Understanding Urethritis and its symptoms, causes

Urethritis is inflammation of the urethra, the tube that carries urine from the bladder out of the body. It is usually caused by an infection.

The term non-gonococcal urethritis (NGU) is used when the condition is not caused by gonorrhoea. If you think you have NGU, see your general practitioner.

NGU can have a number of possible causes, including irritation to the urethra and sexually transmitted infections (STI).

Chlamydia causes 43 out of 100 cases of NGU. There are cases of NGU where no infection is found. You will still be offered treatment for possible infection.

This is also the case if inflammation is caused by an object, such as a catheter in the urethra, or by using creams and soaps around the genitals.

Urethritis is the most common condition among men – about 80,000 men are diagnosed with urethritis every year.

It is more difficult to diagnose urethritis in women because it may not cause as many symptoms.

Symptoms

In women, NGU rarely has noticeable symptoms unless the infection spreads to other parts of the reproductive system, such as the womb or fallopian tubes (which connect the ovaries to the womb).

If the infection does spread, a woman may develop pelvic inflammatory disease (PID), a serious and painful condition.

Repeated episodes of PID are associated with an increased risk of infertility.

Some women don’t have symptoms. If there are any, they may include:

• Pain around the pelvis or lower part of your stomach
• Discomfort or pain deep inside the pelvis during sexual intercourse
• Bleeding between periods and after 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 of 38 Degrees Celsius or above
• Nausea and vomiting

Symptoms in men include:

• A painful or burning sensation when urinating
• The tip of the penis feeling irritated and sore
• A white or cloudy discharge from the tip of the penis
• A frequent need to urinate

Symptoms may begin a few weeks or several months after infection. If NGU has a non-infectious cause, such as irritation to the urethra, symptoms may begin after a couple of days.

Symptoms that start a day or two after sex are usually not caused by an STI, but testing for one is still recommended.

If a current or recent sexual partner informs you that you may have been exposed to an STI that can cause NGU, but you don’t have any symptoms, get tested anyway and seek treatment even if the symptoms of NGU disappear on their own, as there is still a risk you could pass the infection on to someone else.

Causes

Non-specific urethritis (NSU) is most commonly caused by an infection, although there are many cases where no cause is found.

Although STIs can cause NGU, it does not result from a gonorrhoea infection. Urethritis caused by gonorrhoea is called gonococcal urethritis.

Chlamydia – In men, chlamydia is thought to be responsible for up to 43 out of 100 cases of NGU; in women, about four in 10 cases. Chlamydia is an STI and is spread during unprotected sex (sex without a condom), including anal and oral sex

Other infections – A number of other infections can cause NGU. These include bacteria that usually live harmlessly in the throat, mouth or rectum. They can cause NGU if they get into the urethra. This can occur during oral or anal sex.

Non-infectious causes – It is possible for NGU to have a non-infectious cause. This is when something else leads to the urethra becoming inflamed. Non-infectious causes of NGU include: irritation from a product used in the genital area such as soap, deodorant or spermicide; damage to the urethra caused by vigorous sex or masturbation or by frequently squeezing the urethra; damage to the urethra caused by inserting an object into it, such as a catheter.

Sexually transmitted infections – Urethritis is more common among people who are at risk of STIs. This includes people who are sexually active; have had unprotected sex; or have recently had a new sexual partner.

Diagnosis

There are two tests that are usually used to diagnose NGU – a swab test and a urine test. Both may be carried out to ensure the diagnosis is correct.

It is recommended that you are also tested for gonorrhoea and chlamydia at the same time as NGU. These are two STIs that often cause urethritis. You may also be offered tests for other STIs, including HIV.

It is up to you whether to have these or not, but a test for all infections is recommended. You can discuss this with the healthcare professional.

A swab test involves taking a small sample of fluid from your urethra.

The sample can then be examined under a microscope to look for evidence of inflammation or bacteria known to cause NGU.

Urine tests are also done, testing for bacteria known to cause NGU, such as chlamydia.

Treatment

It is important you make sure you take your treatment as prescribed, make sure all your recent partners get the treatment, and not have sex until a week after everyone has been treated.

NGU is usually treated with a short course of antibiotics to kill the bacteria that caused the infection.

Treatment with antibiotics may be started before you receive your test results.

A CRP test can be conducted to confirm whether the cause is infective or not, so you are not given antibiotics unnecessarily.

Most people with NGU are prescribed antibiotic tablets or capsules:

Azithromycin – which is taken just once as a single dose.

Doxycycline – which is taken twice a day for seven days. Antibiotics may cause side effects, such as feeling sick, vomiting, diarrhoea and thrush.

Antibiotics used to treat NGU may interact with the combined contraceptive pill and the contraceptive patch. Your general practitioner or nurse can advise you about which additional contraception is suitable.

Informing partners

It is important your current sexual partner is tested and treated. Any sexual partners you have had since being exposed to the STI will also need to be informed, so they can be tested and treated.

It is suggested you inform any person you have had sex with in the last three months, but this timeframe can vary.

Some people can feel angry, upset or embarrassed about discussing STIs with current or previous partners. However, don’t be afraid to discuss your concerns with your doctor.

He can advise you about who to contact and the best way to contact them.

With your permission, the clinic can arrange for a letter to be sent. The letter explains they may have been exposed to an STI and advises them to have a check-up.

The letter does not have to have your name on it if you so wish. Nobody can force you to tell any of your partners about your STI, but it is strongly recommended you do so.

Left untested and untreated, STIs such as chlamydia can have serious effects on a person’s health, particularly for women.

Complications of untreated chlamydia include:

• Infection of the testicles;
• Infection of the cervix (neck of the womb) in women
• PID, which can increase the risk of infertility and ectopic pregnancy

Complications

NGU can have serious complications, although these are rare.

Persistent urethritis – The most common complication, when you still have urethritis one to three months after being treated for NGU. This affects one or two men in every 10 who are treated for NGU, and can affect women too.

Reactive arthritis – Reactive arthritis is an uncommon complication of NGU, estimated to affect less than one in 100 people with the condition. This can cause joint pain, conjunctivitis (inflammation of the eyes) and recurring urethritis.

Epididymo-orchitis – This is a possible complication of NGU in men. It is a combination of inflammation of the epididymis (a long coiled tube in the testicles that helps store and transport sperm) and testicles.

Pelvic inflammatory disease (PID) – In women, pelvic inflammatory disease (PID) can be a result of NGU if left untreated. PID is a serious condition that can increase the risk of infertility and ectopic pregnancy