Contents of this article
What is Urethritis?
Urethritis is an inflammation of the urethra, which is the tube that carries urine out of the body. This condition is typically caused by a sexually transmitted infection (STI), either bacterial or viral infections. Although it can also result from an injury due to instruments such as urinary catheters or exposure to irritating chemicals like antiseptics or spermicides.
As a lower urinary tract infection (UTI), urethritis causes inflammation of the urethra, the fibromuscular tube responsible for expelling urine in both males and females. In males, the urethra also functions as a passage for semen. Urethritis is commonly associated with STIs and can be classified into gonococcal or nongonococcal types, with Neisseria gonorrhoeae and Chlamydia trachomatis being the primary causative agents.
Urethritis leads to difficulty or pain during urination and is typically caused by bacteria or viruses. It can also be triggered by chemical irritants.
Importantly, urethritis differs from a UTI, which usually affects the entire urinary tract. Although, they may have similar symptoms, but require different methods of treatment. Urethritis may be transmitted through unprotected sexual contact, and if a woman has a vaginal infection, it can be passed to her male partner.
Incidence of Urethritis
Urethritis affects individuals of all ages, with both males and females susceptible to the condition. However, females have a higher likelihood of developing urethritis compared to males. This increased risk is partly due to the anatomical differences; men's urethras are significantly longer, measuring the length of the penis, while a woman’s urethra is significantly shorter (approximately 1.5 inches). This shorter length makes it easier for bacteria to enter the urethra in females.
According to Antimicrobe, urethritis occurs in approximately 4 million Americans each year, with nongonococcal urethritis accounting for about 80 percent of these cases.
Risk factors for Urethritis
Several factors may also contribute to urethritis and they include;
- Being a female
- Being male (20 to 35 years)
- Illegal drug users
- Men having sex with men
- Sexual activity beginning at a young age
- History of sexually transmitted diseases
- Being a commercial sex worker
- Having multiple sexual partners
Causes of Urethritis
Urethritis is primarily caused by bacterial and viral infections, with certain environmental and physiological factors also contributing to the condition. The most common bacterial causes include Neisseria gonorrhoeae,which leads to gonococcal urethritis, and Chlamydia trachomatis,which is responsible for many cases of nongonococcal urethritis.
Other bacterial agents linked to urethritis include;
- Mycoplasma genitalium,
- Ureaplasma urealyticum,
- Escherichia coli, etc.
Several viral infections can also lead to urethritis, including herpes simplex virus (HSV), cytomegalovirus (CMV), and human papillomavirus (HPV). These viral agents can cause inflammation and irritation of the urethra, contributing to the symptoms associated with the condition.
Non-infectious causes of urethritisinclude exposure to chemical irritants such as spermicides, antiseptics, and harsh soaps. Additionally, physical trauma from catheterization, medical procedures, or sexual activity can lead to urethral inflammation.
Other common causes of NGU include;
- Trichomonas vaginalis
- Treponema pallidum
- Adenovirus
- Haemophilus influenza
- Neisseria meningitides
- Candida
Classifications of Urethritis
Urethritis, infectious (sexually transmitted) urethritis have been classified into two categories: gonococcal urethritis, caused by gonorrhea bacteria, and nongonococcal urethritis, caused by bacteria other than gonorrhea.
Gonococcal Urethritis (GU)
Gonococcal urethritis, commonly referred to as "clap," is caused by the bacterium Neisseria gonorrhoeae.This type of urethritis is transmitted through sexual contact, including vaginal, oral, and anal intercourse. Gonorrhea infections can cause significant inflammation of the urethra, leading to symptoms such as painful urination and discharge.
Nongonococcal Urethritis (NGU)
Nongonococcal urethritis is caused by sexually transmitted bacteria other than N. gonorrhoeae.The most common infectious agent responsible for NGU is Chlamydia trachomatis,which leads to the sexually transmitted infection chlamydia.
Other potential causes of nongonococcal urethritis include:Mycoplasma genitalium:A bacterial infection that can contribute to urethral inflammation and irritation.
Trichomonas vaginalis:A protozoan parasite that can be sexually transmitted and cause urethritis.
Signs & Symptoms of Urethritis
Urethritis presents with a variety of symptoms that differ slightly between men and women. While some individuals may remain asymptomatic, others experience significant discomfort.
