Urethritis is inflammation of the urethra – the channel through which urine leaves the bladder. In men it is the most common manifestation of sexually transmitted infections and a frequent cause of burning when passing urine at a young age. In women the inflammation usually takes the form of cystitis or goes unnoticed.
Many people put off seeing a doctor or reach for whatever antibiotic is at hand. This is a mistake – untreated urethritis can affect the testicles and the prostate, leave a permanent narrowing of the channel and be passed on to a partner. Treatment is short and effective when it is aimed at the exact cause.
What is urethritis?
The lining of the urethra reacts to infection or irritation with inflammation, swelling and discharge. Depending on the cause, urethritis can be:
- Gonococcal – caused by the gonococcus (the bacterium behind gonorrhoea); it comes on suddenly and strongly, with a heavy discharge of pus.
- Non-gonococcal – most often caused by chlamydia, less often by mycoplasma, trichomonas or viruses; the symptoms are milder and sometimes absent.
- Non-infectious – after a catheter or other instrumentation, from irritating soaps and spermicides, or as part of reactive arthritis.
Symptoms
- burning, pain or itching in the urethra, worst when passing urine;
- a discharge from the urethra – thick and yellow-green with gonorrhoea, scant and mucous with non-gonococcal urethritis;
- redness and sticking together of the opening of the urethra, stains on your underwear;
- in women – burning, frequent urges or no symptoms at all.
Pain and swelling of a testicle with a fever mean that the infection has reached the epididymis – you need to be seen the same day. Sudden, very severe pain in a testicle may be torsion and requires the emergency department or 112 (the European emergency number) immediately, not waiting for an appointment. Being unable to pass urine and a high temperature with shivering are also reasons to seek emergency help.
Causes and risk factors
The main route of infection is unprotected vaginal, anal or oral sex. The risk is higher with a new partner or several partners and after a previous sexually transmitted infection. Non-infectious urethritis occurs in people with a catheter, after cystoscopy or after surgery. A person can carry and pass on chlamydia or gonorrhoea without having any symptoms.
Diagnosis
The consultation with Dr Penev is calm and confidential: a conversation about your symptoms and risky contacts, and an examination of the opening of the urethra, the penis, the testicles and, if needed, the prostate. The most accurate test is a molecular test of the first portion of urine (first-void urine) or of a discharge sample for chlamydia, gonorrhoea, mycoplasma and trichomonas; if there is a discharge of pus, a culture with antibiotic sensitivity testing is added. A routine urine test distinguishes urethritis from cystitis. With a sexually transmitted infection, testing for syphilis and HIV is also recommended, and with symptoms in the scrotum, an ultrasound. Consultations take place in Plovdiv and Karlovo by appointment.
Treatment
Treatment is with antibiotics chosen according to the cause: for gonorrhoea, an antibiotic injection, usually as a single dose, often combined with a medicine against chlamydia; for chlamydia, tablets for seven days; for mycoplasma and trichomonas, specific treatment regimens. If the picture is clear, Dr Penev may start treatment even before the results are back and adjust it once they are.
Two principles are essential. Partners from the last two months are tested and treated at the same time, even if they have no symptoms – otherwise the infection comes back. Sex is resumed only after both partners have finished treatment. With gonorrhoea and mycoplasma a test of cure is done, and after about three months a repeat test. In non-infectious urethritis the source of irritation is removed.
Untreated urethritis can lead to epididymitis, prostatitis, reduced fertility and urethral stricture, and in women to inflammation of the fallopian tubes and infertility.
When to see a urologist
Whenever you have burning when passing urine or a discharge from the urethra; after unprotected sex with a new partner, even without symptoms; with pain in or behind the testicles; and when your partner has been diagnosed with chlamydia or gonorrhoea. Treating yourself with an antibiotic blurs the picture and often leaves the infection incompletely treated.
Prevention
Using a condom every time outside a stable, mutually monogamous relationship is the most reliable protection. When you change partners, it is sensible for both of you to get tested. Avoid harsh intimate hygiene products and do not check the urethra by squeezing it. You will find more advice in the article how to prevent urinary infections.
Urethritis is treated successfully within days when it is diagnosed accurately and in time. Book an appointment with Dr Penev – discreetly and with a clear plan for you and your partner.
Frequently asked questions
How long after risky sex do symptoms appear?
With gonorrhoea usually after two to seven days, with chlamydia after one to three weeks, and some infected people have no symptoms at all. That is why testing after unprotected sex is sensible even without symptoms.
Can urethritis go away on its own?
The symptoms sometimes ease, but the infection remains and can spread to the testicles, the prostate or your partner. Without treatment a permanent narrowing of the urethra is also possible, so waiting it out and self-treatment are not a good idea.
When can I start having sex again?
Once both you and your partner have finished treatment, at least seven days have passed since it started and the symptoms have gone. Otherwise the infection is passed back and treatment has to start all over again.
Is the consultation confidential if a sexually transmitted infection is suspected?
Yes. The conversation, the tests and the results are covered by medical confidentiality. At the consultation you do not need to share more than is necessary for the correct diagnosis and treatment.
The information on this website is for general education and does not replace an examination and consultation with a doctor. If you have urgent symptoms, seek medical help immediately or call 112.