Urethritis – Types, Symptoms, Treatment and Prevention

Definition

Urethritis is a disease characterized by the swelling or inflammation of the urethra, the tube through which urine travels from the urinary bladder to outside of the body. People with this condition experience acute pain while urinating. One of the most common causes of urethritis is a bacterial infection caused by E.coli, Gonococcus (which also causes gonorrhea) and Chlamydia trachomatis (responsible for chlamydia). The viruses HSV-1 and HSV-2 may also be responsible.

The microorganisms that cause urethritis are often transmitted from one individual to another during sexual intercourse. However, the most common cause is a lack of hygiene near the genitals which causes parasites to enter the urethra. This may lead to more severe infections such as Pelvic Inflammatory Disease (PID) in women and Epididymitis men. When left untreated, these conditions lead to infertility.

Pathophysiology

The different identified organisms are known to be transmitted by sexual intercourse. Vaginal and genito-rectal sexual activities carry the risk of transmitting these organisms, but genito-rectal sexual intercourse carries a higher risk.

Chlamydia is unique because they are obligate intracellular organisms similar to mycoplasma. Because of this, they can be shielded from our immune system. Regardless of the causative organism, an inflammatory response is thought to play the most important role in causing the typical semiology of urethritis.

Because this condition is infectious in etiology, it is commonly found as part of other infectious syndromes, such as epididymitis, orchitis, prostatitis, or urinary tract infections. Patients with untreated urethritis might develop ascending urinary tract infection and bacteremia. This can lead to the development of pneumonia.

Anatomy of Urethra

Types

Doctors have historically classified sexually transmitted (infectious) urethritis into two categories: gonococcal urethritis, caused by gonorrhea bacteria, and nongonococcal urethritis, caused by bacteria other than gonorrhea.

Gonococcal urethritis, commonly called clap, is caused by Neisseria gonorrhoeae bacteria. Gonorrhea infections are passed from person to person during sexual activity (vaginal, oral and anal intercourse).

Nongonococcal urethritis is caused by all sexually transmitted bacteria other than N. gonorrhea. The most frequent cause is Chlamydia trachomatis bacteria, which cause the sexually transmitted infection Chlamydia. Nongonococcal urethritis is the one of the commonest forms of sexually transmitted infection. In addition to C. trachomatis, other possible infectious causes of nongonococcal urethritis include Ureaplasma urealyticum, Mycoplasma genitalium and Trichomonas vaginalis.

Not all urethritis is caused by an infection or trauma. Reactive arthritis (formerly known as Reiter’s syndrome) is an inflammatory disorder that usually has three features:

• Painful and swollen joints, one or many
• Conjunctivitis
• Sterile urethritis

Urethritis risk factors

It is more common in women. Other factors that may increase your chance include:

• Being sexually active
• Use of spermicides
• Recent change in sexual partners
• Unprotected sex (without use of a condom)
• History of other STDs
• Having catheters or tubes placed in the bladder
• Medications that lower resistance to bacterial infection

Causes

It’s thought that around 20% of urethritis cases are caused by gonorrhoea. This is known as gonococcal urethritis. If it’s caused by some other form of infection, this is known as non-gonococcal urethritis. The condition can also occur if your urethra is injured, or becomes irritated for some reason.

Common causes include:

• Other STIs, such as chlamydia or herpes
• A parasitic infection, such as trichomonas vaginalis, which is passed on through unprotected vaginal sex
• A urinary tract infection (UTI), often caused by kidney stones, a full bladder, using a catheter, or a weak immune system. Pregnancy also increases your likelihood of developing a UTI.
• A virus
• An injury caused during sex or masturbation
• Squeezing the urethra
• Damage caused when taking out or putting in a catheter
• Bathroom products or deodorants
• In women, wiping your bottom from back to front

In some cases, no obvious cause can be found. In this case, your doctor will diagnose you with non-specific urethritis (NSU).

Symptoms of Urethritis

The primary symptoms are urethral inflammation and painful urination. In addition, symptoms include:

• Frequent or urgent need to urinate
• Difficulty starting urination
• Itching, pain or discomfort when not urinating
• Pain during sex
• Vaginal or urethral discharge
• Abdominal and pelvic pain
• Fever and chills

Complications

Complications of untreated urethritis can be serious, even life threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications include:

• Chronic pelvic pain
• Epididymitis
• Infertility
• Pelvic inflammatory disease (PID, an infection of a woman’s reproductive organs)
• Perinatal transmission of infection to newborn
• Proctitis
• Prostatitis (inflammation and infection of the prostate)
• Reiter syndrome (joint and ocular inflammation)
• Spread of infection (endocarditis, meningitis, sepsis)
• Urethral scarring and narrowing

Diagnosis and test

Your healthcare provider will examine you and ask about your symptoms and health history. You may also have one or more of the following tests:

• Urine test to take samples of urine and have them checked for problems.
• Blood test to take a sample of blood and have it checked for problems.
• Vaginal culture to take a sample of vaginal discharge to have it tested for problems. A cotton swab is inserted into the vagina.
• Cystoscopy to allow the healthcare provider to look for problems in the urinary tract. The test uses a thin, flexible telescope called a cystoscope with a light and camera attached. The scope is inserted into the urethra.
• Ultrasound to allow the healthcare provider to see a detailed image of the inside of your pelvis. It will not show whether you have urethritis, but it may show other signs of sexually transmitted diseases that can also cause urethritis. Ultrasound will not show whether you have urethritis, but it may show other signs of sexually transmitted diseases that can also cause urethritis.
• Nucleic acid test (NAT) to detect the presence of a virus or bacteria. It may be done instead of a culture because it allows for a faster diagnosis.

Treatment and medications

The goal of the treatment is to eliminate the cause of infection, prevent the spread of infection and improve your symptoms. There are different treatment options depending on the cause and severity of infection. Pain relievers may also be used in conjunction with other medications to lessen painful symptoms of urethritis.

People with urethritis who are being treated should avoid sex or use condoms during intercourse. If an infection is the cause of the inflammation, your sexual partner must also be treated.

Treating urethritis caused by bacteria

Antibiotics can successfully cure urethritis caused by bacteria. Many different antibiotics can treat urethritis, but some of the most commonly prescribed include:

• Doxycycline (Adoxa, Monodox, Oracea, Vibramycin)
• Ceftriaxone (Rocephin)
• Azithromycin (Zithromax, Zmax)

Urethritis due to trichomonas infection (called trichomoniasis) is usually treated with an antibiotic called Flagyl (metronidazole). Tindamax (tinidazole) is another antibiotic that can treat trichomoniasis. Urethritis that does not clear up after antibiotic treatment and lasts for at least six weeks is called chronic urethritis. Different antibiotics may be used to treat this problem.

Treating urethritis caused by a virus

It due to the herpes simplex virus can be treated with a number of medications, including:

• Famciclovir (Famvir)
• Valacyclovir (Valtrex)
• Acyclovir (Zovirax)

Urethritis prevention

It can sometimes result from unprotected sex. In such a situation, you should try to do sexual intercourse safely. Apart from this, you must follow the points mentioned below for prevention of urethritis.

• Use a condom when making a physical connection
• Avoid having sex with more than one person.
• If you have been a victim of sexually transmitted disease, do not hide from anyone. Contact a doctor as soon as possible.
• Drink more water. After sex, clean the vagina, penis with water. Please urinate.