Urethritis is a condition, characterized by inflammation of the urethra. Bacterial and viral infections are known to cause this disorder.
Presentation
Symptoms of urethritis are different for men and women. The following symptoms are experienced [6]:
Symptoms in men with urethritis
- Experiencing burning sensation while urinating
- Itching and burning sensation near the penis region
- Blood in urine or semen
- Pain during intercourse or while ejaculation
- Development of fever
- Lymph nodes in the groin region enlarge
Symptoms in women with urethritis
- Development of abdominal pain, along with fever
- Increase in frequency of urination
- Pain during intercourse
- Discharge
- Burning sensation during urination
- Pain in the pelvic region if the infection has spread to the pelvic area
Entire Body System
- Enuresis
including primary enuresis in younger children. [clinicaladvisor.com]
Enuresis. For treatment regimens in children, see Gonococcal Infections and Chlamydial Infections chapters. Repeat testing should be offered to all children. [phac-aspc.gc.ca]
- Surgical Procedure
Lumbago कटिशूल, लूम्बेगो, कटिवात, Clinical applications include the control of pain in osteoarthritis, lumbago and migraine, and anaesthesia for certain surgical procedures, as well as other ... [studysite.org]
Catheterization Edit During a hospital stay or surgical procedure, a catheter may be inserted through the urethra to drain urine from the bladder. [en.m.wikipedia.org]
Admissions would be feasible for severe complications that may require intravenous antibiotics or surgical/procedural interventions or specialized consultations. Copyright © 2017, 2013 Decision Support in Medicine, LLC. All rights reserved. [infectiousdiseaseadvisor.com]
- Recurrent Urinary Tract Infection
It has classically been documented in older female patients with a history of recurrent urinary tract infections or kidney stones. Most of the literature points toward unilateral ureter involvement, with rare cases of bilateral findings. [shmabstracts.com]
Recurrent urinary tract infection and urinary Escherichia coli in women ingesting cranberry juice daily: a randomized controlled trial. Mayo Clin Proc. 2012;87(2):143-150. Takahashi S, Takeyama K, Kunishima Y, et al. [stlukes-stl.com]
Overview A urinary tract infection (UTI) is an infection in any part of your urinary system — your kidneys, ureters, bladder and urethra. Most infections involve the lower urinary tract — the bladder and the urethra. [mayoclinic.org]
- Perineal Pain
Perineal pain, scrotal masses. Difficulties initiating and maintaining stream. [phac-aspc.gc.ca]
Gastrointestinal
- Vomiting
[…] sex pain when you urinate heavy or painful periods unusual vaginal discharge – especially if it is yellow or green A few women with PID become very ill with: severe lower abdominal pain a fever (high temperature) of 38C (100.4F) or above nausea and vomiting [nhs.uk]
If you are experiencing other signs of illness, such as fever, nausea, vomiting, back and abdominal pain, you may need emergency care. These symptoms could mean the infection has moved beyond the urethra. [emedicinehealth.com]
Signs that the infection may be worsening include fever and chills, nausea, vomiting, and lower back pain. [medical-dictionary.thefreedictionary.com]
- Diarrhea
The other clinical findings which are observed rarely in Kawasaki disease include restlessness, diarrhea, bile tract inflammation, hepatitis, gallbladder hydrops, jaundice, pancreatitis, aseptic menigitis, anterior uveitis, arthralgia and arthritis, respiratory [medical-dictionary.thefreedictionary.com]
Common side effects of the antibiotic treatment include diarrhea, nausea, gastrointestinal upset, dyspepsia, hypersensitivity reactions, and in some cases, photosensitivity. Doxycycline is known to cause hepatic toxicity. [news-medical.net]
Gastrointestinal or Nutrition Issues Antibiotic-associated diarrhea or Clostridium difficile infection should be considered in patients with new-onset diarrhea or abdominal pain after initiation of antibiotics. J. [clinicaladvisor.com]
- Constipation
‘Other causes in women include vaginal infections, cystitis or urethritis, orthopedic problems, and chronic constipation.’ ‘In men, urethral discharge and dysuria are the most common symptoms of sexually transmitted urethritis.’ [en.oxforddictionaries.com]
Appendicitis उण्डुपुच्छशोथ, उण्डुकपुच्छशोथ, आंत में एक प्रकार का फोड़ा, आंत्रपुच्छकोप, उंडुकशोथ, उंडुकदाह, Appendicitis is a painful swelling of the appendix / Laxative use can be dangerous if constipation is caused by a serious condition such as appendicitis [studysite.org]
- Suprapubic Pain
Both cystitis and urethritis may present with pain or difficulty on urination (dysuria), frequency, urgency, and/or suprapubic pain or heaviness. A careful history may help differentiate between the two diseases. [clinicaladvisor.com]
