Urethritis

Definition

Urethritis is inflammation of the urethra from any cause.

Causes, incidence, and risk factors

Urethritis may be caused by bacteria or a virus. The same bacteria that cause urinary tract infections (E. coli) and some sexually transmitted diseases (chlamydia, gonorrhea) can lead to urethritis. Viral causes of urethritis include herpes simplex virus and cytomegalovirus.

People who are sensitive to the chemicals used in spermicides or contraceptive jellies, creams, or foams may develop urethritis.

Injury 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) have the highest risk for urethritis. Young women in their reproductive years are also at risk. A prior history of sexually transmitted diseases raises one's risk of urethritis.

Symptoms

In men:

• Burning pain while urinating (dysuria)
• 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:

• Burning pain while urinating
• 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

The health care provider will perform a physical examination. For men, the areas to be examined include the abdomen, bladder area, penis, and scrotum. A digital rectal exam will also be performed. The physical exam may reveal tender and enlarged lymph nodes in the groin area, discharge from the penis, or a tender and swollen penis.

For women, areas to be examined include the abdominal and pelvic exams. The health care provider will check for lower abdominal tenderness, uterine tenderness, and discharge from the urethra.

The following laboratory tests may be done:

• Urinalysis and urine cultures
• Tests for  gonorrhea and chlamydia and other sexually-transmitted diseases
• Pregnancy test (women only)
• CBC (complete blood count)
• C-reactive protein test
• Pelvic ultrasound (women only)

Treatment

The goal of therapy is to improve symptoms, prevent spread of infection, and eliminate the cause of infection. Antibiotic therapy should target the specific organism causing the infection. In some cases, antibiotics may need to be given by IV. Pain relievers (including pyridium, which works specifically on the urinary tract) may be used along with antibiotics.

Persons with urethritis who are being treated should avoid sex or use condoms during sex. If an infectious organism is the cause of the inflammation, the patient's sexual partner must also be treated.

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

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

Men with urethritis are at risk for the following complications:

• Cystitis (bladder infection)
• Pyelonephritis (kidney infection)
• Epididymitis
• Orchitis (testes infection)
• Prostatitis (prostate infection)  
• Urethral stricture (narrowing of the urine channel in the penis)

Women with urethritis are at risk for the following complications:

• Cystitis (bladder infection)
• Pyelonephritis (kidney infection)
• PID (pelvic inflammatory disease)
• Cervicitis (infection of the cervix)
• Salpingitis (infection of the ovaries)
• Fertility problems
• Ectopic pregnancy
• Miscarriage
• Other complications of pregnancy

Calling your health care provider

Call your health care provider if you have symptoms of urethritis.

Prevention

Some causes of urethritis may be avoided with good personal hygiene and by practicing safer sexual behaviors such as monogamy (one sexual partner only) and using condoms.

References

Lyon CJ . Urethritis. Clin Fam Pract. 2005 Mar; 7(1); 31-41.

Walsh PC. Campbell's Urology. 8th ed. St. Louis, Mo: WB Sanders; 2002:673-678. 

Illustrations

Female urinary tract

Male urinary tract

Page Content:

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