Urethritis is an inflammation of the urethra that is usually caused by a sexually transmitted disease like chlamydia or gonorrhea. Symptoms can include urethral discharge and burning during urination. Diagnosis involves examination for discharge and testing samples of urine or urethral secretions for bacteria and viruses. Treatment involves antibiotics to cure the infection as well as avoiding sexual activity until completion of treatment to prevent spread. Complications can include epididymitis, cystitis, and pelvic inflammatory disease if left untreated.

1. 1
 Urethritis is defined as infection-induced inflammation
of the urethra. The term is typically reserved to
describe urethral inflammation caused by an STD,
and the condition is normally categorized into either
gonococcal urethritis or non-gonococcal urethritis.
Symptoms
 Many patients with urethritis, including approximately
25% of those with NGU, are asymptomatic and
present to a clinician following partner screening. Up
to 75% of women with Chlamydia
trachomatis infection are asymptomatic.
 Signs and symptoms in patients with urethritis may
include the following:-
 Urethral discharge:-
May be yellow, green, brown, or tinged with blood;
production unrelated to sexual activity
 Dysuria (in men):-
Usually localized to the meatus or distal penis,
worst during the first morning void, and made worse
by alcohol consumption; typically not present are
urinary frequency and urgency
 Itching:-
Sensation of urethral itching or irritation between
voids

2. 2
 Orchalgia:-
Heaviness in the male genitals
 Worsens during menstrual cycle (occasionally).
 Systemic symptoms (eg, fever, chills, sweats,
nausea): Typically absent
Diagnosis
 Most patients with urethritis do not appear ill and do
not present with signs of sepsis.
 The primary focus of the examination is on the
genitalia.
 Examination in male patients with urethritis includes
the following:-
 Inspect the underwear for secretions
 Penis: Examine for skin lesions that may
indicate other STDs (eg, condyloma
acuminatum, herpes simplex, syphilis); in
uncircumcised men, retract the foreskin to
assess for lesions and exudate
 Urethra: Examine lumen of the distal urethral
meatus for lesions, stricture, or obvious
urethral discharge; palpate along urethra for
areas of fluctuance, tenderness, or warmth
suggestive of abscess or for firmness
suggesting foreign body
 Testes: Examine for evidence of mass or
inflammation; palpate the spermatic cord,
looking for swelling, tenderness, or warmth
suggestive of orchitis or epididymitis
 Lymphatics: Check for inguinal adenopathy
 Prostate: Palpate for tenderness or bogginess
suggestive of prostatitis

3. 3
 Rectal: During the digital rectal examination,
note any perianal lesions
 Examine female patients in the lithotomy position.
Include the following evaluation:
 Skin: Assess for lesions that may indicate
other STDs
 Urethra: Strip the urethra for any discharge
 Pelvis: Complete pelvic examination, including
the cervix
 Urethritis can be diagnosed based on the presence
of one or more of the following:
 A mucopurulent or purulent urethral discharge
 Urethral smear that demonstrates at least 5
leukocytes per oil immersion field on
microscopy
 First-voided urine specimen that demonstrates
leukocyte esterase on dipstick test or at least
10 WBCs/hpf on microscopy
 All patients with urethritis should be tested
for Neisseria gonorrhoeae and C trachomatis.
Laboratory studies may include the following:
 Gram stain
 Endourethral and/or endocervical culture
for N gonorrhoeae and C trachomatis
 Urinalysis: Not useful test in urethritis, except
to help exclude cystitis or pyelonephritis
 Nucleic acid–based tests: For C
trachomatis and N gonorrhoeae (urine
specimens) and other Chlamydia species
(endourethral samples)
 Nucleic acid amplification tests (eg, PCR
for N gonorrhoeae, Chlamydiaspecies)

4. 4
 KOH preparation: to evaluate for fungal
organisms
 Wet mount preparation: To detect the
movement/presence of Trichomonas
 STD testing for syphilis serology (VDRL) and
HIV serology
 Nasopharyngeal and/or rectal swabs: For
gonorrhea screening in men who have sex
with men
 Pregnancy testing: In women who have had
unprotected intercourse
 Imaging studies, specifically retrograde
urethrography, are unnecessary in patients with
urethritis, except in cases of trauma or possible
foreign body insertion.
 Patients with urethritis may undergo the following
procedures:
 Catherization: In cases of urethral trauma; to
avoid urinary retention and tamponade
urethral bleeding
 Cystoscopy: In cases when catherization is
not possible, for placement of a catheter; to
remove foreign body or stone in the urethra
 Dilation of urethral strictures with filiforms
and followers
 Placement of suprapubic tube: In severe
cases of urethral trauma that prevent
placement of urethral catheters or in the
absence of adequate facilities for emergent
cystoscopy; temporizing measure to divert
urine and relieve patient discomfort

