An Overview of Urethritits in Men

Infectious and Non-Infectious Causes of an Itchy Urethra

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Urethritis is a condition in which the urethra (the tube through which urine exits the body) becomes inflamed and irritated. Urethritis is not a disease unto itself but rather a symptom of an infection or other specific or non-specific causes.

Many of the symptoms of urethritis in men are the same as in women. However, some can be more overt, such as a visible discharge or pain during urination. The causes can also vary given that the urethra also transports semen from the body; it is not unusual, for example, to experience urethral pain following a prolonged or especially robust ejaculation.

Urethritis in men is typically diagnosed with a physical exam, a urethral swab, and a urine test. The treatment can vary based on the underlying cause.

Urethritis symptoms
Illustration by JR Bee, Verywell

Possible Symptoms

Urethritis is inflammation of the urethra, the tube that carries urine from the bladder to the outside of the body. Common symptoms include:

  • Urethral discharge
  • Itching or tingling of the penis or urethra
  • Pain or burning during urination (dysuria)
  • Swelling and tenderness of the penis
  • Pain during sex (dyspareunia)
  • Pinkish urine or semen (due to urethral bleeding)

Most uncomplicated cases do not involve fever. If the underlying infection is severe or systemic, there may be high fever, nausea, vomiting, back pain, abdominal pain, joint or muscle pain, or swollen lymph nodes in the groin (inguinal lymphadenopathy).

Complications

If left untreated, urethritis can increase a man's risk of getting or passing HIV. This is because inflammation draws immune cells to the site of infection in a phenomenon known as viral shedding. This, in turn, attracts HIV to the site of inflammation as it targets the very immune cells (called CD4 T-cells) meant to defend the body against infection.

Even people on HIV therapy with undetectable viral loads can have detectable viral loads in the urethra due to viral shedding.

Treating urethritis is even more imperative in men with HIV as it reduces their infectivity and the risk of sexual transmission.

Causes

There are many reasons why a man's urethra may suddenly become inflamed. The causes can be broadly classified as gonococcal urethritis, non-gonococcal urethritis, and non-specific urethritis.

Gonococcal Urethritis

Gonococcal urethritis is a symptom of gonorrhea caused by the bacterium Neisseria gonorrhoeae. Men infected with gonorrhea may experience dysuria, a milky discharge from the penis, and testicular pain caused by epididymitis (inflammation of the tubes that store and carry sperm from the testicles).

By contrast, women with gonorrhea are often entirely without symptoms.

Non-Gonococcal Urethritis

Non-gonococcal urethritis (NGU) is an infection of the urethra caused by pathogens (germs) other than gonorrhea. The most common include:

Non-Specific Urethritis

Non-specific urethritis (NSU) is an infection of the urethra not caused by gonorrhea or other non-gonococcal causes. As per its name, NSU occurs for no apparent reason. Several pathogens may be suspected, but the actual microorganism is not able to be pinned down for any number of reasons.

In some cases, an actual pathogen is not involved. NSU may be caused by minor trauma, such as vigorous sexual activity or masturbation, or by contact with chemical irritants such as soap, lotions, cologne, latex, spermicidal lubricants, or contraceptive jelly.

Even rough fabric can cause urethritis by abrading the opening of the urethra (called the urinary meatus).

Diagnosis

Urethritis is diagnosed with a physical examination of the penis. The urethra is visually examined by spreading the urinary meatus with two gloved fingers to check for redness, discharge, and other abnormalities.

Next, a dry cotton swab is inserted into the urethra and rotated once to obtain a sample of cells. You will also be askedt to submit a urine sample.

The pathologist will then take the swab sample and smear it on a glass slide for examination under the microscope. At the same time, the urine sample will be evaluated using a nucleic acid amplification test (NAAT) to confirm gonorrhea or chlamydia as the cause. Other tests may be ordered if the cause of the inflammation is unclear.

Whether the cause is known or unknown, urethritis can be declared based on one or more the following:

  • The presence of urethral discharge
  • 10 or more granulocytes (a category of white blood cells) under a high-powered lens
  • The presence of leukocytes (another type of white blood cell) in a urine sample

Differential Diagnosis

Urethritis can mimic other medical conditions in men. If there is any doubt as to the cause of the urethral inflammation, the doctor may conduct a differential diagnosis to ensure that more serious causes are not missed. These may include:

Severe or complicated cases may be referred to a urologist for further evaluation.

Treatment

A variety of drugs may be prescribed based on the underlying cause of urethritis. Antibiotics are typically used if a bacterial infection is diagnosed. Even if the cause cannot be definitively identified, antibiotics may be prescribed if there is either urethral discharge or inflammation.

The antibiotics most commonly used alone or in combination include:

  • Doxycycline, taken twice daily for seven days
  • Erythromycin, taken four times daily for seven days
  • Floxin (ofloxacin), taken twice daily for seven days
  • Levaquin (levofloxacin), taken once daily for seven days
  • Zithromax (azithromycin), taken as a one-time dose

There is some concern that certain strains of N. gonorrhoeae, C. trachomatis, and M. genitalium and C are resistant to some antibiotics, making treatment more difficult.

Viral causes like HSV and CMV may be treated with antiviral drugs such as Zovirax (acyclovir) and Famvir (famciclovir).

nonsteroidal anti-inflammatory drug (NSAID), such as Aleve (naproxen) or Advil (ibuprofen), can be used to relieve pain. Pyridium (phenazopyridine) can also be used to treat pain and reduce the urge to urinate.

According to the Centers for Disease Control and Prevention, men diagnosed with chlamydia, gonorrhea, or trichomonas should return for a follow-up appointment three months after the completion of antibiotic therapy. During the appointment, the STD tests will be repeated due to the high rates of reinfection.

If a man is diagnosed with urethritis, all sexual partners should be referred to a doctor for diagnosis and treatment. Sex should be avoided until the underlying infections are confirmed cleared.

A Word from Verywell

There are precautions that can reduce your risk of urethritis. This includes the consistent use of condoms for vaginal, anal, and oral sex. Limiting your number of sex partners also helps prevent STDs like chlamydia, gonorrhea, and HIV.

If you develop urethritis, abstain from sex until you finish your entire course of antibiotics. Even if your symptoms resolve halfway through treatment, you may still be infectious. Failing to complete a course can lead to antibiotic resistance, making it far more difficult to treat an infection if it returns.

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