urethritis

Urethritis is inflammation of the urethra, the tube that carries urine from the bladder to the outside. It is most commonly due to infection transmitted through sexual contact, but irritation from chemicals or trauma can also cause urethritis. In clinical practice, urethritis is often categorized as gonococcal urethritis, caused by Neisseria gonorrhoeae, and non-gonococcal urethritis (NGU), typically due to Chlamydia trachomatis, Mycoplasma genitalium, or Ureaplasma urealyticum. Less common causes include other bacteria and, rarely, viruses.

Symptoms commonly include dysuria (painful or burning urination), increased urinary frequency or urgency, and urethral discharge. In men, discharge from the penis may be more noticeable; in women, symptoms can be milder and may be mistaken for a urinary tract infection, and some cases are asymptomatic. If left untreated, infection can spread to the epididymis in men or to the uterus and fallopian tubes in women, increasing the risk of complications such as pelvic inflammatory disease.

Diagnosis rests on clinical symptoms and laboratory testing. Nucleic acid amplification tests (NAATs) on urine or urethral/cervical swabs detect Neisseria gonorrhoeae and Chlamydia trachomatis, with additional testing for Mycoplasma genitalium and other pathogens as available. Urinalysis may show pyuria.

Treatment depends on the likely pathogens and local guidelines. Gonococcal urethritis is treated with a cephalosporin (e.g., ceftriaxone), usually with therapy for potential chlamydial coinfection (e.g., doxycycline or azithromycin). NGU is commonly treated with doxycycline or azithromycin. Partners should be informed and treated if indicated, and sexual abstinence until treatment completion is advised. Prevention focuses on safe sex practices and regular screening in at-risk individuals.