Urethritis

Urethritis is a condition in which the urethra, the tube that transports urine from the bladder to outside the body, becomes irritated and swollen. It can be caused by bacterial infections, sexually-transmitted diseases (bacterial and viral), or by physical irritation of the urethra. Urethritis occurs in both men and women.

Causes of Urethritis

The most common cause of urethritis is infection, which causes around 4 million cases in the US each year. It can be caused by the same bacterium that causes urinary tract infections (E. coli), and more than 700,000 cases are due to gonorrhea, a sexually transmitted infection (STI) caused by the Neisseria gonorrhoeae bacteria. A large number of urethritis cases can also be blamed on another common bacterial STI, chlamydia. And in rare cases, the condition can be caused by the herpes simplex virus.

Injury or trauma to the urethra can also result in urethritis. This can be caused by catheterization, diagnostic probes, or even a sensitivity to chemicals like those in spermicides and contraceptive gels or creams.

Risk Factors for Urethritis

Certain people are at increased risk for the condition, including:

  • Women of reproductive age
  • Men between 20 and 35 years (when men are most sexually active)
  • Both men and women who have multiple sexual partners
  • Both men and women who participate in risky sexual acts (such as not using a condom during anal sex)
  • Previous STIs

Symptoms of Urethritis

Some people experience multiple symptoms while others experience none at all. Symptoms largely depend on the condition's underlying cause, and present differently in men and women.

Urethritis in men may cause one or more of the following symptoms:

  • Blood in the semen or urine
  • Frequent, urgent, or painful (burning) urination
  • Discharge from the penis
  • Swelling, tenderness or itching in the groin or penis
  • Pain during ejaculation or sex
  • Fever (rare)

Symptoms of urethritis in women include:

  • Stomach pain
  • Frequent, urgent, or painful (burning) urination
  • Chills and fever
  • Pelvic pain
  • Vaginal discharge

Diagnosis of Urethritis

Before a physician can diagnose urethritis, he must conduct a physical exam and order lab tests.

In men, the physical examination will cover the bladder, abdomen, scrotum and penis, as well as a prostate exam in older men who also have rectal pain.

A physical examination in women includes an abdominal and pelvic exam, with an optional bladder exam (cystoscopy) to look for signs of a bladder infection.

The lab tests that look for signs of an infection include:

  • Blood tests to count the blood cells, check for signs of inflammation and infectious agents that either cause or occur concurrently with urethritis (including the bacteria that cause gonorrhea, chlamydia, and syphilis and the HIV and hepatitis B viruses)
  • Pelvic ultrasound (women only)
  • Urine tests to look for signs of an infection (including an increase in white blood cells, or pus or bacteria in the urine)

Treatment of Urethritis

Treatment of urethritis includes resolving the underlying cause and, if the cause is communicable, preventing the infection from spreading to others.

References

Brill JR. Diagnosis and treatment of urethritis in men. Am Fam Physician. 2010; 81:873-878.

Urethritis. (2012). A.D.A.M. Medical Encyclopedia.

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