Definition

Urethritis is a condition where the urethra is inflamed or irritated. The urethra serves as the final canal for expelling urine from the bladder. In males, it also functions as the passage for ejaculation from the reproductive system. Urethritis is a condition characterized by pain or discomfort during urination. The most common cause of urethritis is a bacterial infection, often resulting from sexually transmitted infections (STIs). Urethritis can affect both males and females.

Causes

Urethritis can stem from either infectious or non-infectious causes. Infections are commonly associated with bacteria or viruses and are often linked to sexually transmitted infections. Urethritis caused by infection can be categorized into two types: gonorrheal urethritis and non-gonorrheal urethritis. Some of the most common microorganisms responsible for urethritis include:

• Neisseria gonorrhoeae: The gonococcus bacterium, transmitted through sexual contact, causes gonorrheal urethritis.
• Chlamydia trachomatis:  Another bacterium transmitted through sexual contact.
• Mycoplasma genitalium
• Escherichia coli (E. coli) bacteria from the gastrointestinal tract
• Herpes Simplex Virus (HSV) 1 and 2
• Trichomonas vaginalis
• Human papillomavirus (HPV)
• Cytomegalovirus (CMV)

Apart from infections, urethritis can also result from other factors. These include trauma to the urethra due to catheterization or foreign objects, genital irritation from tight underwear or irritant products, prolonged physical activities such as cycling, and hormonal changes experienced by menopausal women. These conditions can lead to alterations in the walls of the urethral canal, triggering inflammation.

Risk factor

Urethritis can occur in individuals of any sex, with a higher risk among younger age groups and those who are sexually active. Females are particularly at risk due to the proximity of the urethra to the vagina and anus. Other risk factors include:

• Having multiple sexual partners
• Engaging in unprotected sex (not using condoms)
• Having a history of sexually transmitted infections
• Previous urinary catheter insertion

Symptoms

The symptoms of urethritis can differ between males and females.

In males, symptoms may include:

• Pain and burning sensation during urination often more pronounced in the morning
• Itching and heat at the tip of the penis
• Blood in semen or urine
• Discharge from the urethra, which can be yellow, green, brown, or bloody
• Increased frequency of urination
• Pain in the testicles (scrotum)

In females, symptoms of urethritis may not always manifest, but when present, they typically include:

• Increased frequency of urination (urinary frequency)
• Discomfort or pain during urination
• Pain or burning sensation at the end of the urethra
• Abnormal vaginal discharge
• Pain during sexual intercourse
• Lower abdominal pain

Diagnosis

Diagnosing urethritis involves assessing symptoms and examination results. The symptoms experienced correlate with associated risks, and the doctor will inquire about factors such as previous sexual activity. Physical examination includes assessing the abdomen and genital area. Diagnostic tests are then performed to identify the infecting microorganisms, which may include:

• Urine test or urinalysis, examining urine under a microscope to detect bacteria
• Gram staining, requiring urine samples and swabs from the urethral opening
• Urine culture to cultivate infecting bacteria
• Blood tests, occasionally conducted to check for other sexually transmitted diseases like HIV/AIDS and syphilis

In cases where urethritis may be due to urethral trauma, further examinations may be necessary, such as:

• Cystoscopy, which involves inserting a scope into the urethra to directly observe the urethral wall, particularly when inflammation from other conditions is suspected
• Catheterization to keep the urethral passage open for urine flow
• Suprapubic catheterization, performed if catheterization and cystoscopy fail, typically used when foreign objects or stones are present, mimicking urethritis symptoms

Management

Urethritis caused by bacterial infection can be effectively treated with antibiotics prescribed by a doctor. Common antibiotics used for this purpose include doxycycline, azithromycin, or ceftriaxone. When urethritis is caused by a Trichomonas infection, metronidazole is typically prescribed. Similarly, urethritis resulting from the herpes simplex virus can be managed with acyclovir, famciclovir, or valacyclovir. Additionally, doctors may consider other antibiotic options depending on the specific case.

If urethritis stems from a sexually transmitted infection, it's crucial for your partner to undergo treatment as well. This prevents the recurrence of infections in both individuals. Three months after the beginning of treatment, a re-examination is recommended to ensure the complete eradication of the infection. It's important to abstain from sexual intercourse during the course of treatment for both you and your partner. Resuming sexual activity should only occur after completing treatment and receiving confirmation of its success from your doctor.

In cases where the cause of urethritis is unknown, antibiotics may still be prescribed. Urethritis not caused by infection will be managed based on its underlying cause.

Complications

Complications can arise if urethritis is left untreated. The infection can spread to other parts of the urinary tract, such as the bladder, ureters, and kidneys. In women, the infection can also extend to the reproductive organs.

Complications of untreated urethritis in men may include:

• Prostatitis: inflammation of the prostate gland
• Urethral stricture: narrowing of the urethra
• Epididymitis: inflammation of the epididymis, the tube that carries sperm from the testicles. Inflammation in this area can lead to infertility

In women, complications of untreated urethritis may include:

• Pelvic Inflammatory Disease (PID), can occur when the infection ascends to the uterus and fallopian tubes, potentially leading to infertility. Persistent pelvic pain in women often accompanied by discomfort during sexual intercourse. Increased risk of ectopic pregnancy, where the fertilized egg implants outside the uterus.

Prevention

Preventing urethritis involves adopting home-based measures focused on personal hygiene and safe sexual practices. Here are some examples of methods to prevent urethritis:

• Limiting sexual partners and practicing monogamy
• Consistently using condoms during sexual intercourse 
• Regularly undergoing check-ups with sexual partners to monitor for any signs of sexually transmitted infections.
• Informing potential partners or individuals at risk if diagnosed with a sexually transmitted infection to prevent further transmission.
• Maintaining good genital hygiene
• Staying hydrated by drinking plenty of water
• Avoiding holding urine for prolonged periods
• Urinating after sexual intercourse to help flush out any bacteria that may have entered the urethra during intercourse.
• Limiting consumption of acidic foods and beverages, such as alcohol and soda
• Avoiding contraceptive methods containing spermicides, as they may irritate the urethra and increase the risk of infection.
• Refraining from using soaps or products that may be irritating to the genital area to prevent irritation and inflammation.

When to see a doctor?

If you experience the symptoms mentioned above, it's essential to seek immediate medical attention from a doctor. Prompt and appropriate treatment not only helps prevent complications but also reduces the risk of recurrent infections. If the pain intensifies, if you're unable to urinate, or if the fever develops, it's advisable to seek medical attention promptly for immediate management.

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