Urethritis is the inflammation and swelling of the urethra, the narrow tube that carries urine from the bladder to the outside of the body. It leads to difficulty or pain when urinating.
Urethritis is usually caused by bacteria or a virus. A chemical irritant can also trigger it.
It is different from a urinary tract infection (UTI), which usually affects the whole of the urinary tract.
It can be transmitted through unprotected sex. If a woman has a vaginal infection, she can pass it on to a male partner.
Urethritis can lead to discomfort and pain.
Both men and women can develop urethritis, but the symptoms differ slightly. Some people have no symptoms.
For women, symptoms include:
- Unusual vaginal discharge
- Pelvic and abdominal pain
- Pain with intercourse
- Frequent or urgent urination
- Fever and chills
- Stomach pain
Symptoms in men include:
- Blood in urine or semen
- Painful ejaculation
- Penile discharge
- Burning sensation while urinating
- Itching, tenderness, or swelling in the penis
- Enlarged lymph nodes in the groin area
Fever is possible in men, but it is rare.
Causes and risk factors
Most cases of urethritis happen when bacteria enter the urethra.
Bacterial urethritis can be either gonococcal urethritis, caused by Neisseria gonorrhoeae, or non-gonococcal urethritis (NGU), caused by Chlamydia trachomatis or Mycoplasma genitalium (M. genitalium).
Chlamydia is one of the most common sexually transmitted infections (STI) that affect both men and women.
Other causes are:
- Reiter's syndrome
- Ureaplasma urealyticum
- Trichomonas vaginalis
- Uropathogenic Escherichia coli (E. coli)
According to the National Institutes of Health, urethritis can also result from an injury or sensitivity to chemicals used in contraceptive jellies, soaps, creams or foams, and spermicides.
Disinfectant, antiseptic, or other products, such as tea tree oil, can cause inflammation.
Damage caused by friction during sexual contact or masturbation can also lead to inflammation in men.
People who are more likely to experience urethritis include those who:
Oral sex may be a risk factor for nongonococcal urethritis (NGU), according to a study published in the Journal of Infectious Diseases
Urethritis is not always sexually transmitted, but a person with multiple sexual partners has a greater risk of exposure.
The Centers for Disease Control and Prevention (CDC) recommend that any patient with confirmed or suspected urethritis should also undergo tests for gonorrhea and chlamydia. This will enable people to inform their partner, who may also need to be tested and treated. It can also encourage patients to adhere to treatment.
For a man, a physician will normally examine the abdomen, scrotum, penis, and bladder for any swelling or discharge.
The doctor may spread the urinary meatus apart to see if there are any abnormalities. The urinary meatus is the hole from which urine leaves the body.
A swab is inserted into the urethra and then examined under a microscope.
Women usually undergo abdominal and pelvic exams to check for tenderness of the urethra and lower abdomen. The doctor will also check for any urethral discharge.
Cystoscopy, in which a tube with a camera on the end is inserted into the bladder, may be used.
Diagnostic tests that may be recommended include:
- Complete blood count (CBC)
- C-reactive protein test
- Tests to check for STIs, such as gonorrhea or chlamydia
- Urine test
Women may undergo a pelvic ultrasound test.
Treatment, prevention and complications
Medications will aim to treat the cause of the urethritis and to prevent the spread of infection.
Using protection during sex reduces the risk.
Treatment depends on the underlying cause. If the patient has a bacterial infection, an antibiotic will be prescribed, such as Doxycycline, Erythromycin, or Metronidazole.
Azithromycin and doxycycline are reported to be effective in treating urethritis when it is linked to chlamydia, but other types, such as M. genitalium appear to respond better to azithromycin or moxifloxacin.
There is also concern that some strains of M. genitalium are resistant to some antibiotics, making treatment more difficult.
A non-steroidal anti-inflammatory drug (NSAID), such as naproxen, can be used to relieve pain.
Pyridium, also known as phenazopyridine, is can be used to treat pain and reduce the urge to urinate, and frequency of urination.
The CDC encourage treatment that can be given in a single dose, to encourage adherence. They also recommend giving medication on site in the clinic and observing the first dose.
Are there any natural remedies?
According to the Family Planning Association (FPA) in the United Kingdom, there is no evidence that natural or alternative remedies can cure urethritis.
The University of Maryland Medical Center (UMM) note that home and natural remedies, used together with conventional medical treatment, can help the body fight infection.
Cranberries contain a substance that may prevent bacteria from sticking to the urethra. Drinking between 8 ounces and 16 ounces of unsweetened cranberry juice each day may help women with frequent urinary infections to prevent recurrence.
Cranberry supplements are not recommended if a person is pregnant, breastfeeding, or has kidney stones. Cranberry juice and supplements should not be taken by people using blood-thinning drugs such as warfarin, or Coumadin.
It is also important to stay hydrated by avoiding caffeine and alcohol and drinking six to eight glasses of filtered water each day.
It is important to speak to a physician before using any natural or alternative remedies.
Some effective ways of preventing urethritis, include:
- Refraining from unprotected and risky sexual activity, such as having multiple sexual partners
- Avoiding chemicals that can irritate the urethra such as detergents or spermicides
- Good personal hygiene
Possible complications for men include infections in the bladder, testicles or the prostate.
If symptoms persist or recur, it may be a sign that another condition is present, or that the bacteria that caused the problem is resistant to the treatment given.
It is important for patients to follow up with their physician if pain and other symptoms return or do not go away.