What Is It?

Urethritis is an inflammation of the urethra, which is the tube that carries urine out of the body. It can be caused by:

• Mechanical injury from an instrument such as a urinary catheter or a cystoscope, which is used to examine the urethra
• An irritating chemical such as an antiseptic or a spermicide
• Infection

Doctors usually classify infectious urethritis into two categories: gonococcal urethritis, caused by gonorrhea bacteria, and nongonococcal urethritis, caused by bacteria other than gonorrhea.

Gonococcal urethritis, commonly called clap, is a sexually transmitted disease (STD) that is caused by bacteria called Neisseria gonorrhoeae. These bacteria can be passed from person to person during sexual activity (vaginal, oral and anal intercourse). In addition to urethritis, these bacteria can cause cervicitis and vaginitis. If untreated, these gonorrhea infections in the lower portions of the reproductive tract can spread to higher portions of the reproductive tract, causing prostate inflammation (prostatitis) and inflammation of the epididymis and testes (epididymo-orchitis) in men and pelvic inflammatory disease in women. Less commonly, gonorrhea can spread through the bloodstream, causing fever, rash and arthritis. In very rare cases, it can cause serious infections such as endocarditis (infection of a heart valve), meningitis, or osteomyelitis. If a pregnant woman has untreated gonorrhea, bacteria can spread to the eyes of her baby during childbirth, causing gonococcal ophthalmia, a severe eye infection in newborns. Approximately 600,000 people in the United States are diagnosed with gonorrhea every year. However, the total number of cases might be much higher because many people with gonorrhea do not seek treatment.

Nongonococcal urethritis is diagnosed if laboratory tests show that a person with urethritis has no signs of gonorrhea bacteria. The most frequent cause (in 20 percent to 50 percent of cases) is chlamydia. Chlamydia is an STD that is caused by Chlamydia trachomatis, a species of bacteria that can be found in the urine and in genital-tract secretions of infected people. In addition to causing urethritis, chlamydia can affect several other areas of the reproductive tract, resulting in vaginitis, cervicitis and pelvic inflammatory disease. Chlamydia bacteria also can cause eye infections and pneumonia in newborns who have been delivered to mothers with chlamydia. Nongonococcal urethritis is the most common form of STD in the United States, with an estimated 4 million new cases occurring each year. In addition to chlamydia, other possible infectious causes of nongonococcal urethritis include Ureaplasma urealyticum, Mycoplasma genitalium and Trichomonas vaginalis.

Because 15 percent to 25 percent of males and 35 percent to 50 percent of females with gonorrhea are infected with chlamydia at the same time, doctors typically treat for both diseases at once.

In men, gonococcal urethritis can cause:

• Discharge from the urethra, the tube that carries urine from the bladder to the outside of the body
• Redness around the urethra
• Frequent urination
• Pain or burning during urination

These symptoms generally happen within two to 10 days after a man has been exposed to gonorrhea.

In women, gonorrhea does not cause any symptoms in about 60 percent of cases. When symptoms occur, they can include:

• Pain or discomfort during urination
• Vaginal discharge
• Discomfort in the anal or rectal area

In at least 15 percent of women, the bacteria will spread to the upper reproductive tract (uterus and fallopian tubes), causing additional symptoms, including:

• Pain during intercourse
• Abdominal pain
• Abnormal menstrual bleeding
• Fever

Chlamydia does not cause any symptoms in about 75 percent of infected women and 50 percent of infected men. Because of this, many infected people remain untreated and have the potential to spread chlamydia to others. When nongonococcal urethritis caused by chlamydia or other organisms causes symptoms, they generally are the same as those caused by gonococcal urethritis.

During a physical examination, your doctor will look for an abnormal discharge, usually mucus or pus, from your urethra. In women, a pelvic examination will be performed to look for tenderness, redness or abnormal discharge from the cervix and vagina.

Gonococcal urethritis — Your doctor will take a sample of the discharge from your urethra and have it examined in a laboratory for signs of gonorrhea bacteria. He or she also may ask for a urine sample to perform further laboratory tests.

Nongonococcal urethritis — Your doctor can diagnose this condition if the tests for gonorrhea bacteria are negative. He or she can confirm the diagnosis of chlamydia infection with a urine test, or by swabbing the urethra or cervix and sending the specimen to a laboratory to check for the presence of chlamydia.

Once you start taking antibiotics, bacterial urethritis improves rapidly. Without treatment, the symptoms of gonorrhea and chlamydia urethritis usually go away within three months. However, people continue to remain infectious, and spread the infection to others even when they have no symptoms. Untreated infections can spread to the fallopian tubes in women, where they can cause permanent scarring and infertility.

Because both gonococcal and nongonococcal urethritis are caused by microbes that can be transmitted during sexual intercourse, you can prevent these infections by:

• Not having sex
• Having a sex with only one uninfected partner
• Consistently using male latex condoms during sexual activity, with or without a spermicide

Having sexually transmitted urethritis may increase your risk of HIV infection. If you already have HIV, urethritis may increase the risk that you will pass HIV to a sex partner.

Both types of urethritis can be treated with a variety of antibiotics. Because certain strains of bacteria have become resistant to specific antibiotics, your doctor may need to prescribe a different antibiotic if symptoms continue after you have finished taking the first prescription.

All sex partners of a person infected with either type of urethritis also should be treated. People who are taking antibiotics for urethritis should not have sex until the treatment is complete.

Because many people have gonorrhea and chlamydia at the same time, health experts recommend that all people treated for gonorrhea should be treated for chlamydia as well. For this reason, you may need to take two types of antibiotics, because many commonly used antibiotics will treat only one of the two infections.

Men should call a doctor if they notice an abnormal discharge from the penis, especially if the discharge is cloudy and filled with pus. Women should seek medical attention if they develop an unusual vaginal discharge or bleeding or pain during intercourse. Both men and women should call a doctor if they start urinating more frequently, or if urination causes pain or a burning discomfort, especially if fever or chills occur. Also call your doctor if you have participated in sexual activity with someone who has gonorrhea or chlamydia, especially if you are pregnant.

All sexually active men and women should schedule a routine physical examination every year, even if they have no symptoms of STDs. In women, this physical examination should include a pelvic exam.

If gonococcal urethritis is diagnosed and treated quickly and correctly, there usually is complete recovery. Incomplete recovery or no treatment can lead to advanced pelvic inflammatory disease in women, which can result in scarring that can lead to fertility problems. Full antibiotic treatment also cures chlamydia, and can prevent complications. If untreated, chlamydia infections in men can cause swollen and tender testicles.

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.