Pain or burning during urination is a distressing symptom that should never be ignored. While many people immediately associate this sensation with a bladder infection, it is often a sign of urethritis, a condition defined by inflammation of the urethra. The urethra is the tube that carries urine from the bladder from the body. Most often caused by a sexually transmitted infection (STI), urethritis is a common medical condition that requires prompt diagnosis and treatment. If left untreated, the infection can spread, leading to serious and sometimes permanent complications, including infertility. Understanding the causes, recognizing the symptoms, and committing to proper treatment for both you and your partners are crucial steps in resolving the infection and protecting your long-term health.

Urethritis is an inflammation of the urethra. The urethra is a vital part of the urinary tract. In males, it is a long tube that travels through the penis and serves as the exit pathway for both urine and semen. In females, the urethra is much shorter and is located just above the vaginal opening; it is used only for urination. When the lining of this tube becomes inflamed due to infection or irritation, it results in painful and uncomfortable symptoms of urethritis.

It is important to distinguish urethritis from cystitis (a bladder infection). While both can cause painful urination, cystitis is an inflammation of the bladder itself. Urethritis is specifically inflammation of the exit tube. A key difference is that urethritis, particularly in men, is much more likely to be accompanied by a discharge. However, it is possible for the infections to coexist, with bacteria spreading from the urethra up into the bladder.

Urethritis is most often caused by bacterial or viral infections, though non-infectious causes do exist. In clinical practice, infectious urethritis is divided into two main categories, based on the causative organism.

1. Gonococcal Urethritis (GU): This form of urethritis is caused by the bacterium Neisseria gonorrhoeae. This is the same bacteria that causes sexually transmitted infection gonorrhea. It is a highly contagious infection that specifically targets the mucous membranes, including the lining of the urethra.

2. Nongonococcal Urethritis (NGU): This is a broad category that refers to any case of urethritis not caused by gonorrhea. There are several different organisms that can cause NGU.

• Chlamydia trachomatis: This is the bacteria that causes chlamydia and is the most common cause of NGU worldwide. Chlamydial infections are notoriously silent, especially in women, making them a leading cause of undiagnosed urethritis.
• Mycoplasma genitalium: This is another bacterium that is now recognized as a major cause of NGU. It can be harder to treat than chlamydia and may require specific antibiotics.
• Trichomonas vaginalis: This is a microscopic parasite that causes the STI trichomoniasis. While more known for causing vaginitis in women, it can also cause urethritis in both men and women.
• Herpes Simplex Virus (HSV): The virus that causes genital herpes can also cause inflammation and sores within the urethra, leading to painful urination.

Non-Infectious Causes: In a minority of cases, urethritis is not caused by an infection but by physical irritation or injury to the urethra. This can include irritation from spermicidal jellies, antiseptic creams, or soaps, or minor injury from the insertion of a urinary catheter or from vigorous sexual activity.

You can get urethritis in several ways, but sexual transmission is the most common route, especially in individuals who are sexually active with new or multiple partners.

The key risk factors that increase a person’s chances of contracting infectious urethritis include:

• Being sexually active, especially between the ages of 15 and 35.
• Having multiple or new sexual partners.
• Inconsistent or no condom use. Condoms, when used correctly, are highly effective in reducing transmission of the bacteria that cause urethritis.
• A history of previous STIs. Having one STI can increase your risk of getting another.

It is a critical public health message that many people with the bacteria that cause urethritis, particularly chlamydia, are asymptomatic carriers. They can feel perfectly healthy and still transmit the infection to their partners without knowing it. This is why regular STI screening is so important for sexually active individuals.

Symptoms of urethritis vary between men and women. Some individuals, especially women, may have no symptoms at all, making regular STI screening important for sexually active individuals.

Symptoms in Men: In men, the symptoms of urethritis are usually more obvious and are more likely to prompt a visit to the doctor. They can include:

• Pain or a burning sensation during urination (dysuria): This is often the first and most common symptom.
• Urethral Discharge: This is a hallmark sign. A discharge of pus or fluid from the tip of the penis. The discharge may be thick and yellow or green (more typical of gonorrhea) or clear and watery (more typical of NGU), but there is significant overlap.
• A frequent or urgent need to urinate.
• Itching, tenderness, or irritation at the opening of the penis.

