Urethritis
Urethritis is inflammation of the urethra, the tube that carries urine out of the body. It usually announces itself with burning when you pass urine and with…
Prescription review online
A doctor will review your case and issue a prescription if medically appropriate.
Talk to a doctor online
Discuss your symptoms and possible next steps with a doctor online.
On this page
Medicines commonly prescribed for Urethritis
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 500 mgActive substance: azithromycinManufacturer: Aristo Pharma GmbhPrescription requiredDosage form: INJECTABLE, 500 mg ceftriaxone/20 mg lidocaineActive substance: ceftriaxoneManufacturer: Ldp Laboratorios Torlan S.A.Prescription requiredDosage form: INJECTABLE, 1 gActive substance: ceftriaxoneManufacturer: Kalceks AsPrescription required
Urethritis is inflammation of the urethra, the tube that carries urine out of the body. It usually announces itself with burning when you pass urine and with discharge, and behind it there is most often a sexually transmitted infection. That leads to the single most useful conclusion: with these symptoms you do not start with extra fluids or cranberry, you start with a test, because until the organism is known, treatment is guesswork. Urethritis is easily confused with cystitis, but the two are different and are treated differently: cystitis is an infection of the bladder, commonest in women, whereas urethritis in a man almost always means a conversation about chlamydia and gonorrhoea.
What it feels like
The symptoms are usually modest, and that is the trap — they are easy to put down to a chill or to irritation from underwear.
- burning, stinging or itching when passing urine, felt in the tube itself rather than above the pubic bone;
- discharge that may be clear, white, cloudy or yellowish; it is most obvious first thing in the morning before the first visit to the toilet, and sometimes it amounts to no more than a mark on underwear or a drop seen when the foreskin is drawn back;
- redness and sticking together of the opening of the urethra, soreness at the tip of the penis;
- in women the picture is blurred: painful, frequent passing of urine looks like cystitis, but vaginal discharge, bleeding between periods, pain during sex or low abdominal pain are added to it, which is a sign that the infection has moved higher up and needs sorting out sooner.
Days or weeks pass between catching the infection and the first symptoms, so people do not always connect the two. And the most important point: very often there are no symptoms at all, particularly with chlamydia. The person feels perfectly well, suspects nothing and goes on passing the infection to others.
Why the first step is testing for sexually transmitted infections
Burning on passing urine and discharge in a man are first and foremost a reason to be tested for chlamydia and gonorrhoea, not a reason to drink herbal diuretics. Gonococcal urethritis is caused by gonorrhoea; non-gonococcal urethritis is commoner, and behind it are usually chlamydia and Mycoplasma genitalium, less often trichomonas or a virus. They cannot be told apart by the look of the discharge or by how it feels — only in the laboratory. This is not a formality: the organism decides both which antibiotic is used and whether a follow-up test is needed.
This is where the fork with cystitis lies. Cystitis gives frequent urgency, stinging at the end of passing urine, heaviness above the pubic bone and cloudy urine, but no discharge; it is treated with a short course of antibiotics and the partner does not need treating. Urethritis is defined by discharge and burning inside the tube, needs the organism identified, and its treatment always involves two people. Cranberry, herbal teas and flushing the tube out do nothing for either, and in urethritis they buy a dangerous delay.
Tests for HIV and syphilis are usually offered at the same time. That is standard practice, not a judgement about you: these infections travel together and stay silent for a long time.
When the inflammation is not from an infection
Urethritis can also be non-infectious. People rarely think of it, yet it is not uncommon. The tube becomes inflamed from direct irritation:
- a urinary catheter, cystoscopy or any instrument passed into the urethra;
- mechanical irritation — vigorous or poorly lubricated sex, long hours on a bicycle;
- chemicals: perfumed soap, intimate hygiene gels, bubble bath, spermicides, and the antiseptics people use to try to wash the tube out after sex;
- occasionally the inflamed urethra turns out to be part of reactive arthritis or another systemic condition.
But non-infectious urethritis is a diagnosis of exclusion, and it is not one you can give yourself. Infection is ruled out first, and only then is the irritant looked for. Once it is found the treatment is simple: remove it and put nothing but warm water near the area.
