Urethritis is the infection and inflammation of the urethra, the small tube that provides passage for urine from the bladder to exit the body. Though it may seem like a straightforward condition, its implications are medically significant and often misunderstood. 

When it is progressing, it can result in pain or burning during urination, itching, and discharge from the urethra. The understanding of urethritis requires a multidisciplinary approach with clinical presentation, history of the patient, and proper treatment approaches. 

DocTutorials makes such a complex subject easy for NEET PG aspirants like you to help master fundamental clinical points and ace the exams. Keep reading for a detailed insight into urethritis.

What is Urethritis?

Urethritis refers to inflammation of the urethra—the thin tube that transmits urine from the bladder to the exterior of the body—usually resulting from infectious or, less often, non-infectious causes. Prompt diagnosis and therapy are essential to avoid complications, reinfection, and further spread.

The most common infectious pathogens are sexually transmitted organisms, such as Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma genitalium. Its symptoms can be dysuria (painful urination), urethral itching, and a number of different types of discharge, but some patients can be asymptomatic. 

What are the Symptoms of Urethritis?

Urethritis may have a range of signs and symptoms that are somewhat different between men and women. Whereas men tend to have obvious signs, women can have mild or no symptoms. The urethritis symptoms are as follows:

• Burning sensation or pain on urination (dysuria)
• Itching, irritation, or discomfort at the urethral opening
• Discharge from the penis or vagina (can be mucoid, purulent, or blood-streaked)
• Painful sexual intercourse (dyspareunia)
• Repeated or sudden urge to urinate
• Lower abdominal or pelvic pain
• Blood in semen or urine (in men)
• Painful ejaculation or swollen groin lymph nodes (in men)
• Vaginal discharge, fever, and chills (in women, if the infection is spread)

What are the Causes of Urethritis?

Urethritis is usually caused by infectious agents, particularly sexually transmitted ones, but in some cases, it can result from irritation, trauma, or unknown causes. The common causes are:

• Involvement of bacterial STIs (sexually transmitted infections), such as Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Ureaplasma urealyticum, and Trichomonas vaginalis.
• Viral Infections like Herpes simplex virus (HSV), Cytomegalovirus (CMV)
• Yeast infections 
• Chemical irritation by spermicides, soaps, or contraceptive gels
• Physical trauma or friction (e.g., forceful sexual activity or repeated cycling)
• Urinary catheterisation or insertion of objects into the urethra
• Trauma or compression of the urethra
• Male sex (particularly between the ages of 20–35 years)
• Having multiple sexual partners
• High-risk sexual behaviour (e.g., unprotected anal intercourse)
• History of STIs
• Use of irritating personal hygiene preparations
• Poor genital hygiene

How to Diagnose Urethritis?

Diagnosis of urethritis is a process that encompasses physical examination, history of the patient, and lab tests to determine the underlying cause and appropriate treatment. Here are the major diagnostic methods: 

• Assessment of Medical History

The physician starts by taking a thorough medical and sexual history to determine risk factors, recent exposure, and the pattern of urethritis symptoms. 

• Physical Examination 

In men, the practitioner checks the abdomen, penis, scrotum, and urinary meatus (the opening at the tip of the penis) for swelling or discharge. On the other hand, in women, a pelvic, vaginal discharge, and abdominal examination is performed to check for urethral or lower abdominal tenderness. 

• Laboratory Tests

Lab tests involve urinalysis, in which a sample of urine is examined to see if white blood cells, bacteria, or other indicators of infection are present. It also includes tests like urethral swabs and discharge tests, nucleic acid amplification tests (NAATs), and blood tests to assess inflammation or systemic infection.

• Cystoscopy

A camera-equipped flexible tube is put through the urethra into the bladder to examine the urinary tract for abnormalities, particularly if symptoms persist or structural problems are suspected.

• Pelvic Ultrasound

In women, it may be done to eliminate complications such as pelvic inflammatory disease (PID).

What is the Treatment for Urethritis?

The primary method of treating urethritis involves antibiotics, which may be used separately or in combination. Some commonly prescribed antibiotics used as urethritis medications include:

• Azithromycin
• Ofloxacin
• Levofloxacin
• Doxycycline
• Ceftriaxone
• Cefixime

Additionally, healthcare providers might suggest these medicines for urethritis treatment:

• Non-steroidal anti-inflammatory drugs (NSAIDs), like naproxen, are used to alleviate pain.
• Phenazopyridine which helps lessen the urgency and frequency of urination.

FAQs About Urethritis

1. Can urethritis lead to challenges in urination?

Yes, urethritis can make urination difficult and can cause a burning sensation while doing so. It is often accompanied by a frequent or urgent need to urinate due to the inflammation of the urethra.

2. What complications can arise from untreated urethritis?

If urethritis is left untreated, it can lead to serious complications like bladder or kidney infection, infertility, pelvic inflammatory disease in females, prostatitis or urethral stricture in males, and, in the worst possible case, life-threatening sepsis.

3. How can I avoid urethritis?

You may avoid urethritis through the practice of safe sex, lowering the number of sexual partners, use of condoms, and regular STI screenings. You should also maintain hydration after sex and avoid irritants such as spermicides or acidic foods.

4. What warning signs of urethritis should require immediate medical attention?

It is crucial to obtain immediate medical help if you have severe abdominal or pelvic pain, fever or high chills, blood in discharge or urine, or worsening or no relief of your symptoms with initial urethritis treatments.

5. What is the most effective treatment for urethritis?

Urethritis is typically treated with antibiotics. To recover, it may take one to two weeks for the symptoms to completely disappear.

Conclusion

Urethritis, despite being a focal (localised) infection, indicates the intricacy of diagnosing and treating genitourinary conditions. A clear understanding of its aetiology, presentations, and management is crucial for any budding clinician. 

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