What is Urethritis and what causes inflammation of the urethra?

Urethritis (уретрит, إلتهاب الإحليل البولي) is a medical term used to describe a condition in which the urethra or the fibromuscular tube that carries urine from the bladder to outside the body is inflamed or irritated due to bacterial or viral infection. In males the urethra conducts semen from the ejaculatory ducts to outside the body through the urinary meatus (the external urethral orifice).

Treatment for urethritis typically includes a course of antibiotics or antivirals.

The main symptom of urethritis is dysuria (painful urination), patients usually experience pain when urinating with an increased urge to urinate.

Is urethritis a sexually transmitted disease?

Men commonly have urethritis due to an STD such as an infection with chlamydia or gonorrhea. However, urethritis in a woman is often due to a yeast infection or other condition unrelated to sexually transmitted infections because anatomically women are more prone to developing urinary tract infections than men.

In 2004, 46,000 cases of NSU were reported in the UK alone.

Types of urethritis

What are the types of urethritis?

Etiological classification of urethritis:

Depending on the cause of inflammation, there are two types of urethritis:

1. Gonococcal urethritis (GU)
2. Nongonococcal urethritis (NGU, Non-specific urethritis, NSU)

What is acute gonococcal urethritis?

Gonococcal urethritis (GU) is an infection of the urethra caused by Neisseria gonorrhoeae or gonococcus (the clap) that causes gonorrhea, a bacterial sexually transmitted infection (STI). It accounts for approximately 20% of all cases of urethritis.

The bacteria are usually found in penile discharge, and vaginal fluid.

What is a NSU infection and how do you get NSU??

Nongonococcal urethritis (NGU, Non-specific urethritis, NSU) is an infection of the urethra that is usually caused by Chlamydia trachomatis bacteria that causes Chlamydia infection, which is one of the most common sexually transmitted infections (STIs). Other causes of NSU include: Adenoviridae, an adenovirus that usually causes a localized infection. Less commonly, urethritis can also be caused by other sexually transmitted infections or external genital injuries such as frequent or traumatic sexual intercourse and intimate partner violence.

If chlamydia is present, the bacteria can be found in the urethra, cervix, vagina, and rectum of an infected individual.

The term NGU or non-gonococcal urethritis is used when the condition isn’t caused by gonorrhoea.

Symptoms

What are the symptoms of urethritis?

The most common symptoms of urethritis are: dysuria or painful urination, painful ejaculation, burning urination, penile discharge, itching or burning near the opening of the penis, hematuria or presence of blood in the urine, hematospermia or presence of blood in the semen, difficulty starting urination, low grade fever, and urinary frequency.

What are the symptoms of NSU in males?

Symptoms of NSU in males include:

1. A white or cloudy penile discharge from the tip of the penis in the morning
2. Dysuria or a burning sensation when passing urine.
3. Urinary frequency
4. Itching or irritation on the tip of the penis.

Symptoms of NSU in males can be very mild and may be overlooked. However, if left untreated, NSU can lead to serious health problems such as: infertility, pelvic inflammatory disease (PID), arthritis, etc., especially if it’s caused by chlamydia. In most cases, NSU can be easily treated with antibiotics.

What are the symptoms of NSU in females?

Symptoms of NSU in females include:

1. Vaginal discharge
2. Dysuria or a burning sensation when urinating
3. Abdominal pain
4. Abnormal vaginal bleeding, which may be an indication that the infection has progressed to PID (pelvic inflammatory disease)

What are the symptoms of urethritis in males?

The main symptom of urethritis is dysuria. In addition to pain, urethritis symptoms include: frequent or urgent urination, . difficulty starting urination, etc.

Males with urethritis may experience one or more of the symptoms listed below:

1. Painful Urination or a burning sensation during urination
2. Hesitancy and difficulty starting urination
3. Weak stream of urine
4. After-dribble (post-micturition dribbling or post-void dribbling), dribbling at end of urination
5. Low grade fever
6. Frequent or urgent urination
7. Irritation and itching near the opening of the penis
8. Hematuria or presence of blood in the urine
9. Haematospermia or presence of blood in the semen
10. Penile discharge (discharge from the penis).
11. Burning itch inside the tip of the penis (glans penis)
12. Itching or burning near the opening of the penis or on the tip of the penis

Symptoms in women

What are the symptoms of urethritis in women?