Skin
- Flushing
If correct positioning is questioned, flush the catheter with 30 to 60 mL of normal saline. If the fluid can be flushed and aspirated easily, then the catheter is in the correct position. A catheter that will not irrigate is not in proper position. [msdmanuals.com]
E-coli, the most common cause of urethritis can be treated effectively with D-Mannose, a naturally occurring sugar that binds to E-Coli lectins, coating them and flushing them out of the bladder/urinary tract. [waterfall-d-mannose.com]
Alternative treatment For those individuals who seem to be more susceptible to urinary tract infections, drinking lots of fluids at the first sign of an infection can ward it off by diluting the bacteria present and flushing the system. [medical-dictionary.thefreedictionary.com]
To flush bacteria from the vaginal tract, women should drink some water prior to sexual intercourse and urinate within 15 minutes afterward; if necessary, they should use a water-soluble lubricant (not petroleum jelly) to decrease the risk of bruising [healthcommunities.com]
Ears
- Hearing Impairment
Where to get help Your doctor Melbourne Sexual Health Centre Tel. (03) 9341 6200 or 1800 032 017 or TTY (for the hearing impaired) (03) 9347 8619 Family Planning Victoria Tel. 1800 013 952 or (03) 9257 0100 or (03) 9257 0116 Action Centre (for youth) [betterhealth.vic.gov.au]
Musculoskeletal
- Arthralgia
The other clinical findings which are observed rarely in Kawasaki disease include restlessness, diarrhea, bile tract inflammation, hepatitis, gallbladder hydrops, jaundice, pancreatitis, aseptic menigitis, anterior uveitis, arthralgia and arthritis, respiratory [medical-dictionary.thefreedictionary.com]
Neurologic
- Irritability
NSU usually causes a discharge from the tip if the penis, pain on passing urine or irritation in the urethra. [sexualhealthkingston.co.uk]
Management The patient should be reassured that the symptoms are due to a mild irritation and not infection. [sahealth.sa.gov.au]
Common causes may include physical problems with the urethra, such as abnormal narrowing or urethral irritation or injury. [healthline.com]
Bubble baths should be avoided, because they can irritate the urethra. With regard to sexual transmission, as for any STD, not having sex is the only sure means of prevention. [humanillnesses.com]
[…] of mechanical irritation (e.g. scratching, manipulating), chemical irritation (e.g. new soaps, bubble bath, topical ointments), or contact or allergic irritation (e.g., new undergarments, new detergents). [clinicaladvisor.com]
Urogenital
- Urethral Discharge
Urethral discharge is muco-purulent or haemorrhagic. Periurethral induration may be palpable in some cases. Diagnosis rests on finding tubercle bacilli in the urine and the urethral discharge. [stdpioneer.org]
METHOD: From May 2007 to June 2011, men presenting to the clinic with self-reported symptoms of dysuria and/or urethral discharge were identified and underwent urethral swab, which was microscopically assessed for objective non-gonococcal urethritis. [ncbi.nlm.nih.gov]
- Dysuria
Case 1: a 55-year-old man came to our observation in July 2012 referring a 5-day-history of intense dysuria and scant mucoid urethral discharge. [ncbi.nlm.nih.gov]
Some men report only dysuria or discomfort without discharge. Urethritis can be classified as gonococcal or non-gonococcal urethritis (NGU), or non-specific urethritis (NSU), when no specific pathogen is identified. [sahealth.sa.gov.au]
- Hematuria
BACKGROUND: Idiopathic bulbar urethritis (IBU) is characterized by hematuria ± dysuria without infection. Symptoms result from inflammation of the bulbar urethra, distal to external sphincter. [ncbi.nlm.nih.gov]
Children who have urethritis may present with irritative voiding symptoms, such as dysuria, urgency, or frequency; possible urethral discharge; initial hematuria; or blood spotting on the underwear. [pedsinreview.aappublications.org]
[…] intercourse Multiple sexual partners History of other sexually transmitted infections References:[1][2][3][4][5][6][7] Clinical features Dysuria Burning or itching of the urethral meatus Urethral discharge: purulent, cloudy, blood-tinged, or clear Initial hematuria [amboss.com]
- Painful Ejaculation
For women, symptoms include: Unusual vaginal discharge Pelvic and abdominal pain Pain with intercourse Frequent or urgent urination Fever and chills Stomach pain Itching Symptoms in men include: Blood in urine or semen Painful ejaculation Penile discharge [medicalnewstoday.com]
- Dyspareunia
Dyspareunia Dyspareunia is the medical term for painful sexual intercourse. It’s often confused with vaginismus, but dyspareunia could be due to cysts, pelvic inflammatory disease, or vaginal atrophy. There’s not always a reason for vaginismus. [healthline.com]
