Urethritis

Causes

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:

• 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 - 35
• Having many sexual partners
• High-risk sexual behavior (such as anal sex without a condom)
• History of sexually transmitted diseases

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

Exams and Tests

The doctor or nurse 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)

Treatment

The goals of treatment are to:

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

If you have an infection, you will be given antibiotics.

See also:

• Chlamydia
• Gonorrhea

You may take pain relievers (including nonsteroidal anti-inflammatory drugs or 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.

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.

Outlook (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.

Possible Complications

Men with urethritis are at risk for the following complications:

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

After a severe infection, the urethra may become scarred and then narrowed (urethral stricture).

Women with urethritis are at risk for the following complications:

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

When to Contact a Medical Professional

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.

Alternative Names

Urethral syndrome; NGU; Non-gonococcal urethritis

References

Brill JR. Diagnosis and treatment of urethritis in men. Am Fam Physician. 2010;81:873-878.

McCormack WM. Urethritis. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 106.

Cohen MS. Approach to the patient with a sexually transmitted disease. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 293.

Update Date: 9/24/2012

Updated by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. Louis S. Liou, MD, PhD, Chief of Urology, Cambridge Health Alliance, Visiting Assistant Professor of Surgery, Harvard Medical School. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.