Urethritis

Definition
Urethritis is an inflammation (irritation with presence of extra immune cells) of the urethra.

Causes, incidence, and risk factors

Urethritis may be caused by the same organisms that cause urinary tract infections (E. coli or klebsiella) and by some sexually transmitted diseases (chlamydia, gonorrhea, and Ureaplasma urealyticum infections).

Viral causes of urethritis include herpes simplex virus and cytomegalovirus. Urethritis may also develop because of a chemical irritatant, such as spermacide in condoms or contraceptive jelly, cream, or foam. Trauma may also cause urethritis.

Men between the ages of 20 and 35, those with multiple sexual partners, and those who engage in high-risk sexual behavior (such anal sex without a condom) are at higher risk.

Young women in their reproductive years are also at risk. In women, common bacterial causes include gonorrhea, chlamydia, mycoplasma hominis, ureaplasma urealyticum, and mycoplasma genitalum. Risk factors include youth (younger than 20), multiple partners, and a prior history of STDs (sexually transmitted diseases).

Symptoms
In men:

     
  • Dysuria (burning pain with urination)  
  • Increased urinary frequency or urgency  
  • Itching, tenderness, or swelling in penis or groin area  
  • Fever (rare)  
  • Discharge from penis (usually moderate, yellow or clear, possibly purulent)  
  • Pain with intercourse or ejaculation  
  • Blood in the urine or semen

In women:

     
  • Dysuria  
  • Increased urinary frequency or urgency  
  • Fever and chills  
  • nausea and vomiting  
  • Abdominal pain  
  • Vaginal discharge  
  • PID (pelvic inflammatory disease)  
  • Other infections of reproductive organs (cervicitis, salpingitis)  
  • Fertility problems  
  • Pelvic pain  
  • Ectopic pregnancy  
  • Complications of pregnancy (miscarriage, preterm delivery, premature rupture of membranes, fetal infection, postpartum infection)

Signs and tests

A thorough physical examination of genitourinary tract needs to be performed.

For men, this includes abdomen, flank, suprapubic (bladder) area, penile, scrotal and digital rectal exams. These exams may reveal tender and enlarged inguinal Lymph nodes (groin area), discharge from the penis, or a tender and swollen penis.

Tests and findings:

     
  • Triple-void urine specimens for urinalysis and culture       o #1 initial stream       o #2 mid-stream       o #3 post (after) prostatic massage by examiner  
  • Increased WBCs (inflammatory cells) and bacterial growth on culture in urine #1.  
  • Blood may be noted in urine #1.  
  • Cultures are obtained for gonorrhea and chlamydia.

For women, evaluation includes thorough abdominal and pelvic exams, evaluation for lower abdominal tenderness, uterine and adnexal tenderness, and purulent (pus)discharge from the urethra or cervix. Microscopic examination of the discharge may also aid in the diagnosis.

Laboratory tests include:

     
  • Pregnancy test  
  • Urine analysis and culture  
  • CBC (complete blood count), C-reactive protein  
  • STD-specific cultures and blood tests  
  • Pelvic ultrasound

Treatment

The goal of therapy is to improve symptoms, prevent spread of infection to other genitourinary tract organs, and eliminate the cause of infection. Antibiotic therapy should be tailored to specific organism causing the infection - the patient may or may not need intravenous antibiotics.

Abstinence from intercourse or use of condoms should be recommended throughout the course of treatment. If an infectious organism is the cause of the inflammation, sex partners of the affected person must also be treated.

Urethritis caused by trauma or chemical irritants is treated by avoiding the source of injury or irritation.

Analgesics (pain relievers) and urinary tract-specific analgesics (such as pyridium) may be used along with antibiotics.

Expectations (prognosis)

With appropriate diagnosis and treatment, urethritis usually clears up without any complications. However, urethritis can lead to permanent damage to the urethra and other genitourinary organs in both men and women.

Complications

Urethritis may lead to cystitis (bladder infection), pyelonephritis (kidney infection), epididymitis (epididymis infection), orchitis (testes infection), or prostatitis (prostate infection) in men.

In women, urethritis may cause PID (pelvic inflammatory disease), cervicitis (infection of the cervix), salpingitis (infection of the ovaries), and fertility problems, as well as ectopic pregnancy, miscarriage, and other complications of pregnancy.

Calling your health care provider

Call your health care provider if symptoms suggesting urethritis occur, particularly if you have recently engaged in high-risk sexual behavior.

Prevention

Some causes of urethritis may be avoided with good personal hygiene and by practicing safer sexual behaviors such as monogamy and the use of condoms.

Johns Hopkins patient information

Last revised: December 3, 2012
by Martin A. Harms, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.