Urethritis

Urethra Inflammation, Gonococcal urethritis

What is Urethritis?

Urethritis is an inflammation of the urethra, the tube that carries urine from the bladder to the outside of the body. Urethritis can affect woman as well as men. Usually due to an infection, urethritis may be caused by a variety of organisms, including bacteria and yeasts. Almost always sexually transmitted, urethritis is considered the most common sexually transmitted syndrome among men in the US.

The most common form of urethritis, gonococcal urethritis, is caused by the bacterium that causes gonorrhea. Approximately one million cases of gonococcal urethritis are diagnosed each year. When caused by an identifiable organism other than gonorrhea, the condition is known as non-gonococcal urethritis. In men between the ages of 15 and 40, Chlamydia (another sexually transmitted microorganism) accounts for 40% to 50% of the cases, while mycoplasma bacteria account for another 20% to 25%.

Urethritis can also be caused by the same organisms that cause bladder or kidney infections, such as E. coli. Bacteria from the skin or rectum sometimes spread to infect the urethra. In men over 50, urethritis is often associated with an inflammation of the prostate gland (prostatitis). In approximately one third of the cases of urethritis, the infective agent is either unknown or unidentifiable. When this happens, it is known as nonspecific urethritis.

Although usually caused by an infection, urethritis can also be caused by other factors such as trauma from an accident, or following procedures such as insertion of a catheter or a cystoscopy (viewing tube inserted up the urethra for the purpose of examining the inside of the urethra and bladder). Inflammation of the urethra may also be the result of a chemical irritant or allergic reaction to an antiseptic or spermaticidal (birth control) preparation.

How is it diagnosed?

Signs and symptoms of Urethritis

Most men with urethritis complain of a painful, burning sensation with urination. The pain can be severe and is sometimes likened to passing small fragments of broken glass. Pain may also be present with intercourse and ejaculation. Urine or semen may be blood-stained. When caused by a bacterial infection, particularly gonorrhea, there is often a yellow, pus-filled discharge from the penis.

Symptoms in women are often indistinguishable from a mild bladder infection (cystitis), including painful urination, but without blood in the urine (hematuria).

However, asymptomatic infections are possible in men and women.

Physical exam of the male may reveal a urethral discharge. Women rarely exhibit any urethral discharge.

Tests: A thin urogenital swab is inserted into the urethra to obtain a specimen. The swab is rolled over a glass slide, and the specimen is then Gram stained. In a male, evidence of typical Gram-negative diplococci is sufficient to diagnose gonorrhea, whereas their absence allows for a diagnosis of non-gonococcal urethritis. Even if the organism is identified on the Gram stain, culture for gonococcus is still indicated so that antibiotic susceptibility testing can be performed. Gram stain smears are less often positive in the female, so gonorrhea must be cultured from the urethra and/or cervix. Cultures, direct antigen tests, genetic probes, or an automated polymerase chain reaction are used to identify or rule out other infectious agents, such as Chlamydia.

How is Urethritis treated?

Urethritis caused by gonorrhea and other bacterial infections are usually successfully treated by antibiotic therapy. Since chlamydia often occurs at the same time as a gonococcal infection (dual infection), effective treatment may also include an effective anti-chlamydial regimen as well. Because antibiotic-resistant forms of certain infections (penicillin-resistant and tetracycline-resistant) are on the increase, it is necessary that an antibiotic susceptibility test be performed at the same time the infective agent is cultured.

Since most urethritis is sexually transmitted, abstinence from sexual intercourse or use of condoms is recommended throughout the course of treatment. It is imperative that sexual partners are also evaluated and treated. Antibiotic therapy may also be needed if a bacterial infection follows a urethritis that is due to a noninfectious cause.

Medications

Information Brand Generic Label Rating
Amoxil Amoxil Amoxicillin Off-Label
Minocycline treatment Minocin Minocycline Off-Label
Levaquin price Levaquin Levofloxacin On-Label
Zithromax Zithromax Azithromycin On-Label
Noroxin Norfloxacin
Premarin Conjugated Estrogens

What might complicate it?

Complications of gonococcal urethritis in men include inflammation in the epididymis and testes (acute epididymoorchitis), inflammation of the lymph vessels in the penis (penile lymphangitis), prostatitis (inflammation of the prostate gland (prostatitis), and inflammatory urethral stricture (narrowing of a section of the urethra caused by scarring).

Untreated gonococcal or chlamydial urethritis in women is thought to cause ascending genitourinary infections, which may result in pelvic inflammatory disease, infertility, ectopic pregnancy, and chronic pelvic pain. Urethritis may also be complicated by strains of infectious agents that are resistant to antibiotics.

Predicted outcome

With prompt, accurate diagnosis and treatment, urethritis usually clears up without any complications.

Alternatives

Conditions with similar symptoms include urinary tract infections, prostatitis, urethral stricture, Reiter's syndrome, cervicitis, or Stevens-Johnson syndrome.

Appropriate specialists

Urologist.

Notify your physician if

  • You or a family member has symptoms of urethritis.
  • Any of the following occur during treatment:
    • Oral temperature of 101°F (38.3° C) or higher.
    • Bleeding from the urethra or blood in urine.
    • No improvement in 1 week, despite treatment.

Last updated 15 December 2011


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