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Urethritis

Basic Information

The urethra is the tube that connects the bladder to the tip of the penis. and urethritis is an inflammation of the urethra caused by a sexually transmitted disease (STD). There are two types of urethritis, gonococcal urethritis (GCU) caused by Ngisseria gonorrhoeae or gonorrhea, and non-gonococcal urethritis (NGU) caused mainly by two types of Chlamydia, chlamydia trachomatis or chlamydia psittaci.

Millions of men in the U.S. develop urethritis annually. It is estimated that two million men are treated for GCU annually and that nearly six million men are treated for NGU annually, making NGU the most often seen STD in men. The most common site for infection in all men is the urethra.

Cases of acute GCU are more common among gay men while heterosexual men account for most of the cases of NGU. Urethritis must be treated because if left untreated it can cause problems years down the road. And urethritis makes it easier to catch and pass other STDs including HIV. When you have one STD it is likely that you may have another. And if you should have urethritis, a discussion about HIV is indicated and an HIV test may be recommended.

Here are some facts relating to GCU infection:

  • The throat is infected in 40% of cases involving gay men. A number of cases are thought to be caused by fellatio. You can not only give to but get urethritis during oral sex -- bacteria in the mouth can infect the urethra.
  • The throat is infected in 7% of cases occurring in heterosexual males.
  • The rectum is infected in 25% of cases occurring in gay men. It is easier to give urethritis (from top to bottom) than to get it (from bottom to top) during anal intercourse.
  • Sexual penetration with an infected partner has a 20% transmission rate for males during one sexual encounter.
  • Females who have sexual intercourse with a man are likely to be infected at a transmission rate of 80% during just one encounter.

NGU, which occurs more frequently in heterosexual males than gay males, appears more commonly in men who are in higher socioeconomic classes and is usually caused by:

  • Chlamydia trachomatis and Chlamydia psittaci (20 to 50% of cases)
  • Ureaplasma urealyticum (15 to 30% of cases)

If caused by either of the above, NGU often goes undetected. Other causes include:

  • herpes simplex virus
  • the human papilloma virus

In up to 20% of cases the causes are not identified but other explanations besides STDs have been offered including trauma or even adverse reaction to bath oils and bubble baths.

Symptoms

The incubation period for GCU is 2 to 5 days after exposure during a sexual encounter. Without treatment GCU can last up to 7 weeks, and after 3 months the patient becomes asymptomatic in 95% of cases.

Symptoms can include:

  • a green, milky discharge which can stain underwear
  • sometimes the discharge is yellowish brown
  • urethral tenderness to the touch
  • urethral itching

If there is prostate involvement, frequent urgency to urinate can occur and if it spreads down the vas deferens, acute epididymis can occur. Also a urethral stricture may form years after the initial infection and cure due to scarring and surgery may be needed to open the blockage.

The incubation period for NGU is longer than GCU, lasting approximately one to four weeks after initial infection although the incubation period may be slightly shorter or longer.

Symptoms include:

  • whitish or clear discharge
  • urethral itching
  • swelling of the penis head

Symptoms are usually milder than in cases of GCU, though the potential for complications are considered as serious. They include:

  • epididymitis in heterosexual men
  • nonbacterial prostatitis
  • Reiter's syndrome
  • proctitis in gay men

NGU has a greater morbidity rate than GCU.

Diagnosis/Treatment

Diagnosis is made by culturing the discharge. Also cultures of the throat and rectum may be indicated. If N. gonorrhoeae is not the infectious cause of the urethritis, other agents usually are but they are more difficult to culture. For a diagnosis of NGU the discharge is examined microscopically for white blood cells without gonococcal bacteria.

Antibiotic treatment for both GCU and NGU is necessary. Usually this includes a course of 100mg doxycycline two times a day or 500mg of tetracycline four times a day for one or two weeks.

Do not have sex until you have tested negative after treatment. Your sexual partners should be informed, tested and treated as well. You are unlikely to have a recurrence once treatment has been successful unless you are reinfected.

If you feel you have or have symptoms of GCU or NGU please see your health care provider promptly.