recognise when medical assessment is necessary.
Three conditions worth understanding are urinary tract infections (UTIs), penile thrush and balanitis. Sexually transmitted infections (STIs) must also be considered when the symptoms or sexual history suggest that possibility.
1. Urinary tract infections: Why men should not ignore burning urine
A urinary tract infection occurs when bacteria enter the urinary system and multiply. Most infections affect the bladder, although the kidneys or prostate can also become involved.
UTIs are less common in younger men than in women. When a man develops urinary symptoms, particularly if the problem keeps returning, it is important to consider whether there is an underlying cause, such as an enlarged prostate, a urinary stone, incomplete bladder emptying or a urinary tract abnormality.
What are the symptoms?
Common symptoms of a lower UTI include:
- Burning or stinging when passing urine.
- Needing to urinate more frequently than usual.
- Sudden urgency to urinate.
- Discomfort in the lower abdomen.
- Cloudy urine or blood in the urine.
These symptoms can overlap with prostatitis and sexually transmitted infections, so they should not automatically be attributed to a simple bladder infection.
The NHS guide to urinary tract infections explains common symptoms and when to seek help.
What treatment is available?
Men with suspected UTIs should generally receive prompt clinical assessment. A urine sample for culture may be needed to identify the bacteria and help select an effective antibiotic.
Malaysia’s Ministry of Health provides treatment recommendations in its National Antimicrobial Guideline: Urinary Tract Infections.
Treatment depends on the site and severity of infection, kidney function, other medical conditions, allergies and the results of investigations. Antibiotics should be selected by an appropriate prescriber rather than taken from leftover supplies or purchased on the assumption that all urinary symptoms are the same.
For discomfort, paracetamol may help if suitable. Drinking enough water to avoid dehydration is sensible, particularly in Malaysia’s hot climate, but excessive fluid intake will not cure an infection.
Cranberry products and urinary alkalinising sachets should not be relied upon to treat an established UTI.
How can men reduce the risk of recurrence?
There is no single measure that prevents every UTI, but practical steps include drinking enough fluid, avoiding unnecessarily delaying urination and seeking assessment if the bladder does not seem to empty properly.
Men who experience repeated infections may need further investigations. An enlarged prostate, urinary stones or another problem affecting urine flow may need treatment before the infections can be controlled.
A warning not to ignore: fever, chills, pain in the back or side, vomiting or feeling seriously unwell may indicate a kidney infection or a more widespread infection. Seek urgent medical attention. If there is confusion, collapse or severe illness, emergency care is required.
2. Penile thrush: Itching, redness and irritation
Thrush is caused by an overgrowth of Candida yeast. It can affect the head of the penis and the skin beneath the foreskin, causing a condition sometimes described as candidal balanitis.
Thrush is not usually classified as a sexually transmitted infection, although sexual activity can sometimes trigger symptoms or, less commonly, contribute to transmission between partners.
Men with diabetes, particularly poorly controlled diabetes, may be more susceptible. Antibiotic use, irritation and a weakened immune system can also contribute.
What does penile thrush look like?
Symptoms may include:
- Redness, itching or soreness around the head of the penis.
- Burning or irritation beneath the foreskin.
- Small patches or areas of inflamed skin.
- A whitish discharge beneath the foreskin.
- An unpleasant smell or discomfort when pulling back the foreskin.
- Stinging when passing urine if the skin is inflamed.
The appearance may be less obvious on darker skin, and not every man will have all these symptoms.
Importantly, redness or discharge does not prove that the problem is thrush. Bacterial infection, eczema, contact dermatitis and STIs can produce similar symptoms.
The NHS guide to thrush in men and women explains the symptoms, treatment and reasons to seek assessment.
What treatment is available?
When Candida infection is the likely cause, an antifungal cream such as clotrimazole may be recommended.
Malaysia’s Ministry of Health includes treatment for candidal balanitis in its National Antimicrobial Guideline: Urinary Tract Infections.
Treatment should follow the product instructions and advice from an appropriate healthcare professional. Severe or persistent symptoms may require a medical examination and, in selected cases, additional treatment.
Do not automatically add an antibiotic cream or steroid cream. Antibiotics do not treat Candida, while inappropriate steroid use may worsen or obscure some infections.
If symptoms keep returning, a clinician may recommend checking blood glucose because recurrent genital thrush can sometimes be a clue to previously undiagnosed or poorly controlled diabetes.
How can men prevent thrush from returning?
Helpful measures include:
- Washing the penis gently with water and drying carefully.
- If the foreskin retracts easily, gently washing underneath it and drying the area.
- Avoiding perfumed soaps, shower gels and genital deodorants.
- Avoiding excessive washing or scrubbing, which can irritate the skin.
- Wearing breathable underwear if tight clothing causes discomfort.
- Managing diabetes effectively where applicable.
Do not forcibly retract a tight or painful foreskin. If the foreskin cannot be moved back comfortably, seek medical advice.
