Sexually transmitted diseases are a serious problem today. The frequency of its appearance has increased compared to previous years. Among sexually transmitted diseases, urethritis is one of the infections we frequently encounter in daily practice. The disease mainly occurs as a result of unprotected intercourse with sick people. In this regard, we recommend that people have a safe relationship with a stranger.

Prevention is the primary precaution to be taken against the disease. It is important to raise people’s awareness on this issue. When the disease occurs, it must be treated with appropriate antibiotics. If left untreated, serious problems may arise in the future. In this article, I will give general information about urethritis, taking into account my own experiences.

What is urethritis?

“Urethritis”, also known as “gonorrhea” among the public, is the inflammation of the urinary canal called urethra, which removes urine from the bladder. It manifests itself with burning sensation while urinating and sudden urge to urinate. It is usually an infection caused by causative bacteria.

Urethritis is not the same as urinary tract infection, urethritis is inflammation of the urethra, whereas urinary tract infection is an infection of the urinary tract. They cause similar symptoms, but their treatments are different.

Urethritis can occur at any age and gender, and the risk of infection is higher in women than in men. This is due to the fact that the male urethra is longer than the blood urethra.

What are the symptoms of urethritis in men?

Patients with suspected urethritis consult a physician with complaints mainly originating from the urethra. The urethra is the urinary tract through which urine is excreted after the bladder. The following complaints occur in male patients with urethritis after unprotected intercourse:

• Burning while urinating
• Itching and burning at the tip of the urethra
• Blood in urine or semen
• Discharge from the penis (urethra)

The most common complaint in men with urethritis is pus-like discharge from the urethra, even in a normal state. Men usually consult a Urologist with pus-like discharge in their underwear, burning and itching in the urethra, after unprotected intercourse. This discharge may be green in color if the disease is caused by a microorganism called Trichomonas vaginalis. If it is due to factors other than gonococcal (nongonococcal) (such as Chlamydia, Mycoplasma), then there will be a transparent, light-colored discharge.

Female patients with urethritis may also have similar complaints. Women may also experience vaginal discharge. This discharge may sometimes be in the form of a smelly discharge. The main complaints seen in female patients with urethritis are:

• Frequent need to urinate
• Burning and pain while urinating
• Burning at the end of the urinary tract
• Vaginal discharge

Sometimes women with urethritis may have no symptoms. Men may not have symptoms of urethritis if they have chlamydia or trichomonas urethritis. Therefore, if there is a sexually transmitted infection, it is important to perform the necessary tests.

Usually cases of urethritis occur as a result of a bacterial or viral infection. The most common cause is bacterial causes. The same bacteria can simultaneously infect the bladder and kidney. If bacteria normally found in the genital area pass into the urinary tract, they can cause urethritis.

What are the causes of urethritis?

Gonorrhea or urethritis is an infectious disease caused by bacteria. The microorganisms that often cause this disease are as follows:

• Neisseria gonorrhoeae
• Chlamydia trachomatis
• Mycoplasma genitalium

Infectious agents that cause sexually transmitted diseases can also cause urethritis. These are the bacteria that cause gonorrhea and chlamydia and the parasite that causes trichomoniasis.

Besides bacteria, some viruses also cause urethritis. Viruses that frequently cause urethritis are:

• Human papilloma virus (HPV)
• Herpes simplex virus (HSV)
• Cytomegalovirus (CMV)

What are the types of urethritis?

Urethritis is classified in different ways. We usually classify this disease according to the causative microorganism. The cause of gonorrhea is mostly caused by a microorganism called Neisseria gonorrhoeae (gonococcus, gonococcus). Urethritis is divided into two groups, gonococcal and non-gonococcal, according to the causative microorganism:

• Gonococcal urethritis: This form of urethritis accounts for approximately 20% of cases. These are the same bacteria that cause sexually transmitted gonorrhea.
• Nongonococcal or nongonococcal urethritis: These are caused by other infectious agents other than gonorrhea. Chlamydia and Mycoplasma are common causes of nongonococcal urethritis.

Urethritis, especially in women, can sometimes be caused by more than one microorganism at the same time. In this way, the treatment differs in diseases caused by mixed infectious agents. In such cases, combined treatment directed at the causative microorganism is required.

How is the diagnosis made in patients with urethritis?

