Urethral syndrome

Alternative names
Urethritis - chronic

Definition
Chronic urethritis is an inflammation (irritation with swelling and presence of extra immune cells) of the urethra (the tube that carries urine from the body) that continues for weeks to months.

Causes, incidence, and risk factors

Chronic urethritis is usually caused either by a bacterial infection or structural problem (narrowing of the urethra). It may also be associated with a variety of systemic diseases, including emotional disorders. Urethritis may occur in either women or men.

The major symptoms of urethritis, painful urination and urinary frequency, are quite common. Among people experiencing such symptoms, 50% to 75% have either a first-time or recurrent bacterial infection of the urethra or bladder (cystitis), up to 10% are women with vaginitis, and the remainder are either men or women with urethral syndrome (symptoms present without any evidence of bacterial infection).

Organisms that cause a variety of sexually transmitted diseases are included among the group of possible causative agents. Importantly, sexually transmitted diseases such as chlamydia and gonorhea may cause urethritis.

Other common bacterial organisms that may be responsible for this condition include E. coli, a common bacteria responsible for Urinary tract infections. Common personal hygiene products, especially feminine products, can cause chronic chemical urethritis.

Symptoms

     
  • Urinary frequency/urgency (increased number of time voiding and sensation of the need to void)  
  • Urination discomfort, burning, or stinging of the urethra or lower abdomen during urination (see painful urination)  
  • Urethral discharge (if present, may stain underwear and appear either bloody or pus-like, and is often foul-smelling)

Note: Symptoms are long-standing (chronic).

Signs and tests

     
  • A urinalysis may indicate potential infection or inflammation.  
  • A urine culture (clean catch) is done to confirm infection and causative agent.  
  • Urethral discharge culture or vaginal culture specimen(s) may be obtained to rule out sexually transmitted diseases.  
  • Cystoscopy and urethroscopy may be performed to directly examine the urethra. These tests may reveal a urethral stricture (narrowing), a urethral diverticulum (out-pouching), or a mass (such as a urethral tumor).

Treatment

If evidence of infection is present, antibiotics are initiated, and a follow-up urinalysis or culture will be performed after all the medications have been taken.

Women who have repeated episodes of intercourse-related urethritis or cystitis may be prescribed a peri-coital (taken shortly before or after intercourse) dose of preventive antibiotics.

Phenazopyridine (Pyridium) may be prescribed to decrease urinary discomfort while further evaluation of the cause is conducted.

Possible chemical irritants are also discontinued to determine the causal agent.

Expectations (prognosis)

In the majority of cases, a causative agent can be identified and appropriate treatment initiated. Chronic urethritis, despite the cause, can lead to urethral strictures (narrowing) and require dilation or surgical correction.

Complications

Prolonged, untreated infection may progress to continued narrowing of the urethra, resulting in difficulty in completely emptying the bladder. Recurrent Urinary tract infectionss may also occur. Less commonly, pyelonephritis (kidney infection) or structural damage to the urinary tract system, including impairment of renal (kidney) fuction can occur.

Calling your health care provider

See your health care provider if symptoms of chronic urethritis occur.

Prevention

Maintaining a good water intake may help. Women with intercourse-related Urinary tract infections (symptoms occur within 24 hours after intercourse) should urinate after having intercourse. A small dose of antibiotics after intercourse also decreases episodes of urethritis and cystitis.

Good hygiene practices for the individual and sexual partner are important. Safer sex behaviors can decrease the risk of developing STDs (sexually transmitted diseases), which can cause urethritis.

Seeking help from an appropriate health care provider as soon as symptoms appear is important in preventing structural damage caused by scarring of the urethra.

Johns Hopkins patient information

Last revised: December 8, 2012
by Brenda A. Kuper, M.D.

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