Urethritis / Urethral Dis...

URETHRITIS / URETHRAL DISCHARGE

Urethritis means inflammation of the tube inside the penis through which urine travels out of the bladder when one urinates (the urethra). Though not always the case, Urethritis is usually caused by a sexually transmitted infection (STI). It can occur even within a stable relationship.

Urethral discharge is characterized by an abnormal or mucoid secretions from the penis or, very rarely, the female urethra. Urethral discharge reflects the inflammation of the urethra which is usually caused by infection. Urethritis is defined as the presence of leucorrhea and urethral inflammation. Clinically, urethritis in men is characterized by urethral discharge and is often accompanied by dysuria. Leucorrhea has been defined as the presence of more than 5 WBCs for every high-power field in a urethral swab specimen.

Although urethral discharge can occur in sexually active persons of all ages, it is most common in young adults (the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infection is highest in this bracket). Urethritis of high proportions also occur in men who have sex with men. Discharge from the Urethra occurs after infection in persons that are exposed to infectious agents during oral, vaginal, or anal intercourse.

Historically, urethritis has been differentiated into gonococcal urethritis versus non-gonococcal urethritis (NGU), however, with the discovery of additional causes of urethritis that age old dichotomy has little clinical relevance.

• Gonorrhoeae is one type of STI which can cause urethritis.
• Non-gonococcal urethritis (NGU) is the term used to describe urethritis caused by anything other than gonorrhoeae. A germ Infection with either Chlamydia trachomatis or Mycoplasma genitalium is the common cause of NGU. Though it can also be caused by a variety of other viruses or bacteria.

Urethral discharge is seen almost exclusively in men. Any abnormal discharge will essentially be confirmed with a clinical examination. In males, the urethra would be milked gently if no discharge is visible. Furthermore, doctors will specifically check for urethral discharge among patients who complain of dysuria (painful or difficult urination).

Previously, the term urethritis was reserved for patients with urethral discharge. However, it has recently been demonstrated that some STIs often occur in men without discharge, but with symptoms such as itching, tingling, or dysuria. STIs may even be asymptomatic (without symptoms).

Both. Some men have both gonococcal and non-gonococcal urethritis at the same time.

TYPES OF URETHRITIS

There are basically two different types of urethritis, and these are classified by the cause of the inflammation. They two are;

• Gonococcal urethritis and,
• Non-gonococcal urethritis.

Gonococcal urethritis is caused by the same bacterium that causes gonorrhea, the Sexually Transmitted Infection. It accounts for close to 20 percent of cases of urethritis.

Non-gonococcal urethritis is urethritis caused by other infections that are not gonorrhea. Chlamydia for instance, is a common cause of non-gonococcal urethritis.

It is however possible, for irritation that may be unrelated to STIs to occur. These may include injury, from a catheter, or other kinds of genital trauma.

Majority of patients have either one type of urethritis or the other, but it is also possible to have different causes of urethritis at the same time especially among women.

CAUSES

Most episodes of urethritis are caused by infection by bacteria that enter the urethra from the skin around the urethra's opening. Bacteria that commonly cause urethritis include:

• Gonococcus, which is sexually transmitted and causes gonorrhea
• Bacteria in and around stool or anal area.
• Sexually transmitted Chlamydia trachomatis, which causes chlamydia.
• The herpes simplex virus (HSV-1 and HSV-2) can also cause urethritis.
• Trichomonas a single-celled organism that is sexually transmitted is another cause of urethritis.

Sexually transmitted infections like gonorrhea and chlamydia are usually confined to the urethra. However, they may extend into especially women's reproductive organs, causing pelvic inflammatory disease (PID).

In males, gonorrhea and chlamydia in some cases cause epididymitis, an infection of the epididymis, a tube on the outside of the testes. Both PID and epididymitis can lead to infertility.

Causes of non-gonococcal urethritis

Chlamydia has been established as the cause of about half of cases of NGU. Chlamydia is a bacterium (germ) that is usually caught by sexual contact with an infected person. Chlamydia can be passed on during vaginal, anal or oral sex.

Various other bacteria or viruses, most of which are sexually transmitted can cause NGU. (For example, herpes simplex and the germs that cause urinary tract infections.)

Rare causes of NGU are also possible but are non-infective. For example:

• Injury from a thin, flexible tube (a catheter).
• Surgery to the tube between the bladder and the end of the penis (the urethra).
• A narrowing (stenosis) of the urethra.
• Stones in the urethra.
• Some conditions that affect the lining of the urethra (e.g. irritation from soaps, lotions or spermicide cream).

In about half of all cases no cause can be found. It is believed that STIs that are yet to be identified by tests are probably the cause of some of these.

