Symptoms in Females and Males
Medically reviewed by Alexandra Dubinskaya, MD
Urethritis is the inflammation of the urethra (the tube through which urine exits the body). The majority of cases are caused by two sexually transmitted infections (STIs)—gonorrhea and chlamydia—but there are other infectious and non-infectious causes in females and males.
It can sometimes be difficult to know if you have urethritis or some other medical condition and whether you need antibiotics or can wait for the condition to clear on its own. Given the risk of STIs, it is in your best interest to have it checked out.
This article looks at the symptoms of urethritis in females and males, including how the condition is diagnosed, treated, and prevented. It also explains how long healing takes and what could happen if you leave urethritis untreated.
Urethritis Pain: Symptoms in Females
Urethritis symptoms in females can differ from males. This is partly due to the location of the urethra next to the organs of the female reproductive tract, including the vagina and the donut-shaped opening of the uterus called the cervix.
Because of this, urethritis in females will frequently co-occur with cervicitis (inflammation of the cervix), particularly when gonorrhea or chlamydia are involved.
In such instances, symptoms may include:
Pain with urination (dysuria)
Frequent urination (urinary frequency)
A sudden, uncontrollable urge to pee (urinary urgency)
Vaginal bleeding, particularly after sex
Abnormal vaginal discharge
Even so, urethritis in females is often asymptomatic (meaning without symptoms) and may go unnoticed until serious complications develop. Some studies suggest that up to 75% of females who get chlamydia have no symptoms at all.
Related: Signs and Symptoms of Urethritis
Urethritis Pain: Symptoms in Males
Males are more likely than females to experience symptoms of urethritis. This is partly because the male urethra is longer than the female urethra (7 inches versus 1.5 inches) and therefore has more surface area.
Symptoms of urethritis in males may include:
A whitish discharge from the penis
Urinary frequency and urgency
Tenderness or swelling of the penis
Itching at the opening of the penis
Swollen lymph nodes in the groin
Urethritis in males often co-occurs with proctitis (inflammation of the rectum). This can cause anal itching, rectal pain or bleeding, and tenesmus (a feeling that you need to pass stools even though your bowels are empty).
Causes: Is Urethritis Always From an STI?
While gonorrhea and chlamydia account for a major proportion of urethritis cases, they are not the only cause. There are many possible causes broadly categorized as either:
Gonococcal urethritis: Caused by Neisseria gonorrhea (gonorrhea)
Non-gonococcal urethritis (NGU): Caused by other sexually transmitted, non-sexually transmitted, and non-infectious causes
Chlamydia, caused by Chlamydia trachomatis, accounts for 15% to 40% of NGU cases.
Other common and uncommon causes of NGU include:
Mycoplasma genitalium: A bacterial STI that accounts for 15% of 20% of NGUs
Trichomonas vaginalis: A parasitic STI that accounts for 2% to 13% of NGUs
Adenovirus: A common virus that can be passed through oral or vaginal sex
Escherichia coli (E. coli): An intestinal bacteria that can be passed through anal sex
Haemophilus influenza: A bacteria that can be passed through oral sex
Ureaplasma urealyticum: A bacteria that can be passed through oral or vaginal sex
Candida: A common species of fungus that can overgrow in people with weak immune systems
Menopause: Causes the thinning of vaginal and urethral tissues
Urethral irritation: Such as caused by harsh soaps, spermicides, body powders, tight clothing, bicycle riding, or sex
Related: STI vs. UTI: Which Do I Have?
How Do You Know You Have Urethritis for Sure?
Other infections can mimic symptoms of urethritis, including a urinary tract infection (UTI), cystitis (bladder infection), and prostatitis (inflammation of the prostate gland). Because of this, it is important to see a healthcare provider to confirm you have urethritis and pinpoint the exact cause.
The diagnosis will start with a review of your medical history, including recent sexual contacts. As urethritis is most often caused by an STI, a physical exam will look for signs such as genital lesions, swollen lymph nodes, vaginal inflammation, swollen testicles, abnormal discharge, and inflammation of the meatus (opening of the penis).
If urethritis is suspected, a swab of fluid will be taken from the urethra. A rapid test called a gram stain can determine if there are any foreign bacteria in the sample. A microscopic examination of the sample can establish whether gonococcal urethritis or NGU is the most likely cause.
Based on the findings, a polymerase chain reaction (PCR) test can be performed on a swab or urine sample to confirm gonorrhea, chlamydia, or Mycoplasma genitalium as the cause.
If the findings are negative, other tests will be ordered to investigate less likely causes.
