Urethritis

Description

Urethritis is inflammation of the urethra, the tube from the bladder through which urine is passed.

Causes and risk factors

1. The commonest cause isinfection, the organisms responsible being the same as those causing urinary tract infections (E. coli mainly). Sexually transmitted diseases such as gonorrhoea and chlamydia can also cause urethritis. Other organisms causing urethritis are herpes simplex, adenoviruses and mycoplasma.
2. Injury - straddle injuries
3. Hypersensitivity reactions to products like spermicides.

The highest risk for urethritis is in males aged 20-35 who engage in unprotected sex with multiple partners. A history of previous urethritis is also a risk factor.

Symptoms and signs

The main symptom is dysuria - severe discomfort when passing urine. There is also urinary frequency and urgency, and blood may be present in the urine.

Men typically have a discharge from the penis: this may be anything from clear to purulent. Ejaculation is painful, and there may be blood in the semen. In severe cases, there may be swelling and pain of the penis, with enlarged glands in the groin.

In women, dysuria, urgency and frequency are present, but they often have co-existing pelvic inflammatory disease (PID) as well. PID causes more widespread and severe symptoms, including

• abdominal pain
• fever and chills
• nausea and vomiting
• vaginal discharge

Examination will confirm these observations.

Tests

Some laboratory tests are needed to identify the causative organism and the antibiotics to which it is sensitive. Other ancillary tests are also done:

• a sample of urine is analysed and cultured
• a swab sample is taken of the urethral discharge for analysis and culture
• blood tests for sexually transmitted disease (such as gonorrhoea) are done
• pregnancy test - necessary in women, because not all antibiotics can be used safely during pregnancy
• pelvic ultrasound for women, to detect PID
• full blood count and CRP test in severe cases

Treatment

Symptom relief is provided with painkillers and urinary alkilinisers: these substances reduce the acidity of urine. This lessens the burning pain when urine is passed.

Appropriate antibiotics are prescribed according to the results of the urine culture. In severe or resistant cases, this may be given intravenously.

Contact with irritants is removed or minimised.

Complications

Bladder and kidney infection can result from backwards spread of the urethritis, if it is inadequately treated. In men, infection of the testes, epididymis and prostate can occur, and they are also more likely to develop chronic urethritis and a stricture (permanent narrowing) of the urethra. Women have an increased risk of PID, with subsequent fertility problems and risk of ectopic pregnancies and miscarriages.

Outcome

With early diagnosis and the correct antibiotic treatment, healing almost always occurs without any complications.