They are closely interrelated and commonly overlooked in clinical practice.1 Pain may be experienced at vaginal entry, (superficial dyspareunia) or deep in the pelvis (deep dyspareunia). [ncbi.nlm.nih.gov]
A medical history and complete physical exam are needed to look for other causes of pain with sexual intercourse (dyspareunia). Treatment A health care team made up of a gynecologist, physical therapist, and sexual counselor can help with treatment. [m.ufhealth.org]
They may include: painful intercourse (dyspareunia), with tightness and pain that may be burning or stinging penetration being difficult or impossible long-term sexual pain with or without a known cause pain during tampon insertion pain during a gynecological [medicalnewstoday.com]
Workup
A preliminary physical examination would be carried out in men and women suffering from urethritis. In men, the abdomen, penis, scrotum and bladder will be examined. This would reveal tenderness and swelling in the penis region, abnormal discharge from penis and enlarged lymph nodes in the groin area.
In women, the abdominal and pelvic would be thoroughly examined. The examination would reveal tenderness of urethra accompanied by tenderness in the lower abdominal region and abnormal discharge from the urethra [7].
In many instances, a digital rectal examination would also be carried out. Some additional tests would also be required to confirm the condition of urethritis. These would include a complete blood count, urine culture to test for presence of bacterial infections, urethral swab and tests for sexually transmitted diseases [8]. In addition to these tests, women would also require a pregnancy test and pelvic ultrasound for diagnosing urethritis.
Urine
- Pyuria
The laboratory studies revealed anemia, neutrophilic leukocytosis, elevated erythrocyte sedimentation rate (ESR), hypoalbuminemia, negative rheumatoid factor, pyuria, proteinuria, and the presence of HLA-B27. [ncbi.nlm.nih.gov]
Diagnostics include urine dipstick (pyuria, positive leukocyte esterase), staining of a urethral sample, and nucleic acid amplification testing of first-void urine. [amboss.com]
Acute urethral syndrome Dysuria, frequency Pyuria syndrome > 7 days No bacteria of symptom PID Lower abdominal pain, adenexal tenderness on pelvic examination evidence of MPC often present Cervical gramstaining positive for gonococcus, endometritis on [de.slideshare.net]
Treatment
The primary goal of treatment of urethritis includes eradication of infection, methods to prevent spread of infection and effective management of symptoms. The following methods are employed for treating urethritis [9]:
- In case of bacterial infections, antibiotics are administered.
- In order to relieve symptoms, non steroidal anti-inflammatory drugs are given for relieving the pain
- If the condition does not subside with antibiotics, then a combination of various antibiotics may be required to treat the chronic form of urethritis [10].
- Individuals are advised to refrain from sex during the treatment regime. It is also required that the partner also receives treatment if urethritis is caused due to infections.
Prognosis
If urethritis is diagnosed in the preliminary stages and appropriate treatment is initiated, then the condition recovers completely without causing further complications. However when the disease progresses to more advanced stages then a condition known as urethral stricture can develop. This primarily occurs when the disease continues for longer duration and the urethral tissue gets damaged. In women, if the infection spreads to the pelvic region, then it can lead to fertility problems [5].
Etiology
Bacterial and viral infections are the major factors contributing towards development of urethritis. The bacteria responsible for causing sexually transmitted disease also cause inflammation of the urethra. The normal microflora that is present in the genital regions can also cause urethritis if they gain entry into the urinary tract. Certain viruses such as the human papillomavirus, cytomegalovirus and herpes simplex virus also causes urethritis.
Individuals who are sensitive to the chemicals which are used in spermicides, creams or foams are also predisposed to develop urethritis. Females who are in their reproductive age, males above 35 years, those having multiple sexual partners and those who practice unsafe sex are at an increased risk of developing urethritis [2].
Posttraumatic urethritis may occur following catheterization or foreign body insertion.
Epidemiology
It has been estimated that about 4 million cases of urethritis occur in America each year. Gonococcoal urethritis strikes 700,000 individuals annually. The occurrence rate of gonococcal urethritis has undergone a significant decline from the year 2000. The incidence of nongonococcal urethritis is increasing and about 3 million cases occur annually.