Related: How STIs Are Diagnosed
Urethritis and Antibiotic Treatment
With few exceptions, urethritis doesn't heal on its own and will require medical treatment to clear the underlying infection. Even for non-infectious causes, treatment may be needed.
Ideally, the treatment would be tailored to the infection, but this is not always possible. Because people are sometimes reluctant to return to an STI clinic after the initial diagnosis, public health officials tend to prefer delivering treatment immediately rather than delaying it.
Even if the bacterial cause is not confirmed, an NGU will generally be treated with one of the following three antibiotic regimens:
Doxycycline: 500 milligrams (mg) taken by mouth twice daily for seven days (preferred option)
Azithromycin: 1,000 mg taken by mouth in a single dose
Azithromycin: 500 mg taken by mouth in a single dose, followed by 250 mg taken once daily for seven days
For gonococcal urethritis, the following antibiotic treatment is recommended:
Ceftriaxone: 500 mg given in a single intramuscular injection (typically into the large muscle of the buttocks)
Related: How Gonorrhea Is Treated
When Do Urethritis Symptoms Start to Heal?
Urethritis tends to respond well to the appropriate antibiotic. Symptoms often resolve within a few days, but you must complete treatment to ensure the infection is fully cleared. Stopping early increases the risk of antibiotic resistance, making the drugs less effective if you acquire the infection again.
Even when treatment is completed, it may be time before the underlying infection is fully cleared. Until then, you need to avoid sexual contact until your healthcare provider gives you the OK. This prevents you from transmitting it to others and reduces your risk of reinfection.
When Can I Resume Sex?
If you have been diagnosed and treated for gonorrhea or chlamydia, the Centers for Disease Control and Prevention (CDC) recommends abstaining from sex for the following periods:
Gonococcal urethritis: Wait seven days after you and your partners have been treated. Retesting is recommended in three months regardless of whether your partners have been treated or not.
NGU: Wait until you and your partner have completed the seven-day course of treatment. If a single dose was used, you should also wait seven days. Retesting is recommended in three months.
Risks of Untreated Urethritis
The natural course of untreated gonorrhea and chlamydia is highly variable. Some people may have a persistent asymptomatic infection, while others may spontaneously clear the infection after weeks or months of unpleasant symptoms. Either situation places a person at risk of complications.
If left untreated, gonorrhea and chlamydia can lead to:
Epididymitis: This is an infection of the coiled tube called the epididymis that carries semen from the testicles. Left untreated, epididymitis can cause scarring, scrotal pain, and a loss of fertility.
Newborn infection: Babies can acquire the infection as they pass through the birth canal. This can lead to a potentially serious eye infection (ophthalmia neonatorum) or, in the case of chlamydia, pneumonia.
Arthritis: Both gonorrhea and chlamydia can cause reactive arthritis (formerly known as Reiter's syndrome), while gonorrhea can lead to septic arthritis (caused when the infection spreads into the bloodstream and joints).
A person with an untreated STI also risks transmitting the infection to sexual partners.
Self-Care to Stay Ahead of Another Urethritis
A 2013 study in the Journal of Infectious Diseases reported that 10% to 20% of people successfully treated for chlamydia were reinfected within several months. Reinfection rates were similar among people treated for gonorrhea, hovering at around 14%.
Given the high rate of reinfection, it is important to embrace strategies to avoid exposure to STIs and other infectious and non-infectious causes of urethritis.
A reduction in the number of sex partners
Keeping the area around the urethra clean
Avoiding perfumed soaps, feminine hygiene spray, bubble baths, etc.
Avoiding spermicides like nonoxynol-9
Peeing after sex (which may or may not clear bacteria from the urethra)
Maintaining sterile practices when using urinary catheters
Recommended STI Screenings
Urethritis most often affects sexually active younger people. To better protect yourself, ask your healthcare provider about recommended STI screenings.
The CDC currently recommends annual chlamydia and gonorrhea screening for:
All sexually active women under 25
Women 25 and over with risk factors such as new or multiple sex partners
All sexually active gay, bisexual, and other men who have sex with men
The terms for sex, gender, and sexual orientation from the cited source are used.
Related: A Guide to Regular STI Screenings
Urethritis is the inflammation of the urethra. STIs mainly cause it but it may also be caused by non-sexually transmitted infections, chemical irritants, menopause, and medical procedures.
As bacterial STIs like gonorrhea and chlamydia cause most cases, the treatment usually involves antibiotics. To prevent reinfection or infecting others, you would need to avoid sex for up to seven days following the completion of treatment.
Read the original article on Verywell Health.