Uretritis

Urethritis is inflammation of the urethra, the tube that carries urine from the bladder to the outside of the body. It commonly presents with pain or burning during urination (dysuria) and increased or abnormal discharge, but symptoms can be mild or absent, especially in women. In men, a purulent urethral discharge and dysuria are common features.

Causes include infectious and noninfectious factors. Gonococcal urethritis is caused by Neisseria gonorrhoeae, while non-gonococcal urethritis (NGU) is often due to Chlamydia trachomatis, Mycoplasma genitalium, Ureaplasma species, or other bacteria. Noninfectious urethritis can result from chemical irritants, trauma, or recent instrumentation. Urethritis can occur as part of broader infections such as cervicitis in women or proctitis in men who have sex with men.

Diagnosis relies on clinical evaluation and laboratory testing. Nucleic acid amplification tests (NAATs) on first-void urine or urethral/cervical swabs detect Neisseria gonorrhoeae and Chlamydia trachomatis. Additional testing may include cultures or NAATs for Mycoplasma genitalium and other pathogens. Evaluation for other sexually transmitted infections, including HIV, syphilis, and hepatitis B, may be appropriate in at-risk individuals.

Treatment aims at eliminating the infection and preventing transmission. Gonococcal urethritis is treated with an effective antibiotic, typically a cephalosporin, with options to cover possible chlamydial coinfection (e.g., doxycycline). Nongonococcal urethritis is commonly treated with doxycycline or azithromycin. Sexual partners should be informed, tested, and treated if indicated, and patients should abstain from sexual activity until therapy is completed and symptoms resolve.

Prevention includes safe sex practices, consistent and correct condom use, regular STI screening for sexually active individuals, timely treatment of infections, and partner notification to reduce reinfection risk. Untreated urethritis can lead to complications such as epididymitis in men and pelvic inflammatory disease in women.