What is urethritis?
Urethritis refers to the irritation or inflammation of the urethra. The urethra is the tube that empties urine from the bladder. In men the urethra extends the full length of the penis. In women the urethra is much shorter, about an inch long, and the opening is just above the vagina. Because the opening of a woman's urethra is so close to the vagina and anus, bacteria can easily enter it from these areas.

What is the cause?
Most often, especially in males, urethritis results from a sexually transmitted disease (STD). The two most common STDs associated with urethritis in males are chlamydia and gonorrhoea. However, other STDs can cause these symptoms as well, including herpes simplex virus and the human papilloma virus. Less serious STDs such as trichomoniasis can also cause symptoms.

In most older women, the tissues of the urethra and bladder become thinner and drier after menopause because of a lack of the female hormone oestrogen. This is the usual cause of urethritis in older women. Sometimes vaginal infections (for example, a yeast infection) cause women to have symptoms of urethritis.

Urethritis may at times simply be an irritation caused by rubbing or pressure on the groin area. For example, tight clothing can cause urethritis. It may also result from an irritant such as soap or powder. Another possible cause is long and frequent bicycle riding with a long-nose bike seat.

What are the symptoms?
In men, symptoms are painful urination or discharge from the urethra. The opening of the urethra (the meatus) may be inflamed. In women the symptoms are similar to the symptoms of a bladder infection: painful urination, frequency of urination, and a sensation of incomplete emptying of the bladder and pain during sexual intercourse.

How is it diagnosed?
In men, penile discharge is examined for white blood cells and bacteria. Samples will be tested to find out if gonorrhoea or chlamydia is the cause. If the usual tests for STDs are negative, then it may be a nonspecific urethritis (NSU). There are a few bacteria associated with NSU, but it is not easy to test for them. In women the diagnosis can be more difficult than in men. Urethritis almost never causes a discharge from a woman's urethra. Occasionally the urethra is inflamed. The doctor examines the urethra and area around it and obtains a urine sample. He may also swab the urethral area. The cervix may be swabbed to test for chlamydial infection in the pelvis.

What is the treatment?
In women if there is no evidence for chemical irritation and no evidence of infection in the urine, she may be treated for chlamydial infection as the cause of urethritis. If lab tests show that urethritis is caused by an STD, the doctor will prescribe an antibiotic for the infection.

For older women the most common treatment for genital tissue thinning and dryness is oestrogen. Oral oestrogen, oestrogen cream for the genital area, or oestrogen skin patches may be used.

If the doctor finds or suspects an STD, the sexual partner(s) must be treated too. To avoid re-infection, latex condoms should be used if one is having intercourse while taking the antibiotic. The patient may be recommended to avoid intercourse for a while.

The symptoms caused by an infection should resolve within a few days of starting the antibiotic. In the case of postmenopausal tissue changes treated with oestrogen, it may be 6 weeks to 3 months before one has some relief from the symptoms. Men who have nonspecific urethritis may continue to have a small amount of discharge from the urethra that is clear to slightly cloudy in colour. Usually there is no persistent discomfort.

How can urethritis be prevented?
Avoid irritants and chemicals that cause redness, burning, or itching in the area of the urethra.

Menopausal and older women may consider using oral oestrogen, oestrogen vaginal cream, or oestrogen skin patches to help prevent tissue thinning and dryness.

Use of condoms during sexual intercourse is advised.

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