SYMPTOMS

The symptoms and management of urethritis in men are distinctly different from those in women. Although there are infectious and noninfectious causes, most studies have focused on urethritis as a sexually transmitted infection (STI). The diagnosis and treatment remain both clinical and public health priorities. The goals of treatment are to alleviate symptoms, prevent complications and ultimately to reduce transmission of co-infections especially human immunodeficiency virus (HIV). It is also aimed at tracing, identifying and treating sexual contacts, and encourage behavioral changes to reduce the risk of recurrence.

• Pain or burning sensation when urinating. This is sometimes confused with urine infection.
• A discharge from the tip of the penis is common but is not always the case.
• Soreness or irritation inside the penis, or it could be a feeling of wanting to urinate frequently.
• Some men with urethritis are asymptomatic (i.e. they never develop any symptoms). Especially with chlamydial infections among males, more than half the infected do not have any symptoms.

Both men and women can develop urethritis, but the symptoms differ slightly.

For women, symptoms include:

• Itching
• Pain in the stomach
• Unusual vaginal discharge
• Pelvic and abdominal pain
• Pain during sexual intercourse
• Frequent or urgent urination
• Fever and chills

Symptoms in men include:

• Penile discharge
• Enlarged lymph nodes in the groin area
• Blood in urine or semen
• Painful ejaculation
• Burning sensation while urinating
• Itching, tenderness, or swelling in the penis
• Fever is rare, yet a possibility in men.

Symptoms of non-gonococcal urethritis

• A whitish fluid discharge from the tip of the penis is most common but not in every case.
• Pain or burning during urination which may sometimes be confused with a urine infection.
• Soreness, irritation or itch inside the penis.
• A sensation or pressure of wanting to pass urine frequently.

In a few cases the infection travels up the tube between the bladder and the urethra to the testicles, sometimes causing pain and swelling in one or both testicles.

Up to a quarter of men with urethritis do not have any symptoms.

URETHRAL DISCHARGE IN WOMEN

Urethral discharge in females is usually the first sign of the infection known as urethritis. The causes of white particles in urine, or mucus in urine, is known as gonococcal urethritis, which can also cause pain and burning in the urethra.

Symptoms of female urethral discharge

The urethra is the slender, muscular duct that drains urine from the bladder to the outside of the body. One of the first symptoms of infection or inflammation of the urethra will be a discharge. In women, the lining of the urethra changes in response to the hormones which control her monthly cycle. This provides some protection from serious disease however, it also leaves women susceptible to chronic, low-level bacterial invasion of the urethra. Sometimes it can be difficult to tell whether the discharge is coming from the urethra or the vagina or even both. The Inflammation of the urethra is also called Urethritis or female urethral syndrome.

WHEN TO SEE A DOCTOR

Call the healthcare provider right away if one has any of the following:

• Discharge from the vagina
• Fever of 100.4°F (38.0°C) or higher
• Burning pain with urination
• Abdominal or pelvic pain
• An increased urge or pressure to urinate

RISK FACTORS

People who are more likely to experience urethritis include those who:

• Have a history of sexually transmitted diseases
• Engage in high-risk sexual behavior
• Oral sex may be a risk factor for non-gonococcal urethritis (NGU), according to a study published in the Journal of Infectious Diseases
• Urethritis is not always sexually transmitted, but a person with multiple sexual partners has a greater risk of exposure.

Health experts recommend that any patient with confirmed or suspected urethritis should also undergo tests for gonorrhea and chlamydia. This will enable people to inform their partner, who may also need to be tested and treated.

DIAGNOSIS

• Physical examination, including the genitals, abdomen, and rectum
• Examination of discharge under a microscope
• Urine tests (for gonorrhea, chlamydia, or other bacteria)
• Urinalysis
• Urethral swab
• Urine culture

Doctors can usually make a diagnosis of urethritis based on the symptoms and physical examination. A sample of the discharge, if any, is collected by inserting a soft-tipped swab into the end of the urethra. The urethral swab is then sent to a laboratory for analysis so that the infecting organism can be identified.

If the patient has painful urination, the doctor may assume the presence of an infection. He or she may proceed to treat it with antibiotics right away even as the test results is being awaited.

Blood tests may be done in certain situations, but they are often not necessary for the diagnosis of urethritis.

TREATMENT OPTIONS

Treatment for urethritis typically includes a course of either antibiotics or antiviral medication. Some common treatments for urethritis include:

• Oral antibiotic Doxycycline, typically taken twice a day for seven days.
• Ofloxacin, also an oral antibiotic, typically taken twice a day for seven days
• The antibiotic Azithromycin, taken as a onetime dose.
• Erythromycin, an antibiotic that is administered orally, four times a day for seven days.
• Levofloxacin antibiotic typical dose is once a day for seven days

If the infection was sexually transmitted, it would be vital that all sexual partners undergo testing and treatment if necessary. This would prevent the general spread of the STI and reinfection.

