Urethritis – Causes, Symptoms and Treatment

What is Urethritis?

Urethritis refers to inflammation of the urethra, the tube that carries urine from the bladder out of the body. It can affect both men and women, although symptoms are often more noticeable in men. Urethritis is broadly classified into two types: gonococcal urethritis, caused by the bacterium Neisseria gonorrhoeae, and non-gonococcal urethritis (NGU), caused by other pathogens.

Causes

Urethritis is most commonly caused by sexually transmitted infections (STIs), but can also result from non-infectious causes:

• Gonococci (Neisseria gonorrhoeae): the causative agent of gonorrhea
• Chlamydia (Chlamydia trachomatis): the most frequent cause of non-gonococcal urethritis
• Mycoplasma (Mycoplasma genitalium, Ureaplasma urealyticum)
• Trichomonas vaginalis: a single-celled parasitic organism
• Herpes simplex virus (HSV)
• Less common causes include chemical irritation (e.g., from soaps or lubricants), mechanical trauma, or catheter-associated inflammation

Symptoms

Symptoms of urethritis vary depending on the causative agent and disease severity. Common presentations include:

• Burning or pain during urination (dysuria)
• Purulent or watery discharge from the urethra
• Itching or tingling sensation at the urethral opening
• Increased urinary frequency or urgency
• In women: often asymptomatic or only mild discomfort
• In men: redness and swelling at the urethral opening

In some cases, particularly with chlamydial infections, urethritis may be entirely asymptomatic, facilitating unknowing transmission to sexual partners.

Diagnosis

Diagnosis is made through a combination of clinical assessment and laboratory testing:

• Medical history: review of symptoms and sexual history
• Urethral swab: microscopic examination and culture to identify pathogens
• Urinalysis: detection of leukocytes (white blood cells) indicating inflammation
• PCR testing (polymerase chain reaction): highly sensitive detection of chlamydia, gonococci, and other pathogens
• Blood tests: to rule out additional STIs such as HIV or syphilis

Treatment

Treatment is tailored to the identified or suspected causative organism:

Gonococcal Urethritis

Due to increasing antibiotic resistance, gonococcal urethritis is typically treated with combination antibiotic therapy. Current guidelines commonly recommend ceftriaxone (intramuscular or intravenous injection), sometimes in combination with azithromycin. Always follow the most current clinical guidelines.

Non-Gonococcal Urethritis

For NGU caused by chlamydia or mycoplasma, the following antibiotics are commonly used:

• Doxycycline (oral, 7-day course): first-line treatment for chlamydial infection
• Azithromycin (single dose): an alternative for chlamydia
• Moxifloxacin: used when Mycoplasma genitalium is confirmed

It is essential that sexual partners are also tested and treated to prevent reinfection. Sexual activity should be avoided or condoms should be used throughout the treatment period.

General Measures

• Adequate fluid intake
• Avoiding alcohol and irritating substances
• Follow-up testing after completing treatment to confirm cure

Complications

If left untreated, urethritis can lead to serious complications:

• Epididymitis (inflammation of the epididymis) in men
• Prostatitis (inflammation of the prostate) in men
• Pelvic Inflammatory Disease (PID) in women
• Infertility in both sexes
• Increased risk of HIV transmission

Prevention

Key measures to prevent urethritis include:

• Consistent use of condoms during sexual activity
• Regular STI screening for individuals with multiple sexual partners
• Open communication with sexual partners about health status
• Proper hygiene practices in medical settings to prevent catheter-associated infections

References

1. Workowski KA, Bachmann LH et al. – Sexually Transmitted Infections Treatment Guidelines, Centers for Disease Control and Prevention (CDC), MMWR 2021; 70(4):1-187
2. World Health Organization (WHO) – Global Health Sector Strategy on Sexually Transmitted Infections 2016-2021, WHO Geneva 2016
3. Bachmann LH et al. – Urethritis in Clinical Practice, Infectious Disease Clinics of North America, 2023