Why it may hurt to wee

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, you should visit your local general practitioner for examination and tests.

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

Chlamydia causes up to 43 of every 100 cases of NGU. There are many cases of NGU where no infection is found.

If no cause 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 diagnosed and treated among men in clinics.

Around 80,000 men are diagnosed with urethritis every year. It is more difficult to diagnose in women because it may not cause as many symptoms.

Symptoms

In women, NGU rarely has any 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). This is a serious health condition that can cause persistent pain.

Repeated episodes of PID are associated with an increased risk of infertility. Some women with PID don’t have symptoms. If there are
symptoms, they include:

• Pain around the pelvis or lower part of your stomach
• Discomfort or pain during sexual intercourse that is felt deep inside the pelvis
• Bleeding between periods and after sex
• Pain when you urinate
• Heavy or painful periods
• Unusual vaginal discharge, especially yellow or green

A few women with PID become very ill with:

• Severe lower abdominal pain
• A fever
• 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
• A frequent need to urinate

Depending on the cause, 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 STIs is still recommended.

If a current or recent sexual partner informs you that you may have been exposed to a STI that can cause NGU, but you don’t have symptoms, don’t assume that you do not have NGU.

If this happens, it is always recommended that you get tested. You should still seek treatment if the symptoms of NGU disappear on their own.

Diagnosis

There are two tests – a swab test and a urine test and both may be carried out to ensure the diagnosis is correct.

It is recommended you are also tested for gonorrhoea and chlamydia. These are STIs that often cause urethritis.

You may also be offered tests for other STIs, including HIV. A test for all infections is recommended.

A swab test involves taking a small sample of fluid from your urethra. The sample is examined under a microscope to look for evidence of inflammation or bacteria known to cause NGU.

A urine sample will be tested for bacteria known to cause NGU.

Treatment

Make sure you take your treatment as prescribed; make sure all your recent partners get the treatment; do not have sex until a week after everyone has been treated.

NGU is usually treated with a short course of antibiotics. Treatment with antibiotics may be started before you receive your test results.

A C-reactive protein test can be conducted to confirm whether the cause is infective so you are not given antibiotics unnecessarily.

Most people with NGU are prescribed antibiotic tablets or capsules. This may be:

• Azithromycin – which is taken just once as a single dose.
• Doxycycline – which is taken twice a day for seven days.

Antibiotics may cause some 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.

If you use these methods of contraception, your GP or nurse can advise you about which additional contraception is suitable.

Dr Dulcy Rakumakoe. Picture: Refilwe Modise

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