Urethritis

Signs and Symptoms

There may be no symptoms of urethritis, particularly in women. When there are, symptoms may include:

In men:

• Burning during urination
• Pus or whitish, mucous discharge from the penis
• Burning or itching around the opening of the penis
• Blood in the urine or semen

In women:

• Abdominal pain
• Painful urination
• Unusual vaginal discharge
• Fever and chills
• Frequent, urgent urination

What Causes It?

• Bacteria and other organisms entering the urethra
• Bruising during sexual intercourse (in women)
• Infection reaching the urethra from the prostate gland or through the penis opening (in men)
• Bacterial infection after you have taken a course of antibiotics
• Reiter syndrome
• Sexually transmitted diseases (STDs), such as chlamydia, syphilis, gonorrhea, herpes simplex virus, or HIV and AIDS

What to Expect at Your Doctor's Office

Your doctor will examine your genitals, do laboratory tests on a urine sample, and take a specimen of mucus from inside the urethra and, in women, the vagina.

Treatment Options

• Your doctor may prescribe antibiotics to get rid of the bacteria causing the infection.
• All sex partners should be treated.
• You should not have sex until you complete treatment, because you can still have an infection even after your symptoms go away.

Prevention

• Limit your number of sexual partners.
• Always use condoms.
• If you have symptoms, or think you have an infection, seek treatment immediately and notify all sexual partners.
• Practice good personal hygiene.

Drug Therapies

Depending on the cause of the infection, your doctor may prescribe one of the following treatments:

• Amoxicillin
• Ampicillin
• Ciprofloxacin (Cipro)
• Levofloxacin (Levaquin)
• Sulfamethoxazole-trimethoprim (Bactrim, Septra)

Complementary and Alternative Therapies

Nutrition, herbs, and homeopathic remedies can help your body fight infection, relieve pain, and strengthen the urinary system. Always tell your doctor about the herbs and supplements you are using. Complementary therapies are best used in conjunction with conventional medical care as part of a coordinated approach among your health care providers to affect the best outcomes.

• Cranberries contain substances that may keep bacteria from sticking to the urethra. Preliminary evidence suggests that drinking cranberry juice daily may help prevent urinary tract infections, especially in women who get infections often.
• Avoid caffeine and other stimulants.
• Drink 6 to 8 glasses of filtered water daily.

Herbs are a way to strengthen and tone the body's systems. As with any therapy, you should work with your doctor before starting treatment. You may use herbs as dried extracts (capsules, powders, or teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. (5 g) herb per cup of hot water. Steep covered 5 to 10 minutes for leaves or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone or in combination as noted.

• Cranberry (Vaccinium macrocarpon). Supplements to help prevent urethritis and urinary tract infections. You may also drink 8 to 16 ounces of unsweetened cranberry juice daily. Cranberry supplements or juice may increase the risk of bleeding, especially if you take blood thinners such as warfarin (Coumadin) or clopidogrel (Plavix). People with kidney stones and pregnant or breastfeeding women should not take cranberry supplements. People who are allergic to aspirin should not take large amounts of cranberry supplements. Cranberry can interact with a number of medications. Ask your doctor before taking cranberry supplements.
• Bromelain (Ananus comosus). For pain and inflammation. Bromelain can increase the risk of bleeding, especially if you already take blood thinners. People who are allergic to pineapple should not take bromelain. Ask your doctor before taking bromelain.

Some of the most common remedies used for urethritis are listed below. Usually, the dose is 3 to 5 pellets of a 12X to 30C remedy every 1 to 4 hours until symptoms improve.

• Staphysagria. For urinary infections associated with sexual intercourse.
• Apis mellifica. For stinging pains that are made worse by warmth.
• Cantharis. For intolerable urging with "scalding" urine.
• Sarsaparilla. For burning after urination.

Acupuncture may help strengthen your overall immune system and help relieve pain from urethritis.

Following Up

If your urethritis was caused by a sexually transmitted disease (STD), your sexual partners may need to be treated as well. Possible complications for men include:

• Cystitis
• Epididymitis
• Prostatitis

Possible complications for women include:

• Cystitis
• Pelvic inflammatory disease (PID)
• Fertility problems
• Other gynecological problems

Special Considerations

STDs can cause permanent damage to reproductive organs and infertility in both sexes. They can also cause problems during pregnancy, premature delivery, low birth weight, and infections in newborns.

