Urethritis is an inflammation of the urethra. It is the tube which carries urine from the bladder to eliminate from the body.  

Infection, chemicals, or trauma may cause the associated condition. It is caused due to sexually transmitted infections. 

Urethra injury from catheter or aggressive sex leads to urethritis inflammation. 

Risk factors classified as: 

Infectious causes 

Non- Infectious causes 

Symptoms includes: 

Pain or burning sensation during urination 

Discharge from the urethra 

Pain during sexual intercourse 

Itching or irritation around the urethra 

Blood in the urine or semen 

Unrecognized STD epidemic in the US poses serious threat to health and economy. 20 million cases of STD occur every year in the US, with treatment cost of $16 billion dollars annually.  

CDC notes asymptomatic chlamydial infections make case rates due to screenings.  

Highest urethritis incidence in sexually active people between 20 to 24 years old. 

Urethritis risk higher in men who have sex with men compared to heterosexuals. 

Gram-negative intracellular diplococci on urethral smear indicate gonococcal urethritis.  

Sexually transmitted organism responsible for 15% to 25% of NGU cases in the US are suspected in recurrent urethritis. 

Posttraumatic urethritis possible in 2% to 20% after catheterization or instrumentation/foreign body. 

Haemophilus species cause NGU in patients with unprotected oral sex. 

Causes of urethritis are: 

Sexually Transmitted Infections 

Non-Sexually Transmitted Infections 

Chemical Irritants 

Physical Trauma 

Autoimmune and Systemic Conditions: 

10% to 40% of women with urethritis develop PID, which occurs infertility and ectopic pregnancy due to scar formation. 

Infants of mothers with Chlamydia infection may develop eye, ear, or lung infections during birth. 

C-sections in chlamydia positive mothers and using anti-chlamydial eyedrops on newborns reduce infection rates. 

Patients with uncomplicated urethritis recover spontaneously. 

The clinical history involves a detailed review of symptoms, risk factors, history of present illness, medical history, and sex history of patient. 

• Genitourinary Examination 
• Abdominal Examination 
• Systemic Examination 
• Pelvic Examination 

Acute symptoms are: 

• Sudden onset of dysuria 
• Visible urethral discharge 
• Increased urinary frequency 
• Pain or discomfort in the genital area 

Chronic symptoms are: 

• Persistent mild dysuria 
• Chronic low-grade urethral discomfort or irritation 
• Intermittent 

Use antibiotics to prevent illness and reduce spread. Treat sexual contacts to prevent reinfection. 

Antibiotics for urethritis use to treat both gonococcal and nongonococcal causes, side effects, cost, and adherence. 

Neisseria gonorrhoeae treatment complexity rises with resistance evolution and decreased culture use. 

Use single dose of ceftriaxone 500 mg through intramuscular route for the treatment of GU.  

If ceftriaxone is not available, then administer dose of cefixime 800 mg orally in a single dose. 

WHO recommends one dose of specific antibiotics for genital gonorrhea based on local susceptibility data. 

Re-evaluate patients with persistent symptoms for Mycoplasma genitalium following treatment with doxycycline for NGU. 

Urology

Regularly clean genital area with mild soap to prevent infections. 

Post-sex urination reduces infection risk with flushing bacteria out from urethra. 

Use condoms regularly to reduce the risk of sexually transmitted infections and reduce the number of sexual partners. 

Organise public health campaigns to promote safe sex practice from STIs. 

Proper awareness about urethritis should be provided and its related causes with management strategies. 

Appointments with a urologist and preventing recurrence of disorder is an ongoing life-long effort. 

Urology

Ceftriaxone: 

It is a first-line treatment choice for gonococcal urethritis caused due to Neisseria gonorrhoeae. 

Urology

Moxifloxacin: 

It inhibits DNA gyrase that causes inhibition of bacterial DNA replication and transcription. 

Urology

Doxycycline: 

It inhibits protein synthesis that binds to 30S ribosomal subunits of susceptible bacteria. 

Azithromycin: 

It binds with 50S ribosomal subunit of susceptible microorganisms to blocks dissociation of peptidyl tRNA. 

Urology

Cystoscopy is performed for visual inspection of the urethra and bladder using a cystoscope and thin flexible tube with a camera. 

Meatotomy is surgical enlargement of the urethral opening to treat meatal stenosis. 

Urology

In the initial assessment phase, evaluation of patient history, sex history, and laboratory test to confirm diagnosis. 

Pharmacologic therapy is effective in the treatment phase as it includes use of antibiotics, fluroquinolones, tetracyclines, and macrolides. 

In supportive care and management phase, patients should receive required attention such as lifestyle modification and intervention therapies. 

The regular follow-up visits with the urologist are scheduled to check the improvement of patients along with treatment response.