Dr Dulcy: urinary tract troubles

URETHRITIS: MOST COMMON CONDITION DIAGNOSED IN MEN IN CLINICS Women have fewer symptoms, making it harder to diagnose.

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. If you think you have urethritis, you should visit your local general practitioner for examination and tests.

The usual infective causes are Gonorrhoea and Chlamydia, which account for up to 43 out of 100 cases. But there are many cases of urethritis where no infection is found. Urethritis is the most common condition diagnosed in men in clinics. About 80 000 men are diagnosed with it every year. It is more difficult to diagnose urethritis in women as it may not cause as many symptoms.

Symptoms

In women, urethritis rarely has any symptoms unless the infection spreads to other parts of the reproductive system, such as the womb or fallopian tubes.

If the infection does spread, a woman may develop pelvic inflammatory disease (PID). PID is a serious condition that can cause persistent pain. 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 intercourse 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:

painful or burning sensation when urinating.

the tip of the penis feeling irritated and sore.

white or cloudy discharge from the tip of the penis.

frequent need to urinate. Depending on the cause, symptoms may begin a few weeks or several months after infection. If it 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 sexually transmitted infection (STI) that can cause urethritis, but if you don’t have any symptoms, don’t assume you do not have it. Get tested.

Causes

Urethritis caused by gonorrhoea is called gonococcal urethritis. Other causes include: Chlamydia: This is caused by

Chlamydia trachomatis bacteria. It is an STI spread during unprotected sex, including anal and oral sex.

Other infections: These include 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, 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 during an operation in hospital.

Sexually transmitted infections: Urethritis can be caused by an STI.

Diagnosis

Two tests are used – a swab test and a urine test. A swab test involves taking a small sample of fluid from your urethra. This is examined under a microscope for evidence of inflammation or bacteria known to cause urethritis.

Treatment

It is important to have treatment as prescribed, make sure all your recent partners get treatment and do not have any sex until a week after everyone has been treated. The treatment is usually a short course of antibiotics. It may be started before you receive test results. A CRP test can be conducted to confirm if the cause is infective or not so you do not take antibiotics unnecessarily.

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 also need to be tested. It is suggested that you inform any person you have had sex with in the past three months, but this timeframe can vary. Your doctor can advise you about who to contact and the best way to do it. With your permission, the clinic can arrange for a letter to be given to your former partner/s explaining they may have been exposed to an STI and need to have a check-up.

Complications of urethritis

Persistent urethritis: The most common complication is 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: This is an uncommon complication of urethritis estimated to affect less than one in 100 people with it. It can cause joint pain, conjunctivitis and recurring urethritis.

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

PID: In women, PID can result if urethritis is untreated. PID can increase the risk of infertility.