An Overview of Urethritis in Men

Infectious and Non-Infectious Causes of an Itchy Urethra

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Urethritis is inflammation of the urethra. The urethra is the tube through which urine exits the body.

Urethritis itself is not a disease. Rather, it is a feature of some other condition, like an infection.

Many of the symptoms of urethritis in males are the same as in females. In males, though, they can be more obvious. There may be visible discharge or pain during urination, for example.

The causes of urethritis can also be different in males. This is because the urethra also transports semen from the body. This is why you may have urethral pain after ejaculation.

This article discusses the symptoms and causes of urethritis in males. It also looks at diagnosis and treatment.

Urethritis symptoms

Verywell / JR Bee

Urethritis Symptoms

Common symptoms of urethritis include:

  • Discharge from the urethra
  • Itching or tingling of the penis or urethra
  • Pain or burning during urination, called dysuria
  • Swelling and tenderness of the penis
  • Pain during sex, called dyspareunia
  • Pinkish urine or semen due to urethral bleeding

Most simple cases do not include fever. If the infection that's causing the urethritis is severe or involves the entire body, though, symptoms may include:

  • High fever
  • Nausea
  • Vomiting
  • Back pain
  • Abdominal pain
  • Joint or muscle pain
  • Swollen lymph nodes in the groin

Recap

Urethritis symptoms include itching, burning, pain during sex, and discharge. Severe infections might also include other symptoms, like a high fever, vomiting, or pain in the back, abdomen, or joints.

Urethritis Causes

There are many reasons why the male urethra may become inflamed. The causes can be grouped as:

Gonococcal Urethritis

Gonococcal urethritis is a symptom of gonorrhea. This sexually transmitted infection (STI) is caused by the bacterium Neisseria gonorrhoeae.

Males diagnosed with gonorrhea may have painful urination and a milky discharge from the penis.

They may also have pain in the testicles caused by epididymitis. This is an inflammation of the tubes that store and carry sperm from the testicles.

Females with gonorrhea often do not have symptoms.

Non-Gonococcal Urethritis

Non-gonococcal urethritis (NGU) is caused by pathogens other than gonorrhea. A pathogen is a microorganism or germ that can cause disease.

The most common pathogens that cause urethritis include:

Non-Specific Urethritis

Non-specific urethritis (NSU) is not always caused by an infection. Instead, it may seem to have no obvious cause.

In some cases, doctors may suspect certain pathogens. Sometimes, though, the specific pathogens can't be identified.

In some cases, NSU isn't caused by a pathogen at all. Instead, it may be caused by minor injury. Vigorous sexual activity or masturbation can lead to NSU. So can contact with chemical irritants, such as:

  • Soap
  • Lotions
  • Cologne
  • Latex
  • Spermicidal lubricants
  • Contraceptive jelly

Even rough fabric can cause urethritis. This might happen if the fabric irritates the opening of the urethra.

Other conditions may have urethritis as a symptom. These include:

Severe or complicated cases may be referred to a urologist.

Recap

Urethritis can have many potential causes. Some, like certain bacteria and viruses, are transmitted sexually. Other causes include chemical irritants and conditions like urinary tract infection or kidney stones. Sometimes no cause is found.

Complications of Urethritis

In males, untreated urethritis can increase the risk of acquiring or transmitting HIV. This is because of something called viral shedding.

In viral shedding, inflammation draws immune cells to the site of the infection. HIV targets CD4 T-cells, a type of immune cells that protect the body from infection. The presence of these cells in the urethra attracts HIV.

This happens even in people on HIV therapy with undetectable viral loads. Viral shedding can cause anyone with HIV to have detectable viral loads in the urethra.

If you have urethritis, avoid sex until the infection has cleared. This is important even if you do not have HIV.

Treating urethritis is even more important in males with HIV. Treatment reduces infectivity and the risk of sexual transmission.

Diagnosis of Urethritis

To diagnose urethritis, two gloved fingers are used to spread the opening of the urethra. Visible signs of redness, discharge, and other abnormalities may suggest urethritis.

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

A pathologist will take the swab sample and smear it on a glass slide. It can then be viewed under a microscope.

A nucleic acid amplification test (NAAT) on the urine sample can confirm gonorrhea or chlamydia. Other tests may be ordered if the cause is unclear.

Urethritis can be diagnosed whether the cause is known or unknown. This can be done based on one or more the following:

  • The presence of urethral discharge
  • Ten or more granulocytes, a specific type of white blood cell, in the smear from the swab
  • The presence of leukocytes, or white blood cells, in a urine sample

Recap

See a doctor if you have symptoms of urethritis. Diagnosis is based on a physical exam and lab tests.

Treatment of Urethritis

Treatment of urethritis depends on the cause. Bacterial causes are usually treated with antibiotics. If the cause can't be found but there is discharge or inflammation, you may still be given antibiotics.

For urethritis, the most common antibiotics include:

  • Monodox (doxycycline) taken twice daily for seven days
  • EryPed (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

Certain strains of bacteria may be resistant to some antibiotics. This includes strains of the bacteria that cause gonorrhea, chlamydia, and Mgen. This can make treatment more difficult.

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

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

Males diagnosed with chlamydia, gonorrhea, or trichomoniasis should schedule a follow-up appointment three months after completing antibiotics. This is because these diseases have high rates of reinfection. During the follow-up, you'll undergo repeat testing for STIs.

If you are diagnosed with urethritis, it is important to inform all your sexual partners. Your partners should see a doctor for diagnosis and treatment. Avoid sex until the underlying infections are cleared.

Summary

Urethritis is a symptom of an infection or other condition. It can cause itching, burning, pain, and discharge. If the infection is severe, it may also cause fever and other symptoms.

Urethritis can have bacterial or viral causes. This includes certain kinds of STIs. It may also be caused by chemical irritants, minor injury, or conditions like kidney stones.

When urethritis is caused by an infection, it may be easier to acquire or transmit HIV. Sex should be avoided until the infection goes away.

Urethritis is diagnosed with an exam and lab tests. Treatment depends on the cause. Bacterial causes are treated with antibiotics. Viral causes are treated with antiviral drugs. 

A Word From Verywell

Precautions can reduce your risk of urethritis. Be sure to use external or internal condoms, or other barrier methods when engaging in sexual activity.

It is also important to limit your number of sex partners. This can help prevent STIs like chlamydia, gonorrhea, and HIV.

If you develop urethritis, don't have sex until you finish your entire course of antibiotics. You could still be infectious even if your symptoms go away before you are finished with treatment.

Failure to finish your antibiotics could lead to antibiotic resistance. This can make it harder to treat your infection if it returns.

Frequently Asked Questions

  • Can you have urethritis without an STI?

    Yes. Urethritis is most commonly caused by sexually transmitted infections like gonorrhea, chlamydia, herpes simplex virus, or trichomoniasis. But urethritis can also be caused by other pathogens, like group B streptococcus or adenovirus, and irritants like spermicide, soap, and cologne. 

  • Why does the inside of the tip of my penis itch?

    Inflammation inside the urethra can result in itching in the tube that carries urine out of the body. Urethritis can be caused by an infection or irritation to the urethra.

  • Is urethritis the same as a UTI?

    No, a UTI is a urinary tract infection. The urinary tract includes the kidneys, bladder, ureters, and urethra. Urethritis is inflammation of the urethra only. Symptoms of urethritis and a UTI overlap and include painful urination.

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6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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