Some symptoms of urethritis in women include:

1. Frequent urge to urinate but little comes out
2. Discomfort during urination
3. Burning or irritation at the urethral opening
4. Pelvic and abdominal pain
5. Yellowish urethral discharge
6. Abnormal vaginal discharge may also be present along with the urinary symptoms
7. Stomach ache
8. Dyspareunia or pain with intercourse
9. Frequent or urgent urination
10. Low grade fever and chills
11. Itchy urethra, just inside the tip

Do urinary tract infections cause itching?

Yeast infections (candidiasis or thrush) may cause penile itching, or itching in the genital region (genital pruritus or genital itching), which is often coupled with discharge or a foul smell. However, a yeast infection can be unbearable if the clinical manifestations are coupled with the symptoms of a urinary tract infection.

Causes

What are the causes of urethritis?

In most cases, urethritis is caused by bacterial or viral infections.

Bacteria that commonly cause urethritis include:

1. E. coli, salmonella, shigella, campylobacter, yersenia, and other bacteria present in stool
2. Neisseria gonorrhoeae or Gonococcus, which is sexually transmitted and causes gonorrhea
3. Chlamydia trachomatis, which is sexually transmitted and causes chlamydia
4. Mycoplasma genitalium, which is a type of bacteria that can cause an STD
5. Ureaplasma urealyticum, which is sexually transmitted and causes Ureaplasma Infection
6. G. vaginalis (Gardnerella vaginalis or Haemophilus vaginalis), which is sexually transmitted and causes Gardnerella vaginalis infection.

Viruses that commonly cause urethritis include:

1. Herpes simplex virus
2. Adenovirus
3. Cytomegalovirus

Fungi that commonly cause urethritis include:

1. Candida albicans, which is a type of yeast that can cause Yeast infection (vaginal candidiasis).

It is possible for irritation unrelated to sexually transmitted infections to occur. These causes can include:

External genital injuries such as from a sexual assault, frequent or traumatic sexual intercourse and intimate partner violence (interpersonal violence), or other kinds of genital trauma, such as from a catheter, or sports-related genital trauma may also cause urethral irritation.

Irresponsible use of antibiotics, prolonged treatment with antibiotics can eliminate the healthy intestinal flora or the beneficial bacteria in your intestines, which can cause an overgrowth of E. Coli in the vagina, increasing the risk of urethritis.

In women, urethritis can have more than one root cause.

What are the causes of NGU?

The most common cause of NGU is Chlamydia trachomatis, but it can also be caused by Ureaplasma urealyticum, G. vaginalis, Mycoplasma genitalium, Salmonella, E.coli, Adenovirus, Herpes simplex virus, Candida albicans, and Cytomegalovirus.

Diagnosis

How to diagnose urethritis?

Tests for urethritis can include:

1. A general health check-up
2. A general sexual health check-up
3. Physical examination of the genitalia
4. Abdominal examination
5. Digital rectal examination (if indicated)

Laboratory tests are commonly used for the rapid identification of the causative agent(s). Lab tests may help in identifying microorganisms responsible for disease emergence are and used in confirming a clinical diagnosis of urethritis.

All patients with suspected urethritis should be tested for Neisseria gonorrhoeae and Chlamydia trachomatis.

What is a full STD test?

A full STD panel is an essential (urine and blood) test that you can do to know if you carry a sexually transmitted disease. This standard STD panel tests for gonorrhea, chlamydia, syphilis, herpes, hepatitis A, hepatitis B, hepatitis C, and HIV.

How to get a full std test?

1. Come to the lab on an empty stomach
2. Provide a morning urine sample, about 30 ml, from the initial stream
3. Provide a blood sample
4. Getting your test results

What is a swab test used for?

A swab test is a painless technique, in which a swab is used to obtain a sample of fluid from your urethra. It tests for the presence of bacterial vaginosis, candidiasis, and trichomonas vaginalis.

Treatment

How to treat urethritis and What are the treatment options for urethritis?

