The Call-On-Doc Guide to Urethritis

Most cases of urethritis are caused by sexually transmitted diseases, with the condition typically arising as a symptom of bacteria transmitted through unprotected intercourse. When it comes to STDs, the most common cause of urethritis includes: 

• Chlamydia: A result of the bacteria Chlamydia trachomatis, transmission can lead to urethritis by infecting the cells lining the urethra. The bacteria invade these cells, causing inflammation and an immune response that results in the characteristic symptoms of urethritis, including pain, discharge, and discomfort during urination. Learn more about chlamydia through the CallonDoc Guide to Chlamydia!
• Gonorrhea: The most common cause of urethritis by transmission of the bacterium Neisseria gonorrhoeae. The infection leads to urethritis by infecting the mucous membranes of the urethra. The bacteria trigger an inflammatory response, causing the urethra to become swollen, painful, and produce discharge. Learn more about gonorrhea through the CallonDoc Guide to Gonorrhea!
• Herpes: Herpes, caused by the herpes simplex virus (HSV), can cause urethritis when the virus infects the genital area. During an outbreak, HSV lesions or sores can develop on or near the urethra, leading to localized inflammation and discomfort during urination, resulting in urethritis. Learn more about herpes through the CallonDoc Guide to Herpes!
• Mycoplasma genitalium: Mycoplasma genitalium, a type of bacteria, can cause urethritis by directly infecting and inflaming the cells lining the urethra. This infection triggers an inflammatory response, leading to urethritis, with symptoms such as pain, discharge, and discomfort during urination. Learn more about Mycoplasma genitalium through the CallonDoc Guide to Mycoplasma Genitalium!
• Trichomoniasis: Trichomoniasis, caused by the parasite Trichomonas vaginalis, can lead to urethritis by infecting the urethra and causing irritation and inflammation. The parasite's presence in the urethra can result in symptoms such as itching, burning, and discharge, resulting in urethritis. Learn more about trichomoniasis through the CallonDoc Guide to Trichomoniasis!

When it comes to getting urethritis, the CDC recommends patients get tested for chlamydia, gonorrhea, trichomoniasis, and mycoplasma genitalium. (2) Not only does Call-On-Doc offer testing for all of the above, but we’ve also made the process easier by offering easy-to-use double (gonorrhea and chlamydia) and triple (gonorrhea, chlamydia, and trichomoniasis) testing for those who think they’ve caught any one or all three infections. On top of that, you can get treated before the results 

While not as common, nongonococcal and non-sexually transmitted urethritis is possible. The condition is not isolated to sexually transmitted infections and can be the result of what might seem like minor inconveniences. (3) These can include:

• Urinary Tract Infections: Urinary tract infections or URIs can cause urethritis when bacteria, typically from the gastrointestinal tract, enter the urethra and travel upward into the urinary tract. Once in the urethra, these bacteria can multiply and trigger an inflammatory response, leading to the characteristic symptoms of urethritis, including pain, burning during urination, and increased frequency of urination. 
• Chemical Irritations: Chemical irritation can cause urethritis when substances such as harsh soaps, lotions, or hygiene products come into contact with the sensitive lining of the urethra. These chemicals can disrupt the natural balance of the urethral mucosa, leading to inflammation and irritation. Doing so is also a common cause behind both women’s health conditions: bacterial vaginosis and vaginal yeast. 
• Allergic Reactions: Allergic reactions can cause urethritis when an individual is hypersensitive to certain substances, such as latex or chemicals found in condoms, lubricants, or spermicides. When these allergens come into contact with the urethra during sexual activity, they can trigger an immune response and inflammation in the urethral tissue. 
• Trauma or injury: Trauma and injury to the urethra can cause urethritis when the delicate tissues of the urethra are damaged or irritated. This can result from activities such as catheterization, sexual intercourse, or accidents. 
• Foreign Bodies: when objects or materials become lodged in the urethra, leading to irritation and inflammation. These foreign bodies can include small particles, such as stones or debris, or even objects introduced intentionally or accidentally.
• Friction: Friction can contribute to urethritis when excessive or forceful rubbing or friction occurs during sexual activity. This repeated and intense mechanical irritation can lead to inflammation and discomfort in the urethra. In addition, those who ride bikes may experience the same result. 