One may see improvement in the symptoms just a few days after beginning treatment. However, people must still finish out the entire prescription as recommended by the doctor, otherwise the infection could become worse. People with urethritis should wait one week once they are completely finished with their prescription and their partner has finished treatment before resuming sexual activity.

Potential drug interactions for the medications used to treat urethritis include:

• Seizure medications
• Blood-thinning medications
• Heart medications

NATURAL REMEDIES

According to many health-care experts, there is no evidence that natural or alternative remedies can cure urethritis. However, some healthcare researchers opine that home and natural remedies, when used together with conventional medical treatment, can help the body fight infection.

Cranberries contain a substance that may prevent bacteria from sticking to the urethra. So if one should drink between 8 and 16 ounces of unsweetened cranberry juice each day, it may help women with frequent urinary infections to recurrence.

Cranberry supplements are not recommended if a person is pregnant, breastfeeding, or has kidney stones. Cranberry juice and supplements should not be taken by people using blood-thinning drugs such as warfarin. It is also important to stay hydrated. Avoid caffeine and alcohol and drink six to eight glasses of filtered water each day.

Before using any natural or alternative remedies, it is very important to speak to the doctor.

How does urethritis progress?

Occasionally, symptoms of urethritis may clear without treatment but this may take months. If the condition was caused by an infection, some germs (bacteria) may still be present, even if the symptoms may have gone.

Therefore, one will most likely to be infectious and can still pass on the infection even if symptoms have may abated. One bacterium that commonly causes urethritis (inflammation of the urethra) in men, chlamydia - can cause serious problems in women. It is important that one gets tested, and treated if necessary, in order to prevent complications for oneself and partners too.

• Should people suspects having urethritis, they should contact their local clinics - or see their General medical practitioners.
• A person may be asked to have tests for HIV, hepatitis and syphilis because people with inflammation of the urethra (urethritis) sometimes have these conditions as well.
• Some men who have sex with men may also need to have swabs taken from the back of the throat (pharynx) and back passage (rectum).
• Health facilities and practitioners will always protect confidentiality. However, if they confirm an infection, they may want to contact all sexual partners for up to three months before the diagnosis. This is called 'contact tracing'.
• Medicines usually antibiotics will clear an infection. The antibiotic prescribed will depend on the cause. Be sure to complete the course.
• If the urethritis is due to an infection such as gonorrhea it is vital to have another test after being treated to make sure the infection has been cured. This will usually be done within seven days after treatment.
• The patient will need to ask their sexual partner(s) to see their doctors right away even if they have no symptoms. Many women with sexually transmitted infections do not have symptoms.
• Patients must not have sex (including oral and anal sex) until their sexual partner(s) and themselves have completed all necessary tests and treatments. People should wait seven days after they have had treatment course to avoid passing on the infection:

PREVENTION

Many of the bacteria that cause urethritis can be passed to other persons through sexual contact. Because of this, practicing safe sex is an important preventive measure. The tips below can help reduce the risk:

• Avoid having sexual intercourse with multiple partners.
• Use condoms every time for sex.
• Get tested regularly.
• Protect others. If one is diagnosed with an STI, they need to inform others who are also at risk of the infection so they treat themselves.

Aside from safer sex practices, there are other ways to promote good urinary tract health, so as to lower the risk of urethritis and some other conditions that affect that part of the body.

• Drink plenty of fluids and make sure to urinate shortly after intercourse.
• Avoid acidic foods.
• Also, avoid exposure to spermicides, especially if one knows already know they irritate the urethra.

COMPLICATIONS

Medication can often treat urethritis quickly. If the infection goes untreated, however, the effects can be lasting and quite serious. For instance, the infection could spread to other parts of the urinary tract, including the ureters, kidneys, and bladder. These infections can cause intense pain on their own. Whereas they can be treated with more intensive rounds of antibiotics, they can also cause damage to some organs if not treated for too long. Some untreated infections can also spread to the blood and result in sepsis (Sepsisis the body's extreme response to an infection. It is a life-threatening medical emergency, and can be deadly).

Additionally, the STIs that frequently cause urethritis can damage the reproductive system. Women may develop pelvic inflammatory disease (PID), which is painful and can result in infertility, ongoing pelvic pain, or pain during sex. Women with untreated STIs are also at a higher risk for ectopic pregnancies, which can be life-threatening.

Men may develop painful inflammation or infection of the prostate gland, or the narrowing of a section of the urethra due to scarring, leading to painful urination. For these reasons, people should speak with their doctors as soon as possible if they notice any of the symptoms of urethritis.