Treatment for urethritis typically includes a course of antibiotics or antivirals.

What antibiotics are used for urethritis?

Bacterial STDs can be cured with one of the following antibiotics:

1. Azithromycin (Zithromax) is an antibiotic useful for the treatment of gonorrhea, syphilis, ureaplasma urealyticum and chlamydia. The recommended dose of azithromycin for patients with urethritis is: 1g Single Dose.
2. Doxycycline (Dory, Bio-Tab) is an oral antibiotic used for the treatment of urinary tract infections, and sexually transmitted diseases such as chlamydia and gonorrhea. The recommended dose of doxycycline for patients with urethritis is: 500 mg orally twice a day for seven days
3. Erythromycin (E-Mycin, Eryc, Ery-Tab) is an antibiotic that can be administered orally, it is useful for the treatment of chlamydia infections and gonorrhea. The recommended dose of erythromycin for patients with urethritis is: 500 mg orally four times a day for seven days.
4. Ofloxacin is an oral antibiotic that is used for the treatment of UTI and prostate infections, STDs, and E. Coli infections. The recommended dose of ofloxacin for patients with urethritis is: 300, or 400 mg orally twice a day for 7 days.
5. Levofloxacin is an oral antibiotic that is typically taken once a day for seven days
6. Cefixime (Suprax) 400 mg orally
7. Ciprofloxacin 500 mg orally
8. Ceftriaxone (Rocephin) 250, or 125 mg intramuscularly single dose
9. Tetracycline (Sumycin)
10. Minocycline (Dynacin, Minocin)

Treatment of Pelvic Inflammatory Disease

1. Ofloxacin (Floxin) 400 mg orally twice daily for 14 days
2. Metronidazole (Flagyl) 500 mg orally twice daily for 14 days

Treatment options for Bacterial vaginosis include: Metronidazole (Flagyl) 500 mg orally twice a day for 7 days or 2 g orally in a single dose.

Treatment options for Trichomoniasis include: Metronidazole (Flagyl) 2 g orally in a single dose.

Vaginal thrush (vulvovaginal candidiasis) is a yeast infection, it can be treated with systemic oral azoles (fluconazole, itraconazole, or posaconazole). We suggest you treat thrush with: Fluconazole (Diflucan) 150-mg tablet taken orally in a single dose, or Canesten 500mg Pessary inserted into the vagina at night. Women suffering from intimate dryness may prefer using Canesten Thrush Internal Cream, which is an effective single dose treatment for vaginal thrush.[1][2]

Single-dose therapy with 150 mg of oral fluconazole is a recommended treatment for vulvovaginal candidiasis.

Treatment of Human Papillomavirus Infection

Topical treatments for External genital area: Imiquimod (Aldara) 5% cream (patient-applied) Daily at bedtime three times weekly for up to 16 weeks

Cryotherapy Physician-applied Repeat every 1 to 2 weeks

Treatment for Vaginal area, Anal area, Oral area, and Urethral meatus: Cryotherapy With liquid nitrogen Repeat every 1 to 2 weeks.

STIs (Sexually transmitted infections) can cause serious health problems if left untreated. If you have an STD, it’s vital to avoid having any sexual activity while undergoing treatment, and your sexual partner(s) should undergo testing and treatment if necessary to prevent the transmission of STIs.

Prevention

How can I prevent urethritis?

Most episodes of urethritis are caused by pathogenic microorganisms, such as bacteria, viruses, parasites, or fungi that spread from person to person through sexual contact. Because of this, it is important to practice safe sex to prevent sexually transmitted infections. Here are some steps you can take to reduce your STD risk:

1. Avoid polyamory
2. Avoid having a lot of sexual partners
3. Use a new condom every time you have sex
4. Get tested for stds regularly
5. Protect others. If you’ve got an STI, avoid having any sexual activity while undergoing treatment and inform others who are also at risk of infection.

 

 

 

References

 

Verified by: Dr.Diab (December 19, 2023)

Citation: Dr.Diab. (December 19, 2023). What is Urethritis? Causes Symptoms and Treatment. Medcoi Journal of Medicine, 30(2). urn:medcoi:article17712.