Persistent Urethral Burning Without Identifiable Infection: A Case Report Highlighting Diagnostic Challenges and Integrative Symptom-Oriented Management

Persistent urethral burning without identifiable infection represents a diagnostically challenging condition in male urology and may lead to repeated empirical treatment with limited benefit. We report the case of a 35-year-old man who experienced isolated urethral burning for approximately six years after an initial urinary tract infection. Despite repeated evaluations and multiple conventional treatments, his symptoms persisted. Laboratory investigations, including urinalysis, urine culture, gonococcal smear examination, and prostatic fluid analysis, showed no evidence of active infection or clinically significant prostatic inflammation. Transabdominal pelvic ultrasonography revealed only mild nonspecific prostatic changes without major structural abnormalities. Given the chronic refractory symptoms and negative diagnostic findings, an integrative symptom-oriented management strategy incorporating a modified Gancao Xiexin decoction was initiated. The patient reported gradual improvement, with the visual analogue scale score decreasing from 8 at baseline to 4 after one week and to 0 after two months. Anxiety, sleep quality, bowel habits, and overall well-being also improved, and no adverse effects or symptom recurrence were reported during follow-up. This case highlights the diagnostic uncertainty associated with persistent urethral burning without identifiable infection and suggests that noninfectious pain-related mechanisms may deserve consideration in selected patients. The observed improvement should be interpreted as a temporal association rather than evidence of therapeutic efficacy, and further studies are needed to clarify the underlying mechanisms and evaluate integrative management approaches for chronic unexplained urethral pain conditions.