Urethritis
What is Urethritis?
Urethritis is an inflammation of the urethra, the tube that carries urine from the bladder to the outside of the body. Urethritis can affect woman as well as men. Usually due to an infection, urethritis may be caused by a variety of organisms, including bacteria and yeasts. Almost always sexually transmitted, urethritis is considered the most common sexually transmitted syndrome among men in the US.
The most common form of urethritis, gonococcal urethritis, is caused by the bacterium that causes gonorrhea.
Approximately one million cases of gonococcal urethritis are diagnosed each year. When caused by an identifiable organism other than gonorrhea, the condition is known as non-gonococcal urethritis. In men between the ages of 15 and 40, Chlamydia (another sexually transmitted microorganism) accounts for 40% to 50% of the cases, while mycoplasma bacteria account for another 20% to 25%.
Urethritis can also be caused by the same organisms that cause bladder or kidney infections, such as E. coli. Bacteria from the skin or rectum sometimes spread to infect the urethra. In men over 50, urethritis is often associated with an inflammation of the prostate gland (prostatitis). In approximately one third of the cases of urethritis, the infective agent is either unknown or unidentifiable. When this happens, it is known as nonspecific urethritis.
Although usually caused by an infection, urethritis can also be caused by other factors such as trauma from an accident, or following procedures such as insertion of a catheter or a cystoscopy (viewing tube inserted up the urethra for the purpose of examining the inside of the urethra and bladder). Inflammation of the urethra may also be the result of a chemical irritant or allergic reaction to an antiseptic or spermaticidal (birth control) preparation.
How is it diagnosed?
Signs and symptoms of Urethritis
Most people with urethritis experience some symptoms, although some people may not experience any. The following symptoms may indicate urethritis:
- Intense or frequent urges to urinate, even if there is little urine to pass
- Pain or a burning sensation during urination (dysuria)
- Dark, cloudy, bloody or abnormal-smelling urine
- Pain in the abdomen, pelvic area or lower back
- Fever and/or chills
- Fatigue
- Nausea and vomiting
Symptoms in women are often indistinguishable from a mild bladder infection (cystitis), including painful urination, but without blood in the urine (hematuria).
However, asymptomatic infections are possible in men and women.
Physical exam of the male may reveal a urethral discharge. Women rarely exhibit any urethral discharge.
Tests: A thin urogenital swab is inserted into the urethra to obtain a specimen. The swab is rolled over a glass slide, and the specimen is then Gram stained.
In a male, evidence of typical Gram-negative diplococci is sufficient to diagnose gonorrhea, whereas their absence allows for a diagnosis of non-gonococcal urethritis.
Even if the organism is identified on the Gram stain, culture for gonococcus is still indicated so that antibiotic susceptibility testing can be performed.
Gram stain smears are less often positive in the female, so gonorrhea must be cultured from the urethra and/or cervix.
Cultures, direct antigen tests, genetic probes, or an automated polymerase chain reaction are used to identify or rule out other infectious agents, such as Chlamydia.
How is Urethritis treated?
Urinary tract infections (urethritis) are typically treated with antibiotics, which kill the bacteria causing the infection. Treatment may vary in duration (e.g., three to 10 days) and type of antibiotic prescribed, depending on the patient’s medical history, severity of the infection, and type of bacteria involved.
In addition to taking the prescribed medication, patients may be advised to increase daily fluid intake to help flush any remaining bacteria from the urinary tract. However, some physicians believe this may dilute the medication, making it less effective. No available research has explored this issue.
Patients with urethritis who use a urinary catheter should receive a new catheter and drainage tube prior to beginning antibiotic treatment. Failing to do so puts the patient at risk for reinfection after they have completed their course of antibiotics because bacteria may congregate and grow on the internal surface of the catheter and tubing.
In severe cases, where infection has spread to the kidneys, patients may be hospitalized to receive antibiotic medications intravenously. These patients may need to have their condition monitored by hospital staff to ensure infection does not spread to the bloodstream.
Medications
Noroxin (Norfloxacin), Premarin (Conjugated Estrogens)
What might complicate it?
Complications of gonococcal urethritis in men include inflammation in the epididymis and testes (acute epididymoorchitis), inflammation of the lymph vessels in the penis (penile lymphangitis), prostatitis (inflammation of the prostate gland (prostatitis), and inflammatory urethral stricture (narrowing of a section of the urethra caused by scarring).
Untreated gonococcal or chlamydial urethritis in women is thought to cause ascending genitourinary infections, which may result in pelvic inflammatory disease, infertility, ectopic pregnancy, and chronic pelvic pain. Urethritis may also be complicated by strains of infectious agents that are resistant to antibiotics.
Predicted outcome
With prompt, accurate diagnosis and treatment, urethritis usually clears up without any complications.
Alternatives
Conditions with similar symptoms include urinary tract infections, prostatitis, urethral stricture, Reiter's syndrome, cervicitis, or Stevens-Johnson syndrome.
Appropriate specialists
Urologist.
Notify your physician if
- You or a family member has symptoms of urethritis.
- Any of the following occur during treatment:
- Oral temperature of 101°F (38.3° C) or higher.
- Bleeding from the urethra or blood in urine.
- No improvement in 1 week, despite treatment.
Last updated 7 July 2015