Statistics have also reported that across the globe, about 62 million and 89 million new cases of gonococcal and nongonococcal urethrtitis respectively occur each year [3].
Pathophysiology
There are 2 basic phenomenons that give rise to the condition of urethritis. Infections and traumatic events like catheterization or foreign body insertion can favor development of inflammation of the urethra. Of these, infections are known to be the major causative factor. Bacteria that cause sexually transmitted diseases are the major organisms that are known to play foul.
Patients who undergo catheterization and instrumentation are at an increased risk of contracting urethritis. Individuals who use latex catheterization are 10 times more likely to develop the condition than those who make use of silicone catheterization. In addition to these factors, individuals suffering from certain infectious syndromes such as otitis media, pneumonia, reactive arthritis, prostatitis, urinary tract infection, epididymitis and proctitis are also at an increased risk of suffering from urethritis [4].
Prevention
Practicing safe sex is one of the major methods of preventing urethritis. In addition, following various ways to promote good urinary tract health would also go a long way in preventing the onset of urethritis. Individuals are advised to drink plenty of fluids and urinate shortly after intercourse. Such a practice would help in flushing out bacteria from the urinary system [11].
Summary
Urethra is a tube that is responsible for carrying urine and the removal of fluids from the body. Therefore, individuals suffering from urethritis, experience painful urination. The condition of urethritis, usually occurs due to inflammation caused by sexually transmitted diseases. In other words, individuals with sexually transmitted diseases are at an increased risk of contracting such a type of condition. Males and females are equally affected; however, it is thought that females have higher chances of being affected [1].
Patient Information
- Definition: Urethritis is a condition, characterized by inflammation of the urethra due to infection or underlying disease conditions. Males and female are at an equal risk of developing the condition.
- Cause: Bacteria that cause sexually transmitted disease also favor the development of urethritis. In addition, injury and allergic reaction to spermicidal can also increase the risk of inflammation of urethra.
- Symptoms: Common symptoms include burning sensation while urinating, pain during intercourse, abnormal discharge from the genital organs, blood in urine, abdominal pain and fever accompanied by chills.
- Diagnosis: A preliminary physical examination would be carried out for diagnosing urethritis. In addition, blood tests and urine culture tests are also indicated. A urethral or vaginal swab would also be required for analyzing presence of infections.
- Treatment: Antibiotics form the major part of the treatment regime if infections are the cause. Other medications to relieve the symptoms would also be required.
References
- Johnson LF, Lewis DA. The effect of genital tract infections on HIV-1 shedding in the genital tract: a systematic review and meta-analysis. Sex Transm Dis. Nov 2008;35(11):946-59.
- Bradshaw CS, Tabrizi SN, Read TR, et al. Etiologies of nongonococcal urethritis: bacteria, viruses, and the association with orogenital exposure. J Infect Dis 2006; 193:336.
- CDC. National overview of sexually transmitted diseases (STDs), 2012.
- Lee YS, Lee KS. Chlamydia and male lower urinary tract diseases. Korean J Urol. Feb 2013;54(2):73-7.
- Centers for Disease Control and Prevention. CDC Division of AIDS, STD, and TB. Gonococcal Isolation Surveillance Project (GISP) Annual Report - 2007. Atlanta, Ga: Centers for Disease Control and Prevention.
- Frenkl T, Potts J. Sexually Transmitted Infections: Part II - Associated Vaginitides and Urethritides. AUA Update Series. 2006;25:17-9.
- William M. McCormack. Urethritis. In: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Disease, 7, Gerald L Mandell, John E. Bennet, and Raphael Dolin. (Eds), Elsevier, 2010. Vol I, p.1485.
- Orellana MA, Gómez-Lus ML, Lora D. Sensitivity of Gram stain in the diagnosis of urethritis in men. Sex Transm Infect 2012; 88:284.
- Manhart LE, Gillespie CW, Lowens MS, Khosropour CM, et al. Standard Treatment Regimens for Nongonococcal Urethritis Have Similar but Declining Cure Rates: A Randomized Controlled Trial. Clin Infect Dis. Jan 3 2013;
- Mena LA, Mroczkowski TF, Nsuami M, Martin DH. A randomized comparison of azithromycin and doxycycline for the treatment of Mycoplasma genitalium-positive urethritis in men. Clin Infect Dis 2009; 48:1649.
- Ochsendorf FR. Sexually transmitted infections: impact on male fertility. Andrologia. Apr 2008;40(2):72-5.