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.

Other causes include:

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

Risks for urethritis include:

• High-risk sexual behavior (such as anal sex without a condom)
• History of sexually transmitted diseases
• Male, ages 20 - 35
• Many sexual partners
• Young women in their reproductive years

Symptoms

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 or groin area
• Pain with intercourse or ejaculation

In women:

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

Signs and tests

The health care provider will perform a physical examination. 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 uterus

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 diseases

Treatment

The goals of therapy are to:

• Improve symptoms
• Prevent the spread of infection
• Eliminate the cause of infection

Antibiotic therapy should target the bacteria causing the infection. In some cases, antibiotics may need to be given through a vein (by IV). You may take pain relievers (including pyridium, which works on the urinary tract) along with antibiotics.

People with urethritis who are being treated should avoid sex or use condoms during sex. If an infection is the cause of the inflammation, your 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 the correct diagnosis and treatment, urethritis usually clears up without any complications. However, urethritis can lead to permanent damage to the urethra (scar tissue called urethral stricture) and other urinary organs in both men and women.

Complications

Men with urethritis are at risk for the following complications:

• Cystitis
• Epididymitis
• Orchitis
• Pyelonephritis
• Prostatitis
• Urethral stricture

Women with urethritis are at risk for the following complications:

• Cervicitis
• Cystitis
• Ectopic pregnancy
• Fertility problems
• Miscarriage
• Pelvic inflammatory disease (PID)
• Pregnancy complications
• Pyelonephritis
• Salpingitis (infection of the ovaries)

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

Gerber GS, Brendler CB. Evaluation of the urologic patient: history, physical examination, and urinalysis. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 3.

Frenkl T, Potts J. Sexually transmitted diseases. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 11.

Lentz GM. Urogynecology: physiology of micturition, diagnosis of voiding dysfunction, and incontinence: surgical and nonsurgical treatment. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007: chap 21.

Eckert LO, Lentz GM. Infections of the lower genital tract: vulva, vagina, cervix, toxic shock syndrome, HIV infections. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007: chap 22.