Urethritis is the inflammation of the urethra. The most common symptoms include painful or difficult urination and urethral discharge. It is a commonly treatable condition usually caused by infection with bacteria. This bacterial infection is often sexually transmitted, but not in every instance; it can be idiopathic, for example. Some incidence of urethritis can appear asymptomatic as well. Symptoms and signs
Symptoms vary based on the cause of the diseases. For infectious causes of urethritis, symptoms may start a few weeks to several months after infection. Non-infectious causes of urethritis commonly show symptoms after a few days. Common symptoms include painful urination, continuous urge to urinate, itching and, urethral discharge. Additional symptoms vary based on assigned sex at birth. AMAB (assigned male at birth) individuals may experience blood in the urine or semen, itching, tenderness, or swelling of the penis, enlarged lymph nodes in the groin area, and/or pain with intercourse or ejaculation. AFAB (assigned female at birth) may experience abdominal pain, pelvic pain, pain with intercourse, or vaginal discharge. Non-gonococcal urethritis typically does not have noticeable symptoms in AFAB individuals, however, the infection can spread to parts of the reproductive system. Complications
Serious, yet rare complications associated with Neisseria gonorrhea, may include penile edema, abscessed tissue surrounding the urethra, urethral strictures such as scarring, and penile lymphangitis. If left untreated, the bacteria that cause non-gonococcal urethritis can lead to various complications. In individuals assigned male at birth, complications can lead to epididymitis, reactive arthritis, conjunctivitis, skin lesions, and discharge.
Past and current sexual partners should also be assessed and treated.Individuals displaying persistence or recurrence of symptoms should be instructed for possible re-evaluation. Although there is no standard definition, persistent urethritis is defined as urethritis that has failed to display improvement within the first week of initial therapy. Additionally, recurrent urethritis is defined as urethritis reappearing within 6 weeks after a previous episode of non-gonococcal urethritis. If recurrent symptoms are supported by microscopic evidence of urethritis, then re-treatment is appropriate. The following treatment recommendations are limited and based on clinical experience, expert opinions and guidelines for recurrent or persistent non-gonococcal urethritis:
If doxycycline was prescribed as initial therapy, give azithromycin 500 mg or 1 gram for the first day, then give azithromycin 250 mg once daily for 4 days plus metronidazole 400 – 500 mg twice daily for 5 days
If azithromycin was prescribed as initial therapy, then give doxycycline 100 mg twice daily for 7 days plus metronidazole 400 – 500 mg twice daily for 5 – 7 days
Moxifloxacin 400 mg orally once daily for 7 – 14 days can be given with use of caution, if macrolide-resistant M. genitalium infection is demonstrated Appropriate treatment for these individuals may require further referral to a urologist if symptoms persist after initial treatment. Epidemiology
Urethritis is one of the most common sexually transmitted infections found in men. Gonorrhea and chlamydia are the main pathogens causing urethritis. Health organizations break down the rate of urethritis based on its etiology.