What happens at the appointment
Nothing alarming or drawn out. The doctor will look at the external genitals, examine the scrotum if there is pain, and carry out a pelvic examination in women. The tests are:
- a swab from inside the urethra with a fine bud — uncomfortable for a few seconds and no more; these days it is often replaced by a test on the first part of the urine stream, which most people find far easier;
- not passing urine for an hour or two beforehand, because otherwise the organism is washed away and the result comes back falsely negative; this is the one piece of preparation worth remembering in advance;
- a PCR test that looks for the organism's DNA, plus a culture if gonorrhoea is suspected, because the culture shows which antibiotics it is sensitive to and resistant gonorrhoea is becoming more common;
- a routine urine test, which helps separate urethritis from cystitis and picks up blood.
Results take anything from a few hours to a few days. If the picture is clear-cut, treatment is sometimes started before the laboratory replies, but the test is still taken — it decides what happens next.
Treatment is for both of you
Urethritis is treated with antibiotics chosen to match the organism. Gonorrhoea usually means an injection; chlamydia, a few days of tablets. The course is finished even if things ease off on the second day. Then come three rules that people trip over again and again.
- Both partners are treated at the same time, even if the other one has no symptoms and their test is not back yet. Otherwise the infection returns to the same place within a week — the commonest reason for "the antibiotic did not work".
- No sex until you have both finished treatment and the symptoms have gone. None at all, including oral sex and sex with a condom. Going back to sex a couple of days after the injection is the classic mistake, and it undoes the whole course.
- If symptoms remain, you need a follow-up. Burning may linger for a week or two and fade gradually, and that is normal. Discharge that does not settle means one of three things: the organism was a different one, the antibiotic has not worked, or you have been reinfected. With gonorrhoea and Mycoplasma genitalium a test of cure is done for everyone, however well they feel.
Partners from the last few months are worth telling. They need testing even if they feel entirely fine. It is an awkward conversation, but it saves them consequences that are much harder to treat. And do not treat yourself with leftover antibiotics from the cupboard: half-treated gonorrhoea becomes resistant, and that stops being only your problem.
Why leaving it is a bad idea
Urethritis is rarely agonising, which is exactly why people live with it for months and get used to the burning. The danger is not the discomfort but the infection moving deeper.
- Epididymitis, inflammation of the tube behind the testicle: the scrotum swells and becomes hot and painful. It is treatable, but an episode can leave a mark on fertility.
- Reactive arthritis, an immune response to the infection that weeks later hits the joints and eyes: a painful swollen knee or ankle, red and sore eyes.
- In female partners, inflammation of the womb and tubes. It often runs quietly, with barely any symptoms, but the damage lasts: scarring in the fallopian tubes, chronic pelvic pain, ectopic pregnancy and reduced fertility. That is the strongest argument for both of you being treated, and treated promptly.
- In pregnancy, untreated chlamydia or gonorrhoea puts the baby at risk of picking up the infection during birth, affecting the eyes or the lungs.
See a doctor the same day if you develop: a temperature together with pain or swelling in the scrotum; a temperature with low abdominal pain in a woman; being unable to pass urine when the bladder is full; blood in the urine or in the discharge; sores, blisters or a rash on the genitals. Sudden severe pain in a testicle is not urethritis: that is how testicular torsion presents, hours count, and it needs an ambulance (112 is the single emergency number across Europe) or the nearest hospital.
How to avoid getting it again
Nothing gives a complete guarantee, but the risk drops sharply:
- a condom for vaginal and anal sex, and a condom or a latex barrier square for oral sex;
- do not share sex toys without cleaning them, and change the condom covering them;
- get tested when you change partner even when nothing is bothering you — that is how silent chlamydia is caught;
- do not wash the urethra out with soap or antiseptics and do not douche: this prevents nothing and is a cause of urethritis in its own right;
- make sure your partner actually completed treatment rather than stopping halfway.
Online consultation
Online is a good way to do the thing that keeps people away from a clinic for months: to start. A doctor can work through your symptoms and say whether this sounds more like urethritis or cystitis, tell you which tests to ask for and how to prepare, go through results you already have, help you plan the conversation with your partner, and say when a test of cure is needed and when mild lingering burning is simply the tail end of the inflammation. Non-infectious causes and what to remove from your daily hygiene are also easier to work out in an unhurried conversation. A temperature with scrotal or low abdominal pain, being unable to pass urine and blood in the urine need a face-to-face appointment the same day, and sudden severe testicular pain needs an ambulance.
This material is for information only and does not replace medical advice.
Consult with a doctor about Urethritis
Discuss your symptoms and possible next steps with a doctor online.
Online doctors for Urethritis
Discuss your symptoms and possible next steps for Urethritis with a doctor online.
