Urethritis may be caused by the same organisms that cause urinary tract infections (for example, E. coli or klebsiella) and by some sexually transmitted diseases (for example, chlamydia, gonorrhea, and Ureaplasma urealyticum infections). Viral causes of urethritis include herpes simplex virus and cytomegalovirus. Urethritis may also develop because of a chemical irritation (such as spermacide in condoms or contraceptive jelly, cream, or foam). Trauma may also cause urethritis.

Men between the ages of 20 and 35, those with multiple sexual partners, and those who engage in high-risk sexual behavior (such as lack of condom use, particularly during active anal intercourse) are at higher risk.

Young women in their reproductive years are also at risk. In women, common bacterial causes include gonorrhea, chlamydia, mycoplasma hominis, ureaplasma urealyticum, and mycoplasma genitalum. Risk factors include age younger than 20, unmarried status, inner-city population, multiple partners, and a prior history of STDs (sexually transmitted diseases).

• dysuria (burning pain with urination)
• increased urinary frequency or urgency
• itching, tenderness, or swelling in penis and/or groin area
• fever (rare)
• discharge from penis (usually moderate, yellow or clear, and may or may not be purulent)
• pain with intercourse or ejaculation
• blood in the urine and/or semen

In women

• dysuria
• increased urinary frequency or urgency
• fever/chills
• nausea/vomiting
• abdominal pain
• vaginal discharge
• PID (pelvic inflammatory disease)
• other infections of reproductive organs (cervicitis, salpingitis)
• fertility problems
• pelvic pain
• ectopic pregnancy
• complications of pregnancy (miscarriage, preterm delivery, premature rupture of membranes, fetal infection, postpartum infection)

A thorough physical examination of genitourinary tract needs to be performed.

For men, this includes abdomen, flank, suprapubic (bladder) area, penile, scrotal and digital rectal exams. These exams may reveal tender and enlarged inguinal lymph nodes (groin area), discharge from the penis, and/or a tender and swollen penis.

Tests and findings:

• Triple-void urine specimens for urinalysis and culture
  • #1 initial stream
  • #2 mid-stream
  • #3 post (after) prostatic massage by examiner
• Increased WBCs (inflammatory cells) and bacterial growth on culture in urine #1.
• Blood may be noted in urine #1.
• Cultures are obtained for gonorrhea and chlamydia.

For women, evaluation includes thorough abdominal and pelvic exams, evaluating for lower abdominal tenderness, uterine and adnexal tenderness, and purulent discharge from the urethra or cervix. Microscopic examination of the discharge may also aid in the diagnosis.

Laboratory tests include:

• Pregnancy test
• Urine analysis and culture
• CBC (complete blood count), C-reactive protein
• STD-specific cultures and blood tests
• Pelvic ultrasound

The goal of therapy is to improve symptoms, prevent spread of infection to other genitourinary tract organs/complications, and eliminate the cause of infection. Antibiotic therapy should be tailored to specific organism causing the infection; the patient may or may not need intravenous antibiotics.

Abstinence from intercourse or use of condoms should be recommended throughout the course of treatment. Again, partners must be treated as well.

Urethritis caused by trauma or chemical irritants is treated by avoiding the source of injury or irritation.

Analgesics (pain relievers) and urinary tract-specific analgesics (such as Pyridium) may be used along with antibiotics.

With appropriate diagnosis and treatment, urethritis usually clears up without any complications. However, urethritis can lead to permanent damage to the urethra and other genitourinary organs in both men and women.

Urethritis may lead to cystitis (bladder infection), pyelonephritis (kidney infection), epididymitis (epididymis infection), orchitis (testes infection), or prostatitis (prostate infection) in men.

In women, urethritis may cause PID (pelvic inflammatory disease), cervicitis (infection of the cervix), salpingitis (infection of the ovaries), and fertility problems, as well as ectopic pregnancy, miscarriage, and other complications of pregnancy.

Call your health care provider if symptoms suggesting urethritis occur, particularly if you have recently engaged in high-risk sexual behavior.

Some causes of urethritis may be avoided with good personal hygiene and by practicing safer sexual behaviors (such as monogamy and the use of condoms).