Symptoms in Women:
- Unusual vaginal discharge
- Pelvic pain
- Abdominal pain
- Pain during intercourse
- Frequent or urgent urination
- Fever and chills
- Stomach pain
- Itching or irritation
Symptoms in Men:
- Blood in urine or semen
- Painful ejaculation
- Penile discharge
- Burning sensation while urinating
- Itching, tenderness, or swelling in the penis
- Enlarged lymph nodes in the groin area
Diagnostic Test & Investigations
Diagnosing urethritis involves a thorough medical evaluation, including a physical examination and laboratory tests to determine the underlying cause. The diagnostic process varies slightly between men and women.
Physical examination conducted in men and women include;
In Men:
- Examination of the abdomen, bladder area, penis, and scrotum
- Detection of penile discharge
- Checking for tenderness and swelling in the penis
- Inspection of enlarged lymph nodes in the groin area
- A digital rectal exam may be conducted
In Women:
- Abdominal and pelvic examination
- Checking for urethral discharge
- Assessing tenderness in the lower abdomen and urethra
Laboratory tests may include:
- Full Blood Count (FBC)
- C-Reactive Protein (CRP) Test
- Cystoscopy
- Pelvic Ultrasound for women
- Pregnancy Test women
- Urinalysis and Urine Cultures
- Tests for Sexually Transmitted Infections (STIs)
- Urethral Swab
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Treatment of Urethritis
Treatment for urethritis typically involves a course of antibiotics or antiviral medications, depending on the underlying cause of the condition.
Common Antibiotic Treatments:
- Azithromycin
- Doxycycline
- Erythromycin
- Ofloxacin
- Levofloxacin
- Ceftriaxone
Specific Treatments
Trichomoniasis:Urethritis due to Trichomonas infection is usually treated with: Metronidazole (Flagyl),Tinidazole (Tindamax)
For urethritis caused by the herpes simplex virus,the following antiviral medications are used:
- Acyclovir (Zovirax)
- Famciclovir (Famvir)
- Valacyclovir (Valtrex)
Even if the exact organism causing urethritis cannot be identified, treatment may proceed with empirical antibiotic regimens. For non-gonococcal urethritis (NGU), one of the following regimens is generally prescribed:
- Doxycycline:500 mg taken by mouth twice daily for seven days (preferred option).
- Azithromycin:1,000 mg taken by mouth in a single dose or 500 mg in a single dose followed by 250 mg once daily for seven days.
For gonococcal urethritis, the recommended treatment is Ceftriaxone: 500 mggiven in a single intramuscular injection.
Additional Considerations
- Partner treatment: Sexual partners should be treated simultaneously to prevent reinfection.
- Follow-Up treatment and get tested: Retesting after three months ensures that the infection has cleared.
- Lifestyle adjustments: Patients should avoid irritants such as harsh soaps, spermicides, and tight clothing to prevent further irritation. Also practicing safe sex activities is crucial to avoiding recurrence.
Nursing Management of Urethritis
The subsequent measures are essential for effectively caring for patients with Urethritis
Observation- Monitor T P R BP 4 hourly
- Keep intake and output chart
- Monitor for gastrointestinal disturbances (especially for antibiotic administration)
- Ensure good perineal care especially in females
- Heat may be applied for comfort but care should be taken not to burn the patient
- Give sitz bath
- Frequent hand washing with soap and water
- Apply topical antiseptic such as iodine ointment on urethral meatus as ordered
- Encourage patient to take full course of antibiotics prescribed
- Urge patient to bring partner for treatment
- Advise your patient to discontinue sexual activity temporarily
- Encourage your patient to use condom during sex
- Reduce alcohol intake or even stay away from alcohol
- Encourage drinking of plenty fluids as routine
- Practice pre and post coital voiding
- Avoid postponing urination
- Ensure prompt treatment of conditions such as prostatitis
- Teach women to carefully wipe off the perineum from front to back and also ensure the place is thoroughly cleaned with soap and water after defecation
Complications of Urethritis
If left untreated, men with urethritis are at risk for the following:
Preventions of Urethritis
- Avoid having intercourse with multiple partners.
- Use condoms every time you have sex.
- Get tested regularly.
- Protect your sex partner
- Keep the area around the opening of the urethra clean.
- Follow safer sex practices.
- Have one sexual partner only (monogamy)
- Drink plenty of fluids and make sure to urinate shortly after intercourse.
- Avoid acidic foods.
- Getting regular tests for STIs if you’re sexually active.
- Avoid exposure to spermicides, and actions that may irritate your urethra.