Urethritis

Urethritis is infection of the urethra, the channel that carries urine from the bladder out of the body.

Urethritis may be caused by bacteria, fungi, or viruses. In women, the organisms generally travel to the urethra from the vagina. In most women, the bacteria come from the lower intestine and reach the vagina from the anus. Men are much less likely to develop urethritis because the opening of the male urethra is far removed from the anus and is not as easily injured during sexual intercourse.

Sexually transmitted organisms--such as Neisseria gonorrhoeae, which causes gonorrhea--can spread to the urethra during sexual intercourse with an infected partner (see Section 17, Chapter 200). Chlamydia and the herpes simplex virus are also commonly transmitted sexually and can cause urethritis (see Section 17, Chapter 200). When men develop urethritis, the gonorrheal organism is a very common cause. Although this organism may infect the urethra in women, the vagina, cervix, uterus, ovaries, and fallopian tubes are more likely to be infected. Trichomonas, a type of microscopic parasite, also causes urethritis in men.

Symptoms

In women, urethritis may gradually cause pain during urination and urination may also cause pain if vaginitis is present. The urine, which is acidic, may cause a burning pain as it passes over the inflamed labia. In men, urethritis usually begins with a discharge from the urethra. The discharge contains pus (which is yellowish green) when the gonococcal organism is involved or mucus (which is clear) when other organisms are involved. Other symptoms of urethritis in men include pain during urination and a frequent, urgent need to urinate.

A gonorrheal infection of the urethra that is not treated or is inadequately treated eventually can cause a narrowing (stricture) of the urethra. A stricture increases the risk that infections will develop in the bladder (cystitis) or the kidneys (pyelonephritis). Untreated gonorrhea occasionally leads to an accumulation of pus (abscess) around the urethra. An abscess can produce outpouchings from the urethral wall (urethral diverticula), which can also become infected. If the abscess perforates the skin, urine may flow through a newly created abnormal connection (urethral fistula).

Diagnosis, Prevention, and Treatment

A doctor can usually make a diagnosis of urethritis based on the symptoms alone. A sample of the discharge, if present, is collected by inserting a soft-tipped swab into the end of the urethra. The urethral swab is then sent to a laboratory for analysis so that the infecting organism can be identified.

Sexually transmitted diseases that cause urethritis can be prevented by using a condom. Treatment depends on the cause of the infection. Antibiotics are given for a bacterial infection. Antifungal drugs are used to treat fungal infections. An antiviral drug, such as acyclovir, may be needed for a herpes simplex infection.