Urethritis

Urethritis is an inflammation of the urethra, the tube that carries urine from the bladder to the outside of the body. Urethritis can affect woman as well as men. Usually due to an infection, urethritis may be caused by a variety of organisms, including bacteria and yeasts. Almost always sexually transmitted, urethritis is considered the most common sexually transmitted syndrome among men in the US.

The most common form of urethritis, gonococcal urethritis, is caused by the bacterium that causes gonorrhea. Approximately one million cases of gonococcal urethritis are diagnosed each year. When caused by an identifiable organism other than gonorrhea, the condition is known as non-gonococcal urethritis. In men between the ages of 15 and 40, Chlamydia (another sexually transmitted microorganism) accounts for 40% to 50% of the cases, while mycoplasma bacteria account for another 20% to 25%.

Urethritis can also be caused by the same organisms that cause bladder or kidney infections, such as E. coli. Bacteria from the skin or rectum sometimes spread to infect the urethra. In men over 50, urethritis is often associated with an inflammation of the prostate gland (prostatitis). In approximately one third of the cases of urethritis, the infective agent is either unknown or unidentifiable. When this happens, it is known as nonspecific urethritis.

Although usually caused by an infection, urethritis can also be caused by other factors such as trauma from an accident, or following procedures such as insertion of a catheter or a cystoscopy (viewing tube inserted up the urethra for the purpose of examining the inside of the urethra and bladder). Inflammation of the urethra may also be the result of a chemical irritant or allergic reaction to an antiseptic or spermaticidal (birth control) preparation.

Physical exam of the male may reveal a urethral discharge. Women rarely exhibit any urethral discharge.

Tests: A thin urogenital swab is inserted into the urethra to obtain a specimen. The swab is rolled over a glass slide, and the specimen is then Gram stained. In a male, evidence of typical Gram-negative diplococci is sufficient to diagnose gonorrhea, whereas their absence allows for a diagnosis of non-gonococcal urethritis. Even if the organism is identified on the Gram stain, culture for gonococcus is still indicated so that antibiotic susceptibility testing can be performed. Gram stain smears are less often positive in the female, so gonorrhea must be cultured from the urethra and/or cervix. Cultures, direct antigen tests, genetic probes, or an automated polymerase chain reaction are used to identify or rule out other infectious agents, such as Chlamydia.

Urinary tract infections (urethritis) are typically treated with antibiotics, which kill the bacteria causing the infection. Treatment may vary in duration (e.g., three to 10 days) and type of antibiotic prescribed, depending on the patient’s medical history, severity of the infection, and type of bacteria involved.

In addition to taking the prescribed medication, patients may be advised to increase daily fluid intake to help flush any remaining bacteria from the urinary tract. However, some physicians believe this may dilute the medication, making it less effective. No available research has explored this issue.

Patients with urethritis who use a urinary catheter should receive a new catheter and drainage tube prior to beginning antibiotic treatment. Failing to do so puts the patient at risk for reinfection after they have completed their course of antibiotics because bacteria may congregate and grow on the internal surface of the catheter and tubing.

In severe cases, where infection has spread to the kidneys, patients may be hospitalized to receive antibiotic medications intravenously. These patients may need to have their condition monitored by hospital staff to ensure infection does not spread to the bloodstream.