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Infections in Pregnancy: Acute Urethritis

What is acute urethritis?

Highlights

  1. Acute urethritis is caused by the spread of bacteria into the urethra.
  2. Exposing a newborn to the bacteria can cause conjunctivitis or pneumonia.
  3. If left untreated, acute urethritis can lead to complications like pelvic inflammatory disease.

Acute urethritis involves inflammation and infection of the urethra. The urethra is the canal through which urine flows from the bladder out of the body. It’s usually caused by one of three bacteria:

  • E. coli
  • Neisseria gonorrhoeae (gonorrhea)
  • Chlamydia trachomatis (chlamydia)

E. coli is one of many bacteria normally present in the rectum and vagina. It can enter into the urethra during intercourse or when wiping after a bowel movement. The gonorrhea and chlamydia bacteria are transmitted by sexual contact with an infected partner.

What complications can result from acute urethritis?

Complications

When gonorrhea and chlamydia are found in your urethra, they can usually be found in the cervix as well. In non-pregnant women, these bacteria may cause upper-genital tract infections if not treated promptly. These infections can include pelvic inflammatory disease (PID). Infections with these bacteria during pregnancy may increase the risk of preterm delivery.

Urethritis caused by E. coli or other similar organisms can make its way up into your bladder and kidneys. Infection of the kidneys in pregnancy may lead to preterm labor and other complications.

Another complication can occur when a baby is delivered through an infected birth canal. The baby may develop a serious eye infection caused by gonorrhea or chlamydia. Chlamydia may also cause respiratory tract infections.

How is acute urethritis diagnosed?

Symptoms

Acute urethritis usually has the following urinary symptoms:

  • frequency (the need to urinate often)
  • urgency (the need to urinate immediately)
  • hesitancy (delay in starting the stream of urine)
  • dribbling
  • painful urination

When gonorrhea or chlamydia cause the infection, a  yellow, pus-like discharge from the urethra may be present.

Your doctor may examine a sample of your urine for high numbers of white blood cells to reach a diagnosis. Your doctor may also take a sample of the discharge from your urethra and allow the bacteria to grow. This will help them diagnose gonorrhea. The most useful test for identifying chlamydia in the urethral discharge is a DNA probe.

How is acute urethritis treated?

Treatment

Treatment depends on the cause of the acute urethritis:

E. coli

You can be treated for non-gonococcal urethritis with antibiotics such as:

  • trimethoprim-sulfamethoxazole (Bactrim or Septra)
  • ciprofloxacin
  • nitrofurantoin (Macrobid)

Your doctor may prescribe a 3- or 7-day course of antibiotics.

Gonorrhea or chlamydia

The most cost-effective treatment for gonorrhea is a single, oral dose of cefixime (Suprax) or injection of ceftriaxone (Rocephin). Your doctor will also prescribe a single oral dose of azithromycin (Zithromax) for chlamydia.

Women who are pregnant and have a penicillin allergy will be given a single injection of spectinomycin (Trobicin) for gonorrhea. Others with a penicillin allergy may be treated for gonorrhea with a 7-day course of doxycycline (Vibramycin). They may also be treated with quinolones, such as ciprofloxacin (Cipro) or ofloxacin (Floxin). People with a penicillin allergy can still take azithromycin to treat chlamydia. Your sexual partner must be treated as well.

How can I prevent acute urethritis?

Prevention

Practicing safe sex with barrier contraceptives is one way to prevent sexually transmitted infections or urethritis. Regular testing and checkups with your doctor are also important for your reproductive health. Wiping from front to back after urination or a bowel movement will prevent fecal bacteria from entering the urethra or vagina. You should also stay hydrated. Drinking plenty of water will help your body flush out bacteria.

What is my outlook after being treated for acute urethritis?

Outlook

The outlook for acute urethritis is positive when it’s treated promptly. Follow your doctor’s treatment instructions and take all of your medication as prescribed. If you’ve been diagnosed with acute urethritis, make sure to inform any sexual partners. This will prevent reinfection and ensure they seek treatment if necessary.

You asked, we answered

  • Are there any home remedies that can help manage the symptoms of urethritis?
  • Cranberry juice may help prevent urinary tract infections (UTIs), though clinical studies are divided. The active ingredient in cranberry juice is A-type proanthocyanidins (PACs). This ingredient has been shown to prevent bacteria from sticking to the wall of urinary tract and bladder. But most research says there isn’t enough of this ingredient in cranberry juice to prevent UTIs. A 2012 Cochrane review of multiple clinical studies suggested there may be some benefit over a 12-month period to people who have recurrent infections.

    - University of Illinois-Chicago, College of Medicine

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