Urethritis

What is urethritis?

Urethritis is an inflammation of the urethra, which is the tube that carries urine out of the body. Urethritis is usually caused by a sexually transmitted infection. Much less often, it is the result of an injury from an instrument such as a urinary catheter or exposure to an irritating chemical such as an antiseptic or a spermicide.

Doctors have historically classified sexually transmitted (infectious) urethritis into two categories: gonococcal urethritis, caused by gonorrhea bacteria, and nongonococcal urethritis, caused by bacteria other than gonorrhea.

Gonococcal urethritis, commonly called clap, is caused by Neisseria gonorrhoeae bacteria. Gonorrhea infections are passed from person to person during sexual activity (vaginal, oral, and anal intercourse).

Nongonococcal urethritis is caused by all sexually transmitted bacteria other than N. gonorrhea. The most frequent cause is Chlamydia trachomatis bacteria, which cause the sexually transmitted infection Chlamydia. Nongonococcal urethritis is the one of the most common forms of sexually transmitted infection. In addition to C. trachomatis, other possible infectious causes of nongonococcal urethritis include Mycoplasma genitalium and Trichomonas vaginalis.

Not all urethritis is caused by an infection or trauma. Reactive arthritis (formerly known as Reiter's syndrome) is an inflammatory disorder that usually has three features:

painful and swollen joints, one or many
conjunctivitis
sterile urethritis.

Symptoms of urethritis

The main symptoms of urethritis are pain or burning during urination and an urge to urinate more frequently. Another symptom is redness around the opening of the urethra, the tube that carries urine from the bladder to the outside of the body. Men with gonococcal urethritis also often have a yellow discharge from the urethra.

Women are less likely to have symptoms from sexually transmitted infections such as gonorrhea and chlamydia.

Diagnosing urethritis

Your doctor will ask about your sexual history, including new partners and condom use. Your doctor will look for an abnormal discharge from your urethra. In women, a pelvic examination will be done to look for tenderness, redness or abnormal discharge from the cervix and vagina. Because urethritis usually is caused by sexually transmitted infections, your doctor will examine you for signs of other infections, such as syphilis, genital warts caused by human papilloma virus (HPV) and HIV.

Urethritis caused by injury or chemical irritation is diagnosed based on your medical history and the absence of an infectious cause.

Expected duration of urethritis

Once you start taking antibiotics, infectious urethritis improves rapidly. Even without treatment, the symptoms of gonococcal and nongonococcal urethritis usually go away within three months. However, people continue to remain infectious, and spread the bacteria to others even when they have no symptoms. Untreated infections can spread from the cervix to the fallopian tubes in women, where they can cause permanent scarring and infertility.

Urethritis caused by injury or chemical irritation goes away without treatment once the cause is identified and avoided.

Preventing urethritis

Because both gonococcal and nongonococcal urethritis are caused by bacteria that can be transmitted during sexual intercourse, you can prevent these infections by:

not having sex
having a sex with only one uninfected partner
consistently using male latex condoms during sexual activity. If you or your partner has a latex allergy, use polyurethane condoms.

Having sexually transmitted urethritis may increase your risk of HIV infection. If you already have HIV, urethritis may increase the risk that you will pass HIV to a sex partner.

Urethritis caused by injury or chemical irritation is rare, and there is no way to prevent it. Once it occurs, avoiding the offending substance should prevent urethritis from recurring.

Treating urethritis

Infectious urethritis can be treated with a variety of antibiotics. Because certain strains of bacteria have become resistant to specific antibiotics, your doctor may need to prescribe a different antibiotic if symptoms continue after you have finished taking the first prescription.

All sex partners of a person infected with infectious urethritis also should be treated. People who are taking antibiotics for urethritis should not have sex until treatment is complete.

Because many people have gonorrhea and chlamydia at the same time, health experts recommend that all people treated for gonorrhea receive treatment for chlamydia as well. For this reason, you may need to take two types of antibiotics, because many commonly used antibiotics treat only one of the two infections.

No specific treatment is needed for urethritis caused by injury or chemical irritation. Your doctor may prescribe phenazopyridine (Pyridium) to ease any burning or pain with urination.

Urethritis associated with reactive arthritis is treated with non-steroidal anti-inflammatory drugs (NSAIDs), such as naproxen.

When to call a professional

Men should call a doctor if they notice an abnormal discharge from the penis. Women should seek medical attention if they develop an unusual vaginal discharge or bleeding or pain during intercourse. Both men and women should call a doctor if they start urinating more frequently, or if urination causes pain or a burning discomfort, especially if fever or chills occur. Men and women, especially pregnant women, should call a doctor if they participate in sexual activity with someone who has gonorrhea or chlamydia.

Men and women who have sex with multiple partners should schedule a routine physical examination every year, even if they have no symptoms of sexually transmitted infections. In women, this physical examination should include a pelvic exam.

Prognosis

If gonococcal urethritis is diagnosed and treated quickly and correctly, there usually is complete recovery. Gonococcal urethritis that is not treated correctly or not treated at all can lead to advanced pelvic inflammatory disease in women, which can result in scarring that can lead to infertility. Antibiotic treatment of chlamydia will cure this disease and can prevent complications. If untreated, chlamydia infections in men can cause swollen and tender testicles.

Urethritis caused by injury or chemical irritation will almost always go away once the cause is avoided.

Urethritis associated with reactive arthritis will often recur.