Urethritis

Urethritis is inflammation of the urethra. The most common symptom is painful or difficult urination.^[1][2] It is usually caused by infection with bacteria. The infection is often a sexually transmitted infection (STI), but some are just non-STI urinary tract infections. Urethritis can be idiopathic, but it usually is not.

Causes

The disease is classified as either gonococcal urethritis, caused by Neisseria gonorrhoeae, or non-gonococcal urethritis (NGU), most commonly caused by Chlamydia trachomatis. NGU, sometimes called nonspecific urethritis (NSU), has both infectious and noninfectious causes.

Other causes include:^[1][2]

• Adenoviridae
• Uropathogenic Escherichia coli (UPEC)
• Herpes simplex
• Cytomegalovirus
• Mycoplasma genitalium
• Reactive arthritis
• Trichomonas vaginalis^[3]
• Ureaplasma urealyticum
• Methicillin-resistant Staphylococcus aureus^[4]
• Group B streptococcus^[5]

Diagnosis

In female patients, urethritis can be caused by pelvic inflammatory disease.^[6] With male patients, the physician examines the penis and testicles for soreness or any swelling. The urethra is visually examined by spreading the urinary meatus apart with two gloved fingers, and examining the opening for redness, discharge and other abnormalities. Next, a cotton swab is inserted 1-4 cm into the urethra and rotated once. To prevent contamination, no lubricant is applied to the swab, which can result in pain or discomfort. The swab is then smeared onto a glass slide and examined under a microscope. A commonly used cut-off for the diagnosis of urethritis is 5 or more granulocytes per High Power Field, but this definition has recently been called into doubt.^[7] The physician sometimes performs a digital rectal examination to inspect the prostate gland for swelling or infection.

A urinary tract infection may cause similar symptoms.

Prevention

Risk of some causes of urethritis can be lessened by avoiding unprotected sexual activity, chemicals that could irritate the urethra; this could include detergents or lotions as well as spermicides or contraceptives, and irritation caused by manual manipulation of the urethra.

Treatment

A variety of drugs may be prescribed based on the cause of the patient's urethritis. Some examples of medications based on causes include:^[2] azithromycin, doxycycline, erythromycin, levofloxacin, metronidazole, ofloxacin, or tinidazole.

Proper perineal hygiene should be stressed. This includes avoiding use of vaginal deodorant sprays and proper wiping after urination and bowel movements. Intercourse should be avoided until symptoms subside.

References