Urethritis - Symptoms, Types, Causes & Diagnosis

Urethritis - Symptoms, Types, Causes & Diagnosis

A urinary tract infection and urethritis are not the same things (UTI). A UTI is an infection of the urinary system, whereas urethritis is an inflammation of the urethra. While sharing some symptoms, they might need to be...

"URETHRITIS don’t let it rain on your parade."

What is Urethritis

  • A urinary tract infection and urethritis are not the same things (UTI). A UTI is an infection of the urinary system, whereas urethritis is an inflammation of the urethra. While sharing some symptoms, they might need to be treated using a different approach depending on what caused their urethritis in the first place.

How Long ago was the Disease Identified?

The history of urethritis can be traced back to ancient times, with evidence of its existence found in medical texts from various cultures.

  • In ancient Greece, the physician Hippocrates wrote about the symptoms of urethritis, including painful urination and discharge from the urethra. He recommended various treatments, including the use of herbal remedies and the application of hot compresses.
  • During the Middle Ages, the physician Avicenna described the symptoms of urethritis and recommended the use of warm water baths to alleviate discomfort. Other mediaeval physicians recommended the use of herbal remedies and bloodletting to treat the condition.
  • In the 19th century, French physician Philippe Ricord made significant contributions to the study of sexually transmitted infections, including urethritis. He recognized the link between gonorrhoea and urethritis and developed a diagnostic test to detect the presence of the bacteria responsible for this.
  • In the early 20th century, the German physician Felix Neisser identified the bacterium responsible for gonorrhoea and developed an effective treatment using silver nitrate. Later, antibiotics such as penicillin were found to be effective in treating gonorrhoea and other forms of urethritis.

Today, urethritis is a common condition that can be caused by a variety of factors, including bacterial and viral infections, trauma, and certain medical procedures. It is typically treated with antibiotics, and preventive measures such as practising safe sex and maintaining good hygiene can help reduce the risk of developing the condition.

What is the Epidemiology of Disease?

  • 4 million People are affected with urethritis each year. Around 600,000 new cases of Neisseria gonorrhoea are thought to occur each year, and about 3 million new instances of nongonococcal urethritis do as well.
  • In one study, 127 men (30%) with acute urethritis symptoms and signs had N. gonorrhoeae infections. There were 424 men in total. The infectious agent that infected 143 (48.1%) of the 297 additional males with nongonococcal urethritis was C. trachomatis. In 154 men presenting with nonchlamydial nongonococcal urethritis, the agents detected were: M. genitalium (22.7%), U. urealyticum (19.5%), human adenovirus (16.2%), H. influenzae (14.3%), U. parvum (9.1%), N meningitidis (3.9%), T vaginalis (1.3%).

The epidemiology of urethritis is characterised by high prevalence rates and a range of risk factors that contribute to the transmission and spread of the infection.

  • Prevalence and Incidence:
  • Urethritis is a very common sexually transmitted infection (STI) and its prevalence varies depending on the population being studied. According to the Centers for Disease Control and Prevention (CDC), there were approximately 430,000 cases of gonorrhoea in the United States in 2019, and many of these cases are likely to have involved urethritis as a symptom. The incidence of urethritis is highest among sexually active young adults, with males being more commonly affected than females.
  • Risk Factors:
  • The primary risk factor for urethritis is sexual activity.
  • The infection can be spread through vaginal, anal, or oral sex and individuals who have multiple sexual partners or engage in unprotected sex are at a higher risk of contracting the infection.
  • Other risk factors for urethritis include having a history of STIs, having unprotected sex with a partner who has a history of STIs, and a weakened immune system.

What Can be the Pathogenesis of Urethritis?

The pathogenesis of urethritis can be caused by various infectious and non-infectious factors. Here are some of the common causes and their pathogenesis:

Infectious Causes

a) Bacterial Infections: The most common cause of urethritis is a bacterial infection. Bacteria such as Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma genitalium are common culprits. These bacteria can be transmitted through sexual contact or other means of exposure. Once they enter the urethra, they cause inflammation, which leads to the symptoms of urethritis.