Often similar to other conditions affecting the genitals and urinary tract, urethritis symptoms might appear like those discussed in the CallonDoc Guide to Urinary Tract Infections. Often an indication of a greater infection, urethritis signs and symptoms will be felt differently in men versus women. 

Urethritis Symptoms Male:

• Bloody Urine or seman: Urethritis in men can cause bloody urine or semen due to the inflammation and irritation of the urethral lining, which can lead to small blood vessels within the urethra becoming damaged or ruptured. This can result in the presence of blood mixing with urine or semen, typically as a result of infection or trauma to the urethra.
• Burning or Painful Urination: Men with urethritis often describe a discomforting burning or stinging sensation when they urinate. This symptom can range from mild to severe and is typically one of the earliest signs of urethritis.
• Discharge from the Penis: Urethritis in men commonly leads to the production of penile discharge. This discharge may be visible at the tip of the penis and can vary in color and consistency. It is often white, yellow, or greenish and can be present throughout the day.
• Increased Urinary Frequency: Men with urethritis may find themselves needing to urinate more frequently than usual. This can be bothersome and may disrupt daily activities due to the frequent urge to urinate.
• Itching or Irritation: Some men may experience itching or irritation in the genital area. This discomfort can add to the overall discomfort caused by urethritis.
• Painful Intercourse: Urethritis in men can cause painful intercourse because the inflammation and irritation of the urethra can make the act of penetration and friction uncomfortable and painful. 
• Redness and Swelling: Inflammation of the urethra can result in redness and swelling around the opening of the penis. This can make the area appear inflamed and may be visually noticeable.

Urethritis Symptoms Female:

• Burning or Painful Urination: Women with urethritis can also experience a burning or painful sensation during urination. This discomfort is often felt in the urethral area.
• Increased Urinary Frequency: Similar to men, women may notice an increased need to urinate more frequently, along with a sense of urgency.
• Painful Intercourse: Urethritis in women can result in not only the inflammation of the urethra but also the surrounding genitals, causing a painful reaction to intercourse. 
• Pelvic Pain: Urethritis in women can sometimes lead to pelvic discomfort or pain. This pain may be mild to moderate and can be felt in the lower abdomen or pelvis.
• Vaginal Discharge: While men typically have penile discharge, women with urethritis may have vaginal discharge. This discharge can vary in color and consistency and may be accompanied by an unusual odor.

Caused by the inflammation of the urethra, urethritis symptoms tend to be hard to miss when they arise. However, the condition can vary from person to person and is suspected of being asymptomatic in millions more people than the reported four million affected annually. (4)

The development of urethritis symptoms depends on the infection’s source. For example, if stemming from gonorrhea, it can take two to five days versus chlamydia which can range between seven to fourteen days. (1) Whereas for some, it simply never develops, the most common time of development for nongonococcal urethritis symptoms takes one to five weeks. (5)

In most cases, a diagnosis can be made through a medical provider examining your medical history, reviewing symptoms, and discussing your recent sexual activity. If the condition proves to have urethritis symptoms, the doctor won’t necessarily need to conduct a test, but can if there is some confusion or to rule out other types of infections. (6) The urethritis tests available to doctors and patients include: 

• Blood Tests
• Lab Tests of Discharge or Swabs
• Urine Tests

Urethritis symptoms often are an indication of a greater infection caused by a sexually transmitted disease, or physical trauma. That is why the condition is categorized between the gonococcal and nongonococcal categories because STDs like gonorrhea are a frequent cause of the condition. (1) Doctors will carefully consider the urethritis symptoms presented and the patient’s sexual history, using tests for common conditions to avoid a misdiagnosis.  

