What you need to know about urethritis

Urethritis is inflammation of the urethra, the tube that carries urine from the bladder out of the body. It is usually caused by an infection. If you think you have urethritis, you should visit your doctor for examination and tests.

The usual infective causes are gonorrhoea and chlamydia, which account for up to 43 out of 100 cases. But there are many cases of urethritis where no infection is found.

Urethritis is the most common condition diagnosed in men in clinics – about 80,000 men are diagnosed with it every year. It is more difficult to diagnose urethritis in women because it may not cause as many symptoms.

Symptoms

In women, urethritis rarely has any symptoms unless the infection spreads to other parts of the reproductive system, such as the womb or fallopian tubes. If the infection does spread, a woman may develop pelvic inflammatory disease (PID), a serious condition that can cause persistent pain. Repeated episodes of PID are associated with an increased risk of infertility.

Some women with PID don’t have symptoms. If there are symptoms, they include:

• Pain around the pelvis or lower part of your stomach.
• Discomfort or pain during intercourse deep inside the pelvis.
• Bleeding between periods and after sex.
• Pain when you urinate.
• Heavy or painful periods.
• Unusual vaginal discharge – especially yellow or green.

A few women with PID become very ill with:

• Severe lower abdominal pain.
• A temperature of 38°C or above.
• Nausea and vomiting.

Symptoms of urethritis in men include:

• Painful or burning sensation when urinating.
• The tip of the penis feeling irritated and sore.
• White or cloudy discharge from the tip of the penis.
• Frequent need to urinate.

Depending on the cause, symptoms may begin a few weeks or several months after infection. If it has a non-infectious cause, such as irritation to the urethra, symptoms may begin after a couple of days.

Symptoms that start a day or two after sex are usually not caused by a sexually transmitted infection (STI), but testing for STIs is still recommended. If a current or recent sexual partner informs you that you may have been exposed to an STI that can cause urethritis, but if you don’t have any symptoms, don’t assume you do not have it. Get tested.

Causes

Urethritis caused by gonorrhoea is called gonococcal urethritis. Other causes include:

Chlamydia: This is caused by chlamydia trachomatis bacteria. It is an STI spread during unprotected sex, including anal and oral sex.

Other infections: These include bacteria that usually live harmlessly in the throat, mouth or rectum. The spread can happen during oral or anal sex.

Non-infectious causes: This is when something else leads to the urethra becoming inflamed. These include irritation from a product used in the genital area (such as
soap, deodorant or spermicide); damage to the urethra caused by vigorous sex or masturbation, or by frequently squeezing the urethra; or damage to the urethra caused by inserting an object into it, such as a catheter during an operation in hospital.

Sexually transmitted infections: Urethritis can be caused by an STI and is therefore more common among people who are at risk of STIs, those sexually active, who have had unprotected sex or have recently had a new sexual partner.

Diagnosis

There are two tests that are usually used to diagnose urethritis:

• A swab test
• A urine test

Either test can be used, although both may be carried out to ensure the diagnosis is correct. You may also be offered tests for all STIs, including HIV.

A swab test involves taking a small sample of fluid from your urethra, which is the tube that carries urine from the bladder to the outside of the body. The sample can then be examined under a microscope to look for evidence of inflammation or bacteria known to cause urethritis.

Treatment

It is important that you make sure you take your treatment as prescribed, make sure all your recent partners get the treatment and not have any sex until a week after everyone has been treated.

The illness is usually treated with a short course of antibiotics to kill the bacteria that caused the infection. Treatment with antibiotics may be started before you receive your test results.

A test can be conducted to confirm whether the cause is infective or not so that you are not given antibiotics unnecessarily.

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