  • Neisseria gonorrhoea- A gram-negative diplococci bacteria called Neisseria gonorrhoea is spread through sex. 2 to 5 days pass during incubation. Chlamydia trachomatis co-infection is rather common in patients.
  • Chlamydia trachomatis- which is also spread through sexual contact. Chlamydia trachomatis is a tiny, obligately intracellular parasitic gram-negative bacteria. Typically, the incubation period lasts 7 to 14 days. Neisseria gonorrhoea and Mycoplasma genitalium are frequently co-infected with it.
  • In men with nongonococcal urethritis, Mycoplasma genitalium is frequently the cause of recurring or persistent urethritis. This creature is a tiny, cell-wall-less, self-replicating bacterium. Given its slow growth, this organism may be challenging to find.
  • Both men and women can become Trichomonas vaginalis, a flagellated parasitic protozoan STI, infected in their urogenital tracts.

b) Viral Infections: Viruses such as herpes simplex virus and human papillomavirus (HPV) can also cause urethritis. These viruses can be transmitted through sexual contact and can lead to inflammation of the urethra.

  • Common fungal yeasts like Candida species can infect and irritate the urogenital tract.
  • The double-stranded DNA virus herpes simplex can result in an infection of the urethra in the genitalia.
  • Men's urethritis is rarely caused by adenovirus. Yet it ought to be taken into account in all males who exhibit dysuria, meatitis, and any accompanying conjunctivitis or constitutional symptoms.

Non-infectious Causes

a) Chemical Irritation: Exposure to certain chemicals, such as detergents, soaps, or lubricants can cause irritation and inflammation of the urethra.

b) Trauma: Trauma to the urethra, such as during sexual activity or catheterization can cause inflammation and urethritis.

c) Allergies: Allergic reactions to certain materials, such as latex condoms, can cause inflammation of the urethra.

In summary, urethritis can be caused by various infectious and non-infectious factors. The pathogenesis of urethritis is usually related to inflammation of the urethra.

When to Consult a Doctor?

The signs and symptoms of urethritis may include:

  • Pain or burning during urination
  • Frequent urination
  • Urgent need to urinate
  • Cloudy or bloody urine
  • Discharge from the urethra
  • Pain during sexual intercourse
  • Rashes in the genital area
  • Swelling of the urethra
  • Fever, chills, and other signs of a urinary tract infection (UTI)

What are the Types of Urethritis?

There are several types of urethritis, including:

  • Gonococcal urethritis: This is caused by the bacteria Neisseria gonorrhoeae, which is transmitted through sexual contact. It can cause painful urination, discharge from the penis, and swelling of the urethra.
  • Non-gonococcal urethritis (NGU): This type of urethritis is caused by other types of bacteria such as Chlamydia trachomatis or Mycoplasma genitalium, and it can also be sexually transmitted. Symptoms include discharge from the penis, pain or burning during urination, and sometimes pain or discomfort in the testicles or scrotum.
  • Chemical urethritis: This can be caused by exposure to irritating chemicals such as soaps, spermicides, or other chemicals used during sexual activity. Symptoms can include burning or itching during urination, as well as discharge from the penis.
  • Traumatic urethritis: This can occur due to injury to the urethra, such as during sexual activity or from the insertion of a catheter. Symptoms can include pain or discomfort during urination, blood in the urine, and discharge from the penis.
  • Idiopathic urethritis: This refers to cases where the cause of the urethritis is unknown. Symptoms can include painful urination, discharge from the penis, and swelling of the urethra.

How can Urethritis be Diagnosed?

To diagnose urethritis, a doctor will typically perform a physical exam and ask about the patient's symptoms and medical history. They may also perform tests, such as a urine test or a swab of the urethra, to check for the presence of bacteria, viruses, or other pathogens.

  1. Urine test: A urine test can help identify the presence of bacteria, white blood cells, or other abnormalities that can indicate urethritis.
  2. Swab test: A swab test may be performed to collect a sample of discharge or secretions from the urethra, which can then be analysed to identify the cause of the inflammation.
  3. Blood test: A blood test may be performed to check for the presence of sexually transmitted infections (STIs), which can cause urethritis.
  4. Pelvic exam: A pelvic exam may be performed in women to check for signs of urethritis or other reproductive system infections.