Most urethritis infections are bacterial, meaning antibiotics will be used by doctors to clear it up. While there are different options depending on the infection, the most common and effective urethritis treatment uses: 

• Azithromycin: Azithromycin is considered effective against Chlamydia and some strains of Gonorrhea, which are common urethritis causes. It is often prescribed as a single, high-dose treatment, making it convenient for patients to complete their course of antibiotics. Azithromycin works by inhibiting the growth and replication of bacteria, including the bacteria responsible for these infections.
• Doxycycline: Doxycycline is often prescribed as a course of treatment, typically for 7 to 14 days with it being effective against chlamydia and Mycoplasma genitalium. It works by inhibiting bacterial protein synthesis, which prevents the bacteria from growing and reproducing.
• Erythromycin: Erythromycin is an antibiotic used to treat urethritis, especially when it is caused by sexually transmitted infections (STIs) like Chlamydia or Mycoplasma genitalium. It functions by inhibiting the growth and replication of bacteria, disrupting their ability to produce proteins essential for survival. This urethritis treatment is typically a course that is to be completed. 
• Ofloxacin: Ofloxacin is a fluoroquinolone antibiotic that is sometimes used to treat urethritis, particularly when it is caused by certain sexually transmitted infections such as Gonorrhea. It works by inhibiting bacterial DNA replication and protein synthesis, effectively preventing the growth and reproduction of the bacteria.

Urethritis typically does not resolve on its own without treatment. Infections responsible for urethritis tend to persist and can lead to complications if left untreated. While some mild cases of non-infectious urethritis may improve without specific treatment, it is generally advisable to seek medical attention if you suspect you have urethritis to receive appropriate diagnosis and treatment. (4)

Alongside urethritis treatment, there are some methods that will help soothe the condition down to a manageable level. This includes lifestyle habits and over-the-counter medications like: 

• Stay Hydrated: Drinking plenty of water is essential as it helps dilute urine, reducing the concentration of irritants in the urine that can cause a burning sensation during urination. Staying hydrated also supports overall urinary tract health.
• Avoid Irritants: Harsh soaps, bubble baths, and scented feminine hygiene products can contain chemicals that irritate the urethra and genital area. Opt for mild, fragrance-free products to avoid exacerbating discomfort.
• Pain Relief: Over-the-counter pain relievers like ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) can help reduce pain, inflammation, and discomfort associated with urethritis. Follow the dosing instructions on the medication label or consult a healthcare provider for guidance.
• Rest and Avoid Aggravating Activities: Resting and avoiding activities that may worsen symptoms, such as sexual intercourse or strenuous exercise, can help the body recover more quickly. Giving the affected area time to heal is essential.
• Warm Compresses: Applying a warm, moist compress to the genital area can provide relief from discomfort and help relax the muscles in the pelvic region. Make sure the compress is not too hot to avoid burns.
• Cranberry Juice: Some individuals find that drinking unsweetened cranberry juice can help soothe urinary tract symptoms. Cranberry juice may help prevent urinary tract infections (UTIs), which can contribute to urethritis. However, it's essential to use unsweetened juice to avoid excess sugar, which can exacerbate symptoms.
• Avoid Alcohol and Caffeine: Alcohol and caffeine can act as irritants to the bladder and urinary tract, potentially worsening symptoms. It's a good idea to limit or avoid these substances until symptoms resolve.