Supporting Research

Bally F, Troillet N. Diagnosis and treatment of urethritis. Rev Med Suisse. 2006;2(82):2282-2284, 2286.

Beerepoot MA, ter Riet G, Nys S, et al. Cranberries vs antibiotics to prevent urinary tract infections: a randomized double-blind noninferiority trial in premenopausal women. Arch Intern Med. 2011;171(14):1270-1278.

Berntsson M, Tunback P. Clinical and microscopic signs of cervicitis and urethritis: correlation with Chlamydia trachomatis infection in female STI patients. Acta Derm Venerol. 2013;93(2):230-233.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea -- a review. J Am Coll Nutr. 2006;25(2):79-99.

Cvetnic Z, Vladimir-Knezevic S. Antimicrobial activity of grapefruit seed and pulp ethanolic extract. Acta Pharm. 2004;54(3):243-250.

Dieterle S. Urogenital infections in reproductive medicine. Andrologia. 2008;40(2):117-119.

Doron S, Gorbach SL. Probiotics: their role in the treatment and prevention of disease. Expert Rev Anti Infect Ther. 2006;4(2):261-275.

Dryden GW Jr, Deaciuc I, Arteel G, McClain CJ. Clinical implications of oxidative stress and antioxidant therapy. Curr Gastroenterol Rep. 2005;7(4):308-316.

Gonclaves C, Dinis T, Batista MT. Antioxidant properties of proanthocyanidins of Uncaria tomentosa bark decoction: a mechanism for anti-inflammatory activity. Phytochemistry. 2005;66(1):89-98.

Hale LP, Greer PK, Trinh CT, James CL. Proteinase activity and stability of natural bromelain preparations. Int Immunopharmacol. 2005;5(4):783-793.

Heitzman ME, Neto CC, Winiarz E, Vaisberg AJ, Hammond GB. Ethnobotany, phytochemistry and pharmacology of Uncaria (Rubiaceae). Phytochemistry. 2005;66(1):5-29.

Ito S, Yasuda M, Seike K, et al. Clinical and microbiological outcomes in treatment of men with non-gonococcal urethritis with a 100mg twice-daily dose regimen of sitafloxacin. J Infect Chemother. 2012;18(3):414-418.

Lieske JC, Goldfarb DS, De Simone C, Regnier C. Use of a probiotic to decrease enteric hyperoxaluria. Kidney Int. 2005;68(3):1244-1249.

Lichtenstein AH, Russell RM. Essential nutrients: food or supplements? Where should the emphasis be? JAMA. 2005;294(3):351-358.

Maeda S, Tamaki M, Kubota Y, Nguyen PB, Yasuda M, Deguchi T. Treatment of men with urethritis negative for Neisseria gonorrhoeae, chlamydia trachomatis, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma parvum, and Ureaplasma Urealyticum. Int J Urol. 2007;14(5):422-425.

Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015.

Moi H, Blee K, Horner PJ. Management of non-gonococcal urethritis. BMC Infect Dis. 2015;15:294.

Moi H, Reinton N, Moghaddam A. Mycoplasma genitalium in women with lower genital tract inflammation. Sex Transm Infect. 2009;85(1):10-14.

Nanda N, Michel RG, Kurdgelashvili G, Wendel KA. Trichomoniasis and its treatment. Expert Rev Anti Infect Ther. 2006;4(1):125-135.

Schindler G, Patzak U, Brinkhaus B, et al. Urinary excretion and metabolism of arbutin after oral administration of Arctostaphylos uvae ursi extract as film-coated tablets and aqueous solution in healthy humans. J Clin Pharmacol. 2002;42(8):920-927.

Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002;21(6):495-505.

Stapleton AE, Dziura J, Hooton TM, et al. Recurrent urinary tract infection and urinary Escherichia coli in women ingesting cranberry juice daily: a randomized controlled trial. Mayo Clin Proc. 2012;87(2):143-150.

Takahashi S, Takeyama K, Kunishima Y, et al. Analysis of clinical manifestations of male patients with urethritis. J Infect Chemother. 2006;12(5):283-286.

Taylor-Robinson D. Diagnosis and antimicrobial treatment of Mycoplasma genitalium infection: sobering thoughts. Expert Rev Anti Infect Ther. 2014;12(6):715-722.

Yoon JH, Baek SJ. Molecular targets of dietary polyphenols with anti-inflammatory properties. Yonsei Med J. 2005;46(5):585-596.