Urethritis

Urethral syndrome; NGU; Non-gonococcal urethritis

Both bacteria and viruses may cause urethritis. 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.

Other causes include:

• Injury
• Sensitivity to the chemicals used in spermicides or contraceptive jellies, creams, or foams

Risks for urethritis include:

• Being a female in the reproductive years
• Being male, ages 20 to 35
• Having many sexual partners
• High-risk sexual behavior (such as anal sex without a condom)
• History of sexually transmitted diseases

In men:

• Blood in the urine or semen
• Burning pain while urinating (dysuria)
• Discharge from penis
• Fever (rare)
• Frequent or urgent urination
• Itching, tenderness, or swelling in penis
• Enlarged lymph nodes in the groin area
• Pain with intercourse or ejaculation

In women:

• Abdominal pain
• Burning pain while urinating
• Fever and chills
• Frequent or urgent urination
• Pelvic pain
• Pain with intercourse
• Vaginal discharge

The health care provider will examine you. In men, the exam will include the abdomen, bladder area, penis, and scrotum. The physical exam may show:

• Discharge from the penis
• Tender and enlarged lymph nodes in the groin area
• Tender and swollen penis

A digital rectal exam will also be performed.

Women will have abdominal and pelvic exams. The health care provider will check for:

• Discharge from the urethra
• Tenderness of the lower abdomen
• Tenderness of the urethra

Your health care provider may look into your bladder using a tube with a camera on the end. This is called cystoscopy.

The following tests may be done:

• Complete blood count (CBC)
• C-reactive protein test
• Pelvic ultrasound (women only)
• Pregnancy test (women only)
• Urinalysis and urine cultures
• Tests for gonorrhea, chlamydia, and other sexually transmitted illnesses (STI)
• Urethral swab

The goals of treatment are to:

• Get rid of the cause of infection
• Improve symptoms
• Prevent the spread of infection

If you have a bacterial infection, you will be given antibiotics.

You may take pain relievers, including NSAIDs (such as ibuprofen) or phenazopyridine (Pyridium), which work on the urinary tract, along with antibiotics.

People with urethritis who are being treated should avoid sex, or use condoms during sex. Your sexual partner must also be treated if the condition is caused by an infection.

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

Urethritis that does not clear up after antibiotic treatment and lasts for at least 6 weeks is called chronic urethritis. Different antibiotics may be used to treat this problem.

With the correct diagnosis and treatment, urethritis most often clears up without further problems.

However, urethritis can lead to long term damage to the urethra and scar tissue called urethral stricture. It can also cause damage to other urinary organs in both men and women. In women, if the infection could lead to fertility problems if it spreads to the pelvis.

Men with urethritis are at risk for the following:

• Bladder infection (cystitis)
• Epididymitis
• Infection in the testicles (orchitis)
• Prostate infection (prostatitis)

After a severe infection, the urethra may become scarred and then narrowed.

Women with urethritis are at risk for the following:

• Bladder infection (cystitis)
• Cervicitis
• Pelvic inflammatory disease (PID -- an infection of the uterus lining, fallopian tubes, or ovaries)

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

Things you can do to help avoid urethritis include:

• Keep the area around the opening of the urethra clean.
• Follow safer sex practices, including having one sexual partner only (monogamy) and using condoms.