Urethritis, particularly when it is caused by infections, can be aggravated or worsened by several factors and behaviors. Here are some things that can potentially aggravate or worsen urethritis:

• Sexual Activity: Engaging in sexual activity, especially without using barrier methods like condoms, can introduce additional irritation and potentially reinfect the urethra if the underlying cause is a sexually transmitted infection (STI). It's advisable to abstain from sexual activity or use protection until the infection is fully treated.
• Failure to Complete Treatment: Not completing the full course of antibiotics or prescribed medications as directed by a healthcare provider can allow the infection to persist or develop antibiotic resistance, making it more challenging to treat.
• Harsh Hygiene Products: Using harsh soaps, bubble baths, scented feminine hygiene products, or douches in the genital area can introduce irritants that worsen the inflammation of the urethra.
• Alcohol and Caffeine: These substances can act as irritants to the bladder and urinary tract, potentially exacerbating symptoms of urethritis.
• Dehydration: Inadequate hydration can lead to concentrated urine, which may intensify the burning sensation during urination. Staying well-hydrated can help dilute the urine and reduce irritation.
• Strenuous Activities: Activities that put pressure on the pelvic region, such as heavy lifting or intense exercise, can aggravate discomfort and pelvic pain associated with urethritis. Rest may be beneficial during the healing process.
• Tight Clothing: Wearing tight or restrictive clothing in the genital area can cause friction and irritation, potentially worsening symptoms.

Urethritis prevention is most often similar to preventing the transmission of sexually transmitted diseases through safe sex practices. Alongside being careful who you choose as a sexual partner and what habits you practice regularly, these can include: 

• Use Barrier Methods: Consistently and correctly use barrier methods such as condoms (male or female) during sexual intercourse. Condoms provide a physical barrier that can reduce the risk of STIs, including those that can cause urethritis.
• Limiting Sexual Partners: Aside from celibacy and monogamy, the best way to prevent urethritis and other STDs is to be selective with sexual partners. Limit those chosen to those you can clearly communicate with and trust. 
• Regular STI Testing: If you are sexually active, especially with multiple partners, consider getting regular STI screenings. Early detection and treatment of STIs can prevent them from progressing to urethritis or causing complications.
• Practice Good Hygiene: Maintain good genital hygiene by washing the genital area with mild, unscented soap and water. Avoid washing inside the vagina as this can result in an imbalance of bacteria and fungi, leading to an overgrowth of either. 
• Stay Hydrated: Drink an adequate amount of water to help maintain urinary tract health. Diluted urine is less likely to irritate the urethra.
• Educate Yourself: Educate yourself about STIs, their symptoms, and how they are transmitted. Being informed can help you make safer choices in your sexual relationships.
• Communicate with Partners: Open and honest communication with sexual partners about sexual history, STI testing, and the use of protection is essential for reducing the risk of STIs.
• Seek Prompt Treatment: If you suspect you have an STI or experience symptoms like burning during urination or unusual genital discharge, seek medical attention promptly. Early diagnosis and treatment can prevent complications and reduce the risk of spreading the infection to others.

When it comes to getting urethritis treatment and testing, Call-On-Doc has you covered with a variety of options to make you and your partner feel better, if needed. Get treated seven days a week from the privacy and comfort of your home with same-day treatment sent to your pharmacy. 

1. Young A, Toncar A, Wray AA. Urethritis. [Updated 2022 Dec 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan 1, https://www.ncbi.nlm.nih.gov/books/NBK537282/.
2. “Urethritis and Cervicitis - STI Treatment Guidelines.” CDC, https://www.cdc.gov/std/treatment-guidelines/urethritis-and-cervicitis.htm.
3. “Non-Gonococcal Urethritis (NGU).” Illinois Department of Public Health, https://dph.illinois.gov/topics-services/diseases-and-conditions/diseases-a-z-list/non-gonococcal-urethritis.html.
4. “Urethritis: Causes, Symptoms, Diagnosis & Treatment.” Cleveland Clinic, 5 April 2022, https://my.clevelandclinic.org/health/diseases/22858-urethritis.
5. “Nongonococcal Urethritis (NSU, NGU).” New York State Department of Health, https://www.health.ny.gov/diseases/communicable/nongonococcal_urethritis/fact_sheet.htm.
6. Hoffman, Matthew, and Nayana Ambardekar. “Urethritis: Causes, Symptoms, and Treatment.” WebMD, 26 January 2022, https://www.webmd.com/a-to-z-guides/urethritis-symptoms-causes-treatments.