It is easy to diagnose the disease. As with every disease, patients should be evaluated with a systematic approach. Correct diagnosis is very important for an effective treatment. Diagnosis is made through detailed medical questioning of the patients, urological examination and laboratory tests. We can list the steps that need to be taken to diagnose urethritis as follows:

• Patients are questioned in detail
• Urethral discharge may be present during genital area examination.
• There may be tenderness and pain in the urethra when touched.
• There may be symptoms of other sexually transmitted diseases.
• Urine examination,
• Urethral or vaginal swab is taken for women.
• Blood tests are requested if sexually transmitted diseases such as syphilis or HIV are suspected.
• If necessary, tests are also performed on the opposite sex.

How is urethritis treated?

In patients with suspected gonorrhea, an appropriate treatment plan is made after the diagnosis is made at the end of the urological evaluation. Treatment of urethritis is done according to the cause. If the causative agent is a bacterium, antibiotics are given, and if it is a virus, antiviral agents are given.

• Azithromycin. Single dose given orally
• Doxycycline. It is given orally twice a day for one week.
• Erythromycin: Four doses per day are given orally for one week.
• Ofloxacin: Given orally, twice a day for 1 week
• Levofloxacin: Given orally once a day for 7 days.

In treatment, only the treatment of the man is not enough. If there is a sexually transmitted disease, all partners must be treated. It is recommended that the man not have sexual intercourse with his wife until his treatment is completed. In this way, transmission of infection to the partner is prevented.

Sometimes urethritis treatment requires more complicated treatment. Especially in regions where the disease is common and sexually transmitted diseases are common, more resistant microorganisms may be the causative agent. Sometimes it may be caused by more than one factor rather than a single organism. In these cases, further testing such as culture and antibiogram may be required. In resistant cases, the treatment protocol may vary. Sometimes, some microorganisms transmitted from unprotected women who have intercourse with more than one partner and found only in the vagina may be the causative agent. These are microorganisms called Trichomonas vaginalis. The urologist should evaluate the patient and make an effective treatment plan.

What are the complications of urethritis?

With medication, urethritis is usually treated quickly. If the infection is left untreated, sometimes very serious complications develop. Infection can reach the bladder, ureters and kidneys. If it enters the bloodstream, it causes sepsis, serious organ damage and death.

In addition, urethritis caused by sexually transmitted infections causes serious damage to the reproductive system. Women develop pelvic inflammatory disease (PID), eventually resulting in infertility, pain in the groin or pain during intercourse. If sexually transmitted diseases in women are not treated, they lead to ectopic pregnancy.

In men, urethral stricture develops due to painful inflammation or scar tissue that develops as a result of prostate infection or infection. For these reasons, urethritis is a serious disease that should not be neglected.

To briefly summarize the complications of untreated urethritis:

• Infection can reach the bladder, ureters and kidneys
• If it enters the bloodstream, sepsis, serious organ damage and death may occur.
• Pelvic inflammatory disease (PID) and eventually infertility in women,
• Pain in the groin or pain during intercourse
• Ectopic pregnancy
• Painful inflammation or prostate infection in men
• Urethral stricture develops due to scar tissue that develops as a result of infection.
• Infertility in men as a result of blockage in the seminal ducts.

How to prevent urethritis?

Microorganisms that cause urethritis can be passed from one person to another through sexual intercourse. The microorganisms that cause the disease usually respond well to antibiotics. Cure is possible in patients who receive appropriate treatment, and most of the time there are no sequelae. Since the disease is transmitted sexually, taking protective measures during intercourse is very important in preventing the transmission of the disease. It is possible to avoid contracting the disease by raising people’s awareness on these issues. We can list the protective measures against urethritis as follows:

• Avoiding relationships with multiple partners
• Using a condom during intercourse
• Having regular tests
• People with sexually transmitted diseases should prevent others from getting sick by telling other people they will be with.

Apart from these, it is important to pay attention to the following two points for a healthy urinary tract. Thus, the urinary tract is mechanically cleaned and the possibility of clinical infection is reduced or prevented.

• Drinking plenty of water and urinating after intercourse, thereby clearing the urinary tract.
• Avoiding acidic foods, avoiding spermicides (using spermicide creams during intercourse for birth control purposes).

In summary: Urethritis is an infectious disease that is transmitted especially from sick women to men through unprotected intercourse. Prevention of the disease is as important as treatment. If patients are made aware of these issues, the risk of getting the infection is extremely low. In this regard, first of all, people should be made aware of this disease. Diagnosis of the disease is easy. Diagnosis is easily made by routine clinical evaluation and examination. Urethritis causes serious complications in both men and women if not treated promptly and appropriately. Appropriate antibiotic therapy is very important in treatment. If the woman has a disease, it also needs to be treated. In some cases, the doctor may start combined therapy.

Prof. Dr. Emin ÖZBEK

Urology Specialist

Istanbul- TURKEY