Causes and Treatment of Urethritits in Men

An itchy urethra or discharge from the urethra is usually from a medical condition called urethritis. It is not a disease itself but a symptom of an infection.

Urethritis symptoms
Illustration by JR Bee, Verywell

Understanding Urethritis

Urethritis is an inflammation of the urethra, the tube that carries urine from the bladder to the outside of the body. There are multiple reasons why a man's urethra may become inflamed. The most common cause of urethritis is a sexually transmitted infection, usually Neisseria gonorrhoeae or Chlamydia trachomatis, which causes gonorrhea and chlamydia, respectively.

Other causes of infectious urethritis include the Trichomonas species, Mycoplasma genitalium, and viruses like adenovirus or herpes simplex virus (HSV).

Urethritis can also be caused by bacteria which live inside a sexual partner's mouth, rectum, or vagina that is passed to a man's penis during unprotected sex. 

Less commonly, urethritis may be caused by excessive friction during masturbation or sexual intercourse or from an allergic reaction to soap or detergents.

Urethritis can also be caused by non-infectious reasons. In many of these cases, symptoms will resolve on their own.

HIV and Urethritis

Having HIV and an untreated urethritis can further increase the risk of HIV transmission. This is because any inflammation of the urethra draws immune cells to the site of infection in a process called shedding. This, in turn, draws HIV to the site, as it preferentially targets these very same immune cells for infection.

In doing so, the concentration of HIV in urethral tissue can be far higher than in the person's blood. This is even true for individuals on antiretroviral therapy with undetectable viral loads.

Treating urethritis, therefore, becomes even more imperative in HIV-positive men, as is the avoidance of unprotected sex during a urethritis episode.

Additionally, any persons diagnosed with HIV should be prescribed immediate antiretroviral therapy, whether they are symptomatic or not. This not only lowers the risk of onward infection, but it also reduces the likelihood of complications associated with disease progression.

Symptoms of Urethritis

One or all of these symptoms may be present in the case of urethritis, including:

  • Watery urethral discharge
  • Itching or tingling of the penis or urethra
  • Pain or burning during urination (typically near the opening of the urethra)
  • Swollen lymph nodes in the groin area (this is rare)

It's important to note that urethritis can mimic other medical conditions in men, like inflammation of the prostate, testicles, or scrotum. It can also look like a urinary tract infection. It's important to seek care and advice from a physician to ensure a proper diagnosis and treatment plan.

Diagnosis and Treatment of Urethritis

Using a nucleic acid amplification test, or NAAT, a man's urine will be examined for gonorrhea or chlamydia. In addition, the discharge from his urethra will be stained and examined under a microscope. If an infection is found to be present, a doctor will prescribe an antibiotic.

If the diagnosis is unclear, other tests may be performed (for example, testing for Trichomonas) and/or the doctor may decide to treat the man anyway with antibiotics, especially if he is at a high risk for infection.

Sometimes a person may be referred to a urologist for additional evaluation. Also, a doctor may test for other sexually transmitted infections, like HIV, syphilis, or for hepatitis B.

According to the Centers for Disease Control and Prevention, it's important that men diagnosed with urethritis, as a result of chlamydia, gonorrhea, or trichomonas, return for a follow-up appointment three months after completion of antibiotic therapy. During this follow-up appointment, a man will undergo repeat testing for urethritis, due to the high rates of re-infection.

If a man is diagnosed with urethritis, all of his sexual partners should be referred for evaluation and treatment, and he should avoid sex until he and his partners have been appropriately treated.

A Word from Verywell

There are precautions that can reduce your risk of getting urethritis or help you recover from a bout of urethritis. For instance, it's important to always use condoms for vaginal, anal, and oral sex. This helps prevent sexually transmitted infections like chlamydia, gonorrhea, and HIV.

If you do develop urethritis, be sure to abstain from sex until you finish your entire course of treatment and your symptoms, like discharge from your penis, have resolved. Remember, too, take your antibiotics as prescribed until the course is completed—and when you start treatment, ensure your partners are also evaluated and treated.

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Article Sources

  1. Moi H, Blee K, Horner PJ. Management of non-gonococcal urethritis. BMC Infect Dis. 2015;15:294. doi:10.1186/s12879-015-1043-4

  2. Ward H, Rönn M. Contribution of sexually transmitted infections to the sexual transmission of HIV. Curr Opin HIV AIDS. 2010;5(4):305-10. doi:10.1097/COH.0b013e32833a8844

  3. Young A, Wray AA. Urethritis. StatPearls Publishing. Updated January 6, 2019.

  4. Bachmann LH, Johnson RE, Cheng H, Markowitz LE, Papp JR, Hook EW. Nucleic acid amplification tests for diagnosis of Neisseria gonorrhoeae oropharyngeal infections. J Clin Microbiol. 2009;47(4):902-7. doi:10.1128/JCM.01581-08

  5. Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2015. Updated June 5, 2015.

Additional Reading

  • Bachmann L et al. Advances in the understanding and treatment of male urethritis. Clin Infect Dis. 2015 Dec 15;61 Suppl 8:S763-9.
  • Brill JR. Diagnosis and treatment of urethritis in men. Am Fam Physician. 2010 Apr 1;81(7):873-78.
  • Centers for Disease Control and Prevention. 2015 Sexually Transmitted Diseases Guidelines: Diseases characterized by urethritis and cervicitis.