Men with a first episode, recurrent symptoms, treatment failure or possible STI exposure should have the diagnosis checked rather than repeatedly buying antifungal creams.
3. Balanitis: When the head of the penis becomes inflamed
Balanitis means inflammation of the head of the penis. It is a condition, not a single infection, and it can have several causes.
Candida is one possibility, but bacterial infection, irritation from soap, allergic reactions, eczema and certain skin conditions can also cause balanitis.
What are the symptoms?
Typical symptoms include:
- Redness or swelling around the head of the penis.
- Itching, tenderness or soreness.
- Pain when passing urine.
- An unpleasant smell.
- Discharge beneath the foreskin.
- Difficulty retracting the foreskin because of swelling or pain.
The NHS guide to balanitis explains why the cause needs to be established before treatment is selected.
What treatment is appropriate?
Treatment depends on the underlying cause.
A clinician may recommend an antifungal medicine for Candida, an antibiotic for a confirmed or strongly suspected bacterial infection, or an appropriate anti-inflammatory treatment for certain skin conditions.
Gentle washing with water and avoiding irritants can help reduce discomfort while the cause is assessed.
Men should not assume that every red or itchy penis requires antibiotics or antifungal treatment. Repeated episodes may warrant examination, testing for diabetes or assessment for a skin condition.
If the foreskin becomes trapped behind the head of the penis and cannot be brought forward again, particularly if swelling or pain develops, this can be an emergency called paraphimosis. Seek emergency medical care.
4. Could it be a sexually transmitted infection?
This is an important consideration whenever a man develops genital symptoms, particularly following sex with a new partner or sex without a condom.
Some STIs cause few or no symptoms, so a person can have an infection without realising it.
Symptoms that need attention
Possible warning signs include:
- Discharge coming from the opening of the penis.
- Burning or pain when passing urine.
- Sores, blisters or ulcers on the genitals.
- A rash or unusual genital skin changes.
- Pain or swelling in one or both testicles.
- Persistent discomfort following sexual contact.
Gonorrhoea and chlamydia, for example, can cause urethritis, which is inflammation of the tube carrying urine out of the body. Genital herpes can cause painful blisters or sores, while syphilis can cause a sore that may initially be painless.
These infections cannot reliably be distinguished from other conditions by symptoms alone.
Malaysia’s Ministry of Health provides clinical guidance in its National Antimicrobial Guideline: Sexually Transmitted Infections.
Men with possible STI symptoms should attend a Klinik Kesihatan, GP or appropriate sexual health service for testing and treatment. Until assessed, it is sensible to avoid sexual contact. If an STI is diagnosed, follow advice about partner testing, treatment and when it is safe to resume sex.
Do not take leftover antibiotics. The wrong treatment may fail to clear an STI and can contribute to antibiotic resistance.
5. Do not overlook prostatitis
Not every urinary problem in a man is a bladder infection or penile condition. Prostatitis, inflammation of the prostate gland, can also cause significant symptoms.
Possible features include painful urination, difficulty passing urine, frequent urination, pain in the penis or testicles, discomfort around the bottom or pelvis, pain during ejaculation and fever.
Acute bacterial prostatitis can be serious and requires urgent medical assessment. Men who cannot pass urine need emergency assessment, particularly when accompanied by severe pain or fever.
The NHS guide to prostatitis explains the symptoms and treatment.
Persistent urinary symptoms, a weak stream, difficulty starting urination or a feeling that the bladder has not emptied fully may also indicate an enlarged prostate or another urinary problem. These symptoms deserve assessment, particularly in older men.
Can you tell the difference?
| Feature | UTI | Penile thrush | Balanitis | Possible STI |
| Typical symptom | Burning urine and frequency | Itching and redness | Swelling, soreness or redness | Discharge, burning, sores or blisters |
| Discharge | Not usually from the penis | Sometimes beneath foreskin | Possible, depending on cause | May come from the urethra |
| Main treatment | Antibiotics when indicated | Antifungal treatment | Depends on the cause | Testing and specific treatment |
| Prevention | Address contributing urinary problems | Gentle hygiene and control of contributing factors | Avoid irritants and treat the underlying cause | Condoms, testing and appropriate partner management |
This is a general guide, not a diagnostic test. Conditions can overlap, and some infections cause few symptoms.
A final word from your community pharmacist
Men sometimes delay seeking help because they feel embarrassed discussing intimate symptoms. Yet urinary and genital problems are routine healthcare concerns, and healthcare professionals are accustomed to discussing them.
The pharmacist’s role is not simply to recommend a cream or tablet. It is to ask the right questions, recognise when symptoms may indicate something more serious and help the patient reach the appropriate service.
For men in Malaysia, the message is straightforward: do not assume that burning urine always means a UTI, that every red or itchy penis is thrush, or that an antibiotic will solve every problem.
Seek help early, avoid self-medicating with leftover antibiotics and have recurring symptoms investigated. A correct diagnosis can prevent unnecessary treatment, reduce complications and sometimes reveal an underlying condition that needs attention.
Until next time, take care of your health.
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