Urethritis in men

The urethra is a hollow tube that runs from the bladder through the penis and opens at the head of the penis. From the inside, the urethra is covered with a layer of mucous membrane, which protects the underlying tissues from irritation and inflammation. When the urethra becomes inflamed, this condition is called urethritis. The urethra becomes swollen, its lumen narrows, which causes burning pain and discomfort when urinating.

Other symptoms of urethritis may include itching or tingling inside the penis or discharge of pus from the urethra. A man may also experience pain during sex and masturbation. Some men with signs of urethritis may have little to no symptoms.

Urethritis is usually triggered by sexually transmitted infections (STIs), but this is not always the case. Sometimes the cause can be bacteria from the skin or even non-infectious factors.

In urological practice, several forms of urethritis are divided – specific (aka – gonococcal) and non-gonococcal (or non-specific) urethritis in men.

Non-gonococcal urethritis is an infection of the urethra or an inflammatory process caused by other factors. The symptoms of non-gonococcal urethritis are similar to gonorrhea, but conventional treatments for gonorrhea will not work.

What is urethritis

Nongonococcal urethritis is an infection of the urethra (the tube that leads from the bladder to the tip of the penis).

The most common culprit is a sexually transmitted infection (STI). It can be either vaginal sex or oral or anal sex. Less often, these are non-infectious causes, usually in older men.

Useful information about urethritis

Causes of urethritis in men

Gonorrhea is one of the most common infections that can cause urethritis. Then we are talking about a specific process that requires treatment with antibiotics.

Non-gonococcal urethritis (NGU) is a term used to describe a whole group of urethritis caused by anything other than gonorrhea. It can be a bacterial infection caused by Chlamydia trachomatis (chlamydia) or Mycoplasma genitalium (mycoplasmosis). Inflammation can also be caused by a variety of other pathogens (bacteria or viruses).

Rarely, the cause of urethritis may be a non-infectious cause, such as trauma to the urethra or blockage by a passing stone, a reaction to soap or cream.

In three out of ten men with urethritis, doctors find no obvious cause for the inflammation.

Pathology is most often detected among sexually active men under the age of 25 who have recently changed their sexual partner. Urethritis is also more likely if the man has unprotected sex (without a condom).

Symptoms of urethritis in men

As a rule, after infection with delicate infections, it can take from 1 to 3 weeks before the first signs of urethritis in a man. The first symptom is usually a discharge of milky fluid (thick mucus) from the tip of the penis. The amount of discharge can vary from insignificant, barely noticeable to quite abundant. There may also be a mild burning sensation in the penis during urination.

If the symptoms are ignored, the discharge may decrease even though the infection is still present. Sometimes a man with an STI has no symptoms at all.

When should you see a doctor immediately?

It is imperative to see a urologist if a man has any of the following symptoms:

• fever 38 °C or higher;
• blood in urine or semen;
• burning pain when urinating;
• constant desire to urinate;
• discharge from the penis;
• itching, soreness, or swelling of the penis or groin;
• pain during sex or masturbation;
• inability to urinate.

Treatment of urethritis in men

If a man thinks that he has gonorrhea or non-gonococcal urethritis, you should not try to cure the problem on your own – you need a doctor. He will examine the genitals and, if necessary, conduct testing. A sample of secretions from the penis will be taken for analysis and tested for the germs that cause gonorrhea and chlamydia.

It should be noted that 20% of men with gonorrhea are also infected with chlamydia. In confirmed cases, NGUs should also be tested for HIV and other STIs, as they may be acquired at the same time or after contracting this infection.

Diagnostics

A man may also have one or more of the following tests:

• Analysis of urine. This is done in order to remove the diagnosis of urinary tract infection: cystitis and pyelonephritis.
• Blood test. A blood sample will show the presence of inflammation in the body.
• Sowing discharge from the urethra. A fluid sample is taken from inside the urethra and examined under a microscope. To obtain a sample, a cotton swab is inserted into the opening of the penis and into the urethra.
• Cystoscopy. This test allows the doctor to identify problems with the urinary tract. The examination uses a thin flexible tube (cystoscope). It has a backlight and a camera, is inserted into the urethra and bladder to examine them from the inside.

Modern treatments

Treatment depends on the cause of the urethritis. If this is a consequence of a bacterial infection (gonorrhea, chlamydia, mycoplasma or non-specific microbes), antibacterial drugs will be prescribed.

Drugs should be selected based on the sensitivity of microbes to them. The doctor can talk about additional treatment options against the background of antibiotics (which you need to drink to the end, even if it gets better).

In parallel with antimicrobial therapy, unpleasant symptoms can also be treated. Anti-inflammatory medications such as ibuprofen and herbal medicine may be prescribed to relieve pain and swelling. If urethritis is left untreated, symptoms may worsen. Scars and adhesions may form in the urethra.

How is non-gonococcal urethritis treated?

It is usually treated with antibiotics, which kill the germs that cause the infection. Antibiotics most commonly used to treat NGU include doxycycline taken twice a day for a week, or macrolide antibiotics such as Azithromycin given as a single dose. This treatment cures the infection in about 90% of cases. If the patient is allergic to doxycycline or does not clear the infection, other medicines may be used.

It is important to take all medications prescribed by your doctor. Do not stop taking medication, even if all symptoms disappear. Do not share your medicine with other people.

You should not have sex until all the medicines are drunk and the results of control tests are received.

You can conduct a self-examination by determining the presence of discharge by gently squeezing the penis. The best time to do this is in the morning before you urinate. Fluid coming out of the penis is normal. A discharge that looks like milk or pus means the man still has the infection. Do not check for discharge more than once a day. More frequent squeezing of the penis can cause irritation and discharge even if there is no infection.

If the discharge does not go away, or if it disappears and then comes back, you should contact your doctor for further treatment.

Prevention of urethritis in men at home

The most important thing is to avoid intimacy without protection with unfamiliar partners. When it comes to sex, it’s important to take care of yourself and be safe. Any sexual contact can become a source of STIs and urethritis. The only sure way to prevent STIs is to use condoms for protection.

Popular questions and answers

Regarding the diagnosis and treatment of urethritis in men, the features of treatment, we talked with urologist, specialist in ultrasound diagnostics, doctor of the highest category of the Center for Disaster Medicine Yuri Bakharev.