Urethritis

Urethritis is the inflammation of the urethra, which can result from infectious or non-infectious causes. The urethra is a tube that connects the bladder to the outside of the body, allowing urine to be expelled. In men, the urethra also serves as a conduit for semen during ejaculation.

The condition is more commonly diagnosed in men than women, partly because women may have milder symptoms that can be confused with urinary tract infections or vaginal infections. In men, urethritis often presents with more obvious symptoms like discharge from the penis.

While urethritis can be uncomfortable and concerning, it is generally treatable with appropriate medical care. Early diagnosis and treatment are important to prevent complications and reduce the risk of transmission to sexual partners.

Urethritis symptoms can vary between men and women, and some people may have mild symptoms or no symptoms at all. The severity and type of symptoms often depend on the underlying cause.

Common Symptoms in Men

• Painful urination (dysuria) - burning or stinging sensation
• Penile discharge - clear, white, yellow, or green discharge
• Penis pain - discomfort at the tip or along the shaft
• Frequent urination - increased urge to urinate
• Urethral itching or tingling
• Blood in urine (hematuria) - pink or red-tinged urine
• Swollen or tender testicles (if infection spreads)

Common Symptoms in Women

• Painful urination - burning sensation while urinating
• Frequent urination - more frequent trips to the bathroom
• Vaginal itching - irritation around the genital area
• Unusual vaginal discharge
• Suprapubic pain - lower abdominal discomfort
• Blood in urine - visible blood or microscopic traces
• Pelvic pain or pressure

Additional Symptoms

• Retention of urine - difficulty emptying the bladder
• Sharp abdominal pain - acute pain in lower abdomen
• Fever (if infection is severe or spreads)
• General malaise or feeling unwell
• Swollen lymph nodes in the groin area

Urethritis can result from various infectious and non-infectious causes. Understanding these causes is important for proper treatment and prevention.

Infectious Causes

• Neisseria gonorrhoeae: Bacteria causing gonorrhea (gonococcal urethritis)
• Chlamydia trachomatis: Most common cause of non-gonococcal urethritis
• Mycoplasma genitalium: Emerging cause of NGU
• Ureaplasma urealyticum: Bacteria that can cause urethral inflammation
• Trichomonas vaginalis: Parasitic infection
• Herpes simplex virus (HSV): Can cause viral urethritis
• Adenovirus: Less common viral cause

Non-Infectious Causes

• Physical trauma: Catheter insertion, sexual activity, or injury
• Chemical irritants: Soaps, spermicides, douches, or personal care products
• Medications: Certain drugs can cause urethral irritation
• Autoimmune conditions: Reactive arthritis (Reiter's syndrome)
• Anatomical abnormalities: Urethral strictures or malformations

Risk Factors

• Sexual activity, especially with multiple partners
• History of sexually transmitted infections
• Unprotected sexual contact
• Age 15-35 years (peak incidence)
• Male gender (symptoms more apparent)
• Recent urological procedures
• Catheter use
• Compromised immune system
• Poor personal hygiene
• Use of irritating personal care products

Diagnosing urethritis involves a combination of clinical evaluation, laboratory tests, and sometimes imaging studies. Accurate diagnosis is crucial for appropriate treatment.

Clinical Examination

• Medical history: Sexual history, symptoms, and previous infections
• Physical examination: Inspection of genitals and palpation for tenderness
• Discharge evaluation: Examination of any urethral or vaginal discharge

Laboratory Tests

• Urinalysis: Checks for white blood cells, bacteria, and blood
• Urine culture: Identifies specific bacteria and antibiotic sensitivity
• Nucleic acid amplification tests (NAATs): Highly sensitive for chlamydia and gonorrhea
• Gram stain: Rapid test for gonorrhea in urethral discharge
• PCR testing: For specific pathogens like Mycoplasma genitalium

Specialized Tests

• First-void urine test: First portion of urine stream for testing
• Urethral swab: Direct sampling of urethral discharge
• Partner testing: Testing sexual partners for STIs
• Follow-up testing: Test of cure after treatment completion

Imaging (if complications suspected)

• Ultrasound: To check for complications or anatomical issues
• Cystoscopy: Direct visualization of urethra and bladder
• Retrograde urethrography: X-ray study of urethral anatomy

Treatment for urethritis depends on the underlying cause. Bacterial causes require antibiotic therapy, while non-infectious causes may need different approaches.

Antibiotic Treatment for Gonococcal Urethritis

• Ceftriaxone: 500mg intramuscular injection (preferred)
• Alternative antibiotics: For patients allergic to cephalosporins
• Dual therapy: Often combined with treatment for chlamydia
• Partner treatment: All recent sexual partners must be treated

Antibiotic Treatment for Non-Gonococcal Urethritis

• Azithromycin: 1g single dose or 500mg daily for 3 days
• Doxycycline: 100mg twice daily for 7 days
• Levofloxacin: 500mg daily for 7 days (alternative)
• Erythromycin: Alternative for pregnant women

Treatment for Specific Pathogens

• Mycoplasma genitalium: Azithromycin extended course or moxifloxacin
• Trichomonas: Metronidazole or tinidazole
• Viral urethritis: Antiviral medications (acyclovir for HSV)
• Persistent NGU: Longer courses or alternative antibiotics

Supportive Care

• Pain relief: NSAIDs like ibuprofen or acetaminophen
• Increased fluids: Helps flush the urinary system
• Avoid irritants: Harsh soaps, douches, or spermicides
• Sexual abstinence: Until treatment is complete and symptoms resolve

Treatment for Non-Infectious Urethritis

• Identify and eliminate irritating substances
• Anti-inflammatory medications
• Topical anesthetics for symptom relief
• Address underlying medical conditions

While urethritis is generally treatable, untreated or recurrent infections can lead to complications, particularly if caused by sexually transmitted organisms.

Complications in Men

• Epididymitis: Inflammation of the epididymis causing testicular pain and swelling
• Prostatitis: Infection of the prostate gland
• Urethral stricture: Narrowing of the urethra from scarring
• Reactive arthritis: Joint inflammation following urethritis
• Infertility: Rare but possible from untreated chlamydia or gonorrhea

Complications in Women

• Pelvic inflammatory disease (PID): Infection of reproductive organs
• Chronic pelvic pain: Ongoing pain in the pelvic region
• Infertility: From untreated chlamydia or gonorrhea
• Ectopic pregnancy: Increased risk from PID complications
• Reactive arthritis: Joint problems following infection

General Complications

• Recurrent infections: Repeated episodes of urethritis
• Antibiotic resistance: From incomplete treatment
• Transmission to partners: Spreading STIs to sexual contacts
• Chronic urethritis: Long-term inflammation