Dr Dulcy on the scourge of urethritis
COMMON: AROUND 80 000 MEN ARE DIAGNOSED WITH THE CONDITION EVERY YEAR
The illness is usually treated with a short course of antibiotics to kill the bacteria.
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 usual infective causes are gonorrhoea and chlamydia which account for up to 43 out of 100 cases.
There are many cases of urethritis, though, where no infection is found.
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 much more difficult to diagnose urethritis in women because it may not cause as many symptoms.
SYMPTOMS
In women, urethritis rarely has any symptoms unless the infection spreads to other parts of the female 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).
PID 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 (abdomen)
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 if it is yellow or green
A few women with PID become very ill with:
severe lower abdominal pain a fever (high temperature) of 38oC or above
nausea and vomiting
Symptoms of urethritis 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
Depending on the cause of the urethritis, symptoms may begin a few weeks or several months after an infection.
If it has a non-infectious cause, such as irritation to the urethra, symptoms may begin after a couple of days.
If a current or recent sexual partner informs you that you may have been exposed to a sexually transmitted infection (STI) that can cause urethritis, but you don’t have any symptoms, don’t assume that you do not have it. If this happens, get tested.
CAUSES
Urethritis caused by gonorrhoea is called gonococcal urethritis. Other causes include:
Chlamydia – Chlamydia is caused by chlamydia trachomatis bacteria. It 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 urethritis. These include other bacteria that usually live harmlessly in the throat, mouth or rectum. The spread can happen during oral or anal sex.
Non-infectious causes – This is when something else leads to the urethra becoming inflamed. These 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 of the urethra, damage to the urethra caused by inserting an object into it, such as a catheter – this can be done during an operation in hospital.
Sexually transmitted infections (STIs) – Urethritis can be caused by an STI and is more common among people who are at risk of STIs. This includes people who are sexually active or have had unprotected sex.
DIAGNOSIS
There are two tests that are usually used to diagnose urethritis – a swab test and a urine test.
Either test can be used, although both may be carried out to ensure the diagnosis is correct. You may also be offered tests for all STIs, including HIV.
A swab test involves taking a small sample of fluid from your urethra, which is the tube that carries urine from the bladder to the outside of the body.
The sample is then examined under a microscope to look for evidence of inflammation or bacteria known to cause urethritis.
TREATMENT
It is important that you make sure you take your treatment as prescribed, make sure all your recent partners get the treatment and not have any sex until a week after everyone has been treated.
The illness 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 that you are not given antibiotics unnecessarily.
INFORMING PARTNERS
It is important that 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 that 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 their current partner or previous partners.
However, don’t be afraid to discuss your concerns with your doctor.
They 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 given to your former partner or partners.
The letter explains that they may have been exposed to an STI and advises them to have a checkup.
COMPLICATIONS OF URETHRITIS
Persistent urethritis – The most common complication is persistent or recurrent urethritis. This is when you still have urethritis one to three months after being treated. This affects one or two men in every 10 who are treated, and can affect women too.
Reactive arthritis – Reactive arthritis is an uncommon complication of urethritis, 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 – Epididymo-orchitis is a possible complication 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 the testicles. Pelvic inflammatory disease (PID) – In women, pelvic inflammatory disease (PID) can be a result of urethritis if left untreated. PID is a serious condition that can increase the risk of infertility and ectopic pregnancy.