Urology Conditions
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      Urethritis

      Condition: Urethritis

      Brief Overview: Urethritis is inflammation of the urethra, the tube that carries urine from the bladder to the outside of the body. It can be caused by infectious or noninfectious factors, leading to symptoms such as pain, burning with urination, and discharge.
      Infectious urethritis is most commonly due to sexually transmitted infections (STIs), including Neisseria gonorrhoeae (gonorrhea) and Chlamydia trachomatis (chlamydia), while noninfectious urethritis may be caused by irritation, trauma, or chemical exposure.
      Prompt recognition and treatment are important to prevent complications such as infection spread, scarring, or infertility.

      Prevalence: According to Cleveland Clinic, “about 4 million people in the US get [urethritis] each year.”

      Etiology:

      • Neisseria gonorrhoeae
      • Chlamydia trachomatis
      • Mycoplasma genitalium
      • Trichomonas vaginalis
      • Herpes simplex vírus (HSV)
      • Neisseria meningitidis
      • Noninfectious causes: Chemical irritation (spermicides, soaps, bubble baths), Catheter or instrumentation trauma
      • Can have unknown etiology

      Risk Factors:

      • Multiple sexual partners
      • Unprotected intercourse

      Commonly Associated Conditions:

      • Sexually transmitted infections (STIs)
      • Epididymitis or Prostatitis in males
      • Cervicitis or Pelvic inflammatory disease (PID) in females
      • Reactive arthritis (Reiter’s syndrome)

      Common Medications:

      • Ceftriaxone IM
      • Doxycycline PO
      • Azithromycin PO

      Common Labs, Imaging, and Tests:

      • Point-of-care (POC) testing: urethral swab
      • First-catch urine testing – urinalysis, NAAT
      • Full panel STI testing

      Common Symptoms:

      • Can be asymptomatic
      • Dysuria
      • Penile discharge, vaginal discharge
      • Itching or irritation at urethral opening
      • In women: pelvic discomfort, vaginal irritation

      Common Treatments:

      • Antibiotic therapy based on pathogen and resistance patterns
      • Partner evaluation and treatment to prevent reinfection
      • Abstinence from sexual activity for at least 7 days after starting treatment (including single-dose treatment regimens) and symptoms resolve
      • Avoidance of irritants: harsh soaps, spermicides, bubble baths
      • Symptom management: adequate hydration, NSAIDs (as directed by healthcare provider), and urinary analgesics as needed (as directed by healthcare provider)
      • Follow-up testing: repeat testing as directed by healthcare provider to ensure eradication

      Physical Findings:

      • Penile discharge
      • Meatal inflammation, edema
      • Redness or tenderness of the urethral opening
      • Pelvic or suprapubic tenderness (if ascending infection)

      Potential Complications and Contraindications:

      • Persistent/recurrent symptoms
      • Untreated infection can lead to
        • epididymitis, prostatitis, or testicular infection
        • Cervical, bladder infections
        • Pelvic inflammatory disease (PID)
      • Infertility
      • Ectopic pregnancy
      • Reactive arthritis
      • Urethral stricture or scarring from chronic inflammation.
      • Reinfection if sexual partners are not treated

      General Health and Lifestyle Guidance:

      • Per UpToDate, “In order to decrease the risk of transmission, males with infectious urethritis should be instructed to refrain from sexual activity for at least seven days following the initiation of therapy (including single-dose therapy) and until their symptoms have resolved.”
      • Safe sexual practices (condom use)
      • Avoid any known irritants (soaps, creams, etc.)
      • STI testing regularly as needed for sexually active individuals
      • Limit number of sexual partners and ensure mutual testing.
      • Avoid sexual contact during active infection or treatment.
      • Make sure to complete all follow up testing to ensure resolution of infection

      Suggested Questions to Ask Patients:

      • When did your symptoms start, and what are they like?
      • Have you noticed discharge or pain with urination?
      • Have you had unprotected sex or new partners recently?
      • Has your partner had any symptoms or been tested?
      • Have you ever been treated for an STI before?
      • Are you taking any medications or using new personal hygiene products?
      • Would you like information on STI prevention or partner testing?
        • Partner Management from UpToDate:
          • All individuals who have had sexual contact with patients diagnosed with  gonorrhoeae, C. trachomatis, or T. vaginaliswithin the 60 days prior to the diagnosis should be evaluated and presumptively treated. Management of sexual partners of patients with M. genitalium is discussed elsewhere. (See "Mycoplasma genitalium infection", section on 'Partner management'.)
          • If the patient's most recent sexual contact was greater than 60 days prior to diagnosis, the most recent sexual partner should be evaluated and treated. For partners of patients with urethritis but no identified pathogen, we suggest empiric therapy for chlamydia as well as testing and directed therapy for any pathogen identified.

      Suggested Talking Points:

      • Urethritis is an inflammation of the urethra, often caused by infection, and it’s typically treatable.
      • Avoid sexual contact until treatment is completed and symptoms are gone, or as directed by your healthcare provider.
      • Even if symptoms improve quickly, it’s important to complete all medication doses, as directed by your healthcare provider.
      • Encourage follow-up testing to help ensure the infection has fully cleared.
      • Discuss prevention strategies to reduce the risk of future infections.
      • Always ask your healthcare provider for specific advice on when to call to report symptoms, and when to seek urgent/emergency care.  

      Sources:

      This resource is for educational purposes only and is not a substitute for professional medical advice. The patient should always follow your healthcare provider’s instructions.

      This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner