Urinary tract infections (UTIs) are a common health problem in both males and females although it is more frequently seen in females. Most of the time it is due to bacteria that enter the urinary tract to infection the bladder, a condition known as cystitis. However, a bladder infection rarely occurs on its own and often the urethra is also infected to produce the characteristic UTI symptoms.
What is Urethritis?
The urethra is the end tube through which urine, produced by the kidneys and stored in the urinary bladder, is finally expelled from the body. Inflammation of the urethra is therefore known as urethritis. It should not be confused with the ureter which is the long tube in the torse that leads from the each kidney to the bladder. The urethra lies in the genitalia.
The most frequent cause of urethritis is infection of the urethra. There are some non-infectious causes of urethritis as well, such as injury caused by chemical or mechanical trauma. However, these non-infectious cases are not very common. Therefore, the term “urethritis” is usually meant to indicate an infection of the urethra. The spread of infection in men could reach the prostate gland, leading to inflammation of the prostate (or prostatitis).
In women, the infection from the urethra may spread to the urinary bladder, resulting in cystitis. The infection may also affect many other parts of the genitourinary system, such as ureters, kidneys, epididymis, testes, vagina, ovaries and fallopian tubes. Adjacent tissues (such as the rectum) and organs located far away from the urinary system (such as lungs) may also get affected in some cases.
Read more on urinary tract infections.
Urethritis is characterized by typical signs and symptoms of inflammation. The lining of the urethra may exhibit painful swelling. Urination may become painful as well. If left untreated, the urethra may become narrow due to scar formation on the walls of the urethra. Less commonly a urethral infection may extend all the way up to the kidneys to cause a kidney infection (pyelonephritis).
Signs and Symptoms
Urethritis may not always present any obvious symptoms. In other cases, symptoms may develop any time between four days and two weeks after the onset of infection. In addition, the symptoms of urethritis in men and women may differ. Some of the common symptoms of urethritis in both men and women include:
- Difficulty in urination caused by a burning sensation or pain during urination (technically referred to as dysuria).
- Very frequent urination throughout the day, with short intervals in between.
- Constant urge to urinate.
- Discharge from the genitals.
- Painful intercourse.
- Itching in the anal region.
- Swelling in the lymph nodes of the groin region.
- Bowel tenesmus (constant urging even after passing stool).
- Herpetic ulcers in the genital area.
Despite the various symptoms, an increased frequency of urination on its own is usually indicative of infection in the urinary bladder or the prostate gland. This frequent urination is uncommon when the infection is restricted to the urethra.
Some of the signs and symptoms of urethritis that are specific to men include:
- Itching of the penis.
- Swelling on the tip of the penis.
- An involuntary discharge from the opening of the penis (urethra).
- Painful ejaculation.
- Blood in semen (technically known as hematospermia) or urine (technically known as hematuria).
- Painful swelling in the scrotum (usually on one side).
Some of the signs and symptoms of urethritis that are specific to women include:
- Itching sensations in the vulva or vagina.
- Abnormal discharge from the vagina.
- Abnormal episodes of bleeding between periods.
- Fever and chills.
- Swollen vulva.
- Pain in the lower abdominal region or pelvic region.
- Heavy menstrual bleeding
Menstruation may aggravate these symptoms in women.
Diagnosis of Urethritis
Diagnosis of urethritis is based on collection of urine and urethral discharge for cytology and culture analysis. Both gross appearance and microscopic analysis of the urine or discharge are taken into consideration while diagnosing this condition. The presence of both gonococcal and non-gonococcal urethritis can be confirmed through cytology and culture analysis. Additional tests may include a complete blood count, and nucleic acid amplification tests for the presence of gonorrhea or chlamydia. In women, pelvic ultrasound and pregnancy tests may also be done.
Causes of Urethritis
As mentioned previously, the predominant cause of urethritis is infection. However, injury is a possible cause of non-infectious urethritis.
A variety of pathogens can cause infectious urethritis. Broadly, these pathogens are classified into gonococcal and non-gonococcal groups. Gonococcal urethritis is a sexually transmitted infection caused by the bacteria, Neiserria gonorrhoeae. Sexually transmitted infections are the most common cause of urethritis.
Read more on gonorrhea.
Non-gonococcal pathogens responsible for many cases of urethritis include Escherichia coli, Chlamydia trachomatis, Trichomonas vaginalis, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum, and Treponema pallidum. Apart from sexually-transmitted bacterial infections, urethritis can also be caused by enteric bacteria that live in the gut.
Viruses can also cause urethritis. However, viral urethritis is rare. Cytomegalovirus and herpes simplex virus are examples of viruses that can cause urethritis.
Injury is the most common non-infectious cause of urethritis. Both mechanical and chemical injuries can lead to urethritis. Examples of mechanical causes of urethritis include insertion of foreign body into the urethra, vigorous sexual intercourse, catheterization, and passage of kidney stones through the urethra. Examples of chemical causes of urethritis include soaps, lubricants, condoms, spermicidal creams, and topical fragrances. Urethritis caused by both mechanical and chemical causes is usually temporary and resolves on its own, unless a secondary infection sets in or the causative factor persists.
Treatment of Urethritis
Since the predominant cause of urethritis is infection, the main line of treatment for urethritis is antibiotic therapy. Antibiotics are used to treat both gonococcal and non-gonoccocal cases of urethritis. Both oral and injectable forms of antibiotics may be used. Examples of antibiotics used to treat gonococcal urethritis include ciprofloxacin (oral), cefixime (oral), ofloxacin (oral), azithromycin (oral), spectinomycin (injectable) and ceftriaxone (injectable).
Oral doxycycline and azithromycin are used to treat non-gonococcal causes of urethritis. Recurrent cases of non-gonococcal urethritis may be treated with erythromycin and metronidazole. Urethritis caused by herpes simplex virus is treated with acyclovir. Trimethoprim-sulfamethoxazole may also be used in cases where both chlamydia and gonorrhea have been excluded as the cause of urethritis.
Complications of Urethritis
Left untreated, urethritis may result in complications such as urethal strictures, urethral diverticula, urethral fistula, abscess formation around urethra, cystitis, pelvic inflammatory disease, prostatitis, orchitis, and cervicitis. In women, these complications may result in increased risk of ectopic pregnancy, pelvic pain, and infertility. Life-threatening septicemia may also occur. For these reasons, urethritis caused by infections should be treated promptly after diagnosis.