5. 5
Management
 Symptoms of urethritis spontaneously resolve over
time, regardless of treatment. Administer antibiotics
that cover both GU and NGU. Regardless of
symptoms, administer antibiotics to the following
individuals:
 Patients with positive Gram stain or culture
results
 All sexual partners of the above patients
 Patients with negative Gram stain results and
a history consistent with urethritis who are
not likely to return for follow-up and/or are
likely to continue transmitting infection
 Antibiotics used in the treatment of urethritis include
the following:
 Azithromycin
 Ceftriaxone
 Cefixime
 Ciprofloxacin
 Ofloxacin
 Doxycycline
 Moxifloxacin
Causes
 Both bacteria and viruses may cause urethritis. The
same bacteria that cause this condition are E
coli, chlamydia, gonorrhea.
 These bacteria also cause urinary tract
infections and some sexually transmitted diseases.

6. 6
Viral causes are herpes simplex virus and
cytomegalovirus.
 Other causes include:-
 Injury
 Sensitivity to the chemicals used in
spermicides or contraceptive jellies, or foams
 Sometimes the cause is unknown.
 Risks for urethritis include:
 Being a female
 Being male, ages 20 to 35
 Having many sexual partners
 High-risk sexual behavior (such as anal sex
without a condom)
 History of sexually transmitted diseases
Exams and Tests
 The health care provider will examine you. In men,
the exam will include the abdomen, bladder area,
penis, and scrotum.
 The physical exam may show:
 Discharge from the penis
 Tender and enlarged lymph nodes in the groin
area
 Tender and swollen penis
 A digital rectal exam will also be performed.

7. 7
 Women will have abdominal and pelvic exams. The
provider will check for:
 Discharge from the urethra
 Tenderness of the lower abdomen
 Tenderness of the urethra
Your provider may look into your bladder using a tube
with a camera on the end. This is called cystoscopy.
 The following tests may be done:
 Complete blood count (CBC)
 C-reactive protein test
 Pelvic ultrasound (women only)
 Pregnancy test (women only)
 Urinalysis and urine cultures
 Tests for gonorrhea, chlamydia, and other
sexually transmitted illnesses (STI)
 Urethral swab
Treatment
 The goals of treatment are to:
 Get rid of the cause of infection
 Improve symptoms
 Prevent the spread of infection
 If we have a bacterial infection, we will be given
antibiotics.
 We may take pain relievers, urinary pain reliever
along with antibiotics.

8. 8
 People with urethritis who are being treated should
avoid sex, or use condoms during sex.
 Our sexual partner must also be treated if the
condition is caused by an infection.
 Urethritis caused by trauma or chemical irritants is
treated by avoiding the source of injury or irritation.
 Urethritis that does not clear up after antibiotic
treatment and lasts for at least 6 weeks is called
chronic urethritis.
 Different antibiotics may be used to treat this
problem.
Complications
 Men with urethritis are at risk for the following:
 Bladder infection (cystitis)
 Epididymitis
 Infection in the testicles (orchitis)
 Prostate infection (prostatitis)
After a severe infection, the urethra may become
scarred and then narrowed.
 Women with urethritis are at risk for the following:
 Bladder infection (cystitis)
 Cervicitis
 Pelvic inflammatory disease (PID -- an
infection of the uterus lining, fallopian tubes,
or ovaries)

9. 9
Prevention
 Things we can do to help avoid urethritis include:
 Keep the area around the opening of the
urethra clean.
 Follow safer sex practices. Have one sexual
partner only (monogamy) and use condoms.
Reference:-
 Kapitan Pediatrics Book
 GHAI Essential Pediatrics (Eighth Edition)
 Health line ( https://www.healthline.com )
 WebMd ( https://www.webmd.com )
 Mayo Clinic ( https://www.mayclinic.org )
 My Self