What is urethritis and what causes it?

Urethritis means inflammation of the urethra. The urethra is the tube between the bladder and the end of the penis. Urethritis is usually caused by a sexually transmitted infection but not always. It can occur within a stable relationship.

• Gonorrhoea is one type of sexually transmitted infection which can cause urethritis. See separate leaflet called 'Gonorrhoea' for more details.
• Non-gonococcal urethritis (NGU) is the term used to describe urethritis caused by anything other than gonorrhoea. A bacterium called chlamydia is the common cause of NGU. This is one type of sexually transmitted infection. NGU can also be caused by a variety of other bacteria or viruses (germs). NGU may rarely have a non-infective cause. For example, damage from a catheter, a thrush infection, soap, spermicides, a narrowing of the urethra (stenosis) and diseases affecting the urethral lining can all cause inflammation. See separate leaflet called 'Urethritis - Non-gonococcal', which describes NGU in more detail.
• No cause can be found in up to three out of ten men with urethritis.

Some men have gonococcal and non-gonococcal urethritis at the same time.

Who gets urethritis?

You are at higher risk of getting urethritis if you are sexually active, aged under 35 and have had a recent partner change. Men who have sex with men and those who have unprotected vaginal intercourse are also at higher risk.

What are the symptoms of urethritis?

• A discharge (fluid) from the end of the penis is common but does not always occur.
• Pain or burning when you pass urine. This may be confused with a urine infection.
• You may have irritation inside the penis, or a feeling of wanting to pass urine frequently.
• Some men with urethritis never develop any symptoms. For example, up to half of men with chlamydial infection (the most common cause of NGU) do not have any symptoms.

How does urethritis progress?

Occasionally, symptoms may clear without treatment but may take months to do so. If your condition has been caused by an infection, germs may still be present, even if the symptoms have gone.

Therefore, you are still likely to be infectious and can still pass on the infection even if symptoms go. The bacterium that commonly causes urethritis in men (chlamydia) can cause serious problems in women.

What should I do if I have symptoms of urethritis?

• See a doctor, or go to your local genitourinary medicine (GUM) clinic, even if symptoms go. You can go to the local GUM clinic without a referral from your GP.
• Your doctor may do a test or refer you to a GUM clinic. This will usually be a urine test, although a 'swab' of urethra may be taken as well.
• You may be asked to have tests for HIV, hepatitis and syphilis, as people with urethritis sometimes have these conditions as well.
• Men who have sex with men may also require swabs from the back of the throat (pharynx) and rectum.
• The GUM clinic will protect your confidentiality but, if they confirm you have an infection, they may want to contact anyone you had sex with up to six months before you were diagnosed. This is called 'contact tracing'.
• Antibiotics will usually clear an infection. The antibiotic prescribed depends on the cause. Make sure you complete the course.
• If your urethritis is due to gonorrhoea it is vital that you have another test after you have been treated to make sure the infection has been cured. This will be done three or seven days after treatment, depending on the type of test.
• Tell your sexual partner(s) to see their doctor or go to a GUM clinic, even if they have no symptoms. Many women with sexually transmitted infections do not have symptoms.
• Don't have sex (including oral and anal sex) until you and your sexual partner(s) have completed tests and treatment. In some cases, you will need to wait seven days after you have finished your treatment course: your doctor will advise.

Further help and information

If you suspect that you have a sexually acquired urethritis or any other sexually transmitted infection, then contact your local GUM clinic or see your GP. You can go to the local GUM clinic without a referral from your GP. You can ring the local hospital or health authority and ask where the nearest clinic is. It may also be listed in the phone book under 'Genito-Urinary Medicine'.

fpa
Helpline: 0845 122 8690 Web: www.fpa.org.uk
Provides information and advice on all aspects of contraception and sexual health.

British Association for Sexual Health and HIV (BASHH)
Web: www.bashh.org
A professional association but their website includes contact details of GUM clinics.

Chlamydiae.com
Web: www.chlamydiae.com
The comprehensive reference and education site for chlamydia and the chlamydiae. By the University of Southampton.

National chlamydia screening programme website
Web: www.chlamydiascreening.nhs.uk
Includes information about the national screening programme to detect young people with chlamydia who do not have symptoms.

References

• Management of chlamydia trachomatis genital tract infection, British Association for Sexual Health and HIV (2006)
• Standards for the management of sexually transmitted infections, British Association for Sexual Health and HIV (2010)
• Plewa M, Male Urethritis in Emergency Medicine, Medscape, Apr 2010
• Guidelines on Urological Infections, European Association of Urology (2011)
• Urethritis - male, Prodigy (September 2009)