If a bacterial infection is suspected, the doctor may prescribe antibiotics to treat the infection. If a STD is diagnosed, the patient's sexual partners may also need to be tested and treated. It's important to follow the full course of treatment and avoid sexual activity until the infection is fully resolved to prevent complications and the spread of infection to others.

How it Can be Treated?

The treatment of urethritis typically involves a combination of antibiotics and symptom management.

The following are some general guidelines for treating urethritis:

  • Antibiotics: Antibiotics are the primary treatment for bacterial urethritis. The choice of antibiotic depends on the suspected or confirmed cause of the infection. For example, gonorrhoea is typically treated with ceftriaxone or azithromycin, while chlamydia is treated with azithromycin or doxycycline.
  • Symptom management: Pain and discomfort associated with urethritis can be managed with over-the-counter pain medications such as acetaminophen or ibuprofen. It is also important to drink plenty of fluids to help flush out the urinary system.
  • Sexual partners: If the cause of urethritis is an STI, it is important to inform sexual partners so that they can be tested and treated if necessary.
  • Follow-up testing: Follow-up testing is important to ensure that the infection has been cleared and to identify any potential complications.

How it Can be Prevented?

To prevent urethritis, you can take the following measures:

  • Practise safe sex: Use condoms or dental dams during sexual activity to reduce the risk of getting sexually transmitted infections (STIs) that can cause urethritis
  • Get vaccinated: Vaccines are available for some of the STIs that can cause urethritis, such as hepatitis B and human papillomavirus (HPV).
  • Limit your number of sexual partners: The more sexual partners you have, the higher your risk of getting an STI that can cause urethritis.
  • Get tested for STIs: If you are sexually active, it's a good idea to get tested for STIs regularly, even if you don't have any symptoms.
  • Practise good hygiene: Clean your genital area regularly and urinate after sexual activity to flush out bacteria.
  • Avoid irritants: Try to avoid using irritants such as perfumed soaps, lotions, and sprays in the genital area.

If you experience symptoms of urethritis, such as painful urination or discharge from the penis, see a healthcare provider for diagnosis and treatment. Prompt treatment can help prevent complications and further spread of the infection.

What is the Prognosis of the Disease?

  • When diagnosed and treated properly, patients have a great prognosis and a high percentage of the recovery.
  • When it makes sense given the nature of the infectious organism, treatment for sexual partners should be addressed.
  •  Regrettably, untreated partners frequently re-infect sexually active people. It's crucial to look at co-infections and other less common causal agents when urethritis persists despite therapy for the most common organisms.
  • While several of the causal organisms do pose the danger of unpleasant and damaging sequelae, quick identification and treatment are crucial.

What if Left Untreated?

  • Neisseria gonorrhoea complications, among the most prevalent causes of urethritis, have been linked to a few uncommon complications such as
    •  Penile edema
    •  Periurethral abscesses
    •  Post-inflammatory urethral strictures
    •  Penile lymphangitis.
    •  Pelvic inflammatory illness
    •  Infertility
    •  Ectopic pregnancy
    •  Fitz-Hugh-Curtis syndrome
    •  Proctitis
    •  Reactive arthritis

Urethritis, uveitis, and arthritis make up the Reiter syndrome, often known as a complete reactive arthritis triad.

This is a rare condition that includes acute epididymitis, orchitis, and prostatitis and may be brought on by Chlamydia trachomatis.

Patient Education

  • It is crucial to inform the patient about safe sexual behaviour if a STI has been identified.
  •  This involves talking with the patient about telling their partners and encouraging them to get checked out by a medical professional and seek the right kind of care.
  • It is crucial to emphasize the possibility of recurrence even in asymptomatic partners because they can have hidden illnesses. Individuals should be advised to delay having a relationship until both they and their partner have received effective treatment and are symptom-free.

Urethritis may be tough, but you're tougher. Don't let urethritis keep you down, rise above it with treatment.