Symptoms in Women: In women, the symptoms of urethritis are often mild, non-specific, or completely absent. When they do occur, they can be easily mistaken for a bladder infection or a vaginal yeast infection. Symptoms can include:

• Pain or burning during urination.
• A frequent and urgent need to urinate.
• Increased vaginal discharge.
• Lower abdominal or pelvic pain.
• Pain during sexual intercourse.
• Vaginal bleeding between periods or after sex.

Because symptoms are so often absent in women, the infection can go untreated for a long time, increasing the risk of serious complications. Patients often describe urethritis as “burning with every drop” an intense discomfort that’s hard to ignore once it begins.

When to See a Doctor

It is essential to see a healthcare provider if you experience any of the symptoms of urethritis. Do not let embarrassment prevent you from seeking care. Urethritis is a common medical condition, and doctors are trained to diagnose and treat it in a confidential and non-judgmental manner. Prompt treatment is crucial to relieve your symptoms, cure the infection, and prevent serious long-term health complications.

Diagnosis

The diagnostic process is straightforward and is focused on identifying the specific organism causing the infection.

• Medical and Sexual History: Your doctor will ask you about your symptoms and your sexual history. It is important to be honest and open to ensure you get the correct diagnosis and treatment.
• Physical Examination: The doctor may perform a physical exam to check for any signs of infection.
• Urine or Swab Testing: The definitive diagnosis is made by testing a sample.
  • NAATs (Nucleic Acid Amplification Tests): These are the most sensitive and highly recommended tests. A NAAT can detect the genetic material (DNA or RNA) of the infecting organisms. These tests can be performed on a simple first-catch urine sample (meaning the first part of the urine stream) or on a swab taken from the urethra, cervix, vagina, rectum, or throat, depending on your sexual practices.
  • Microscopy: In some clinics, especially for men with discharge, the doctor may take a swab of the discharge and look at it under a microscope to immediately check for signs of inflammation (white blood cells) and for the characteristic appearance of the gonorrhea bacteria.

Treatment

Treatment depends on the underlying cause. Most cases of urethritis resolve with antibiotics or antivirals within days.

• Antibiotic choice depends on the specific cause. However, co-infection with both gonorrhea and chlamydia is very common, and because test results can take a few days, doctors will often treat both infections at the same time.
• The current treatment guidelines from the Centers for Disease Control and Prevention (CDC) for uncomplicated cases often involve a combination of an injectable antibiotic (like ceftriaxone) for gonorrhea and an oral antibiotic (like doxycycline or azithromycin) for chlamydia.
• It is absolutely vital to take all medication exactly as prescribed and to complete the full course, even if your symptoms improve quickly.
• You should also refrain from any sexual activity for at least seven days after you and all your partners have completed treatment.

If left untreated, the bacteria can spread and cause serious, sometimes irreversible, damage.

Complications of Untreated Urethritis

• In Men: The infection can spread up the reproductive tract to cause a painful infection of the epididymis (epididymitis) or the prostate gland (prostatitis). Rarely, this can lead to infertility. Chronic, untreated urethritis can also cause scarring that narrows the urethra (urethral stricture).
• In Women: This is where the consequences can be most devastating. The infection can travel from the cervix up into the uterus, fallopian tubes, and ovaries, causing Pelvic Inflammatory Disease (PID). PID is a major cause of chronic pelvic pain, ectopic pregnancy (a life-threatening condition), and infertility.

Partner Notification

This is a critical, though sometimes difficult, part of managing urethritis.

• Why it’s necessary: You must inform all of your sexual partners from the last 60 days that they have been exposed. This is for two reasons: 1) to allow them to get tested and treated before they develop serious complications, and 2) to prevent them from unknowingly passing the infection back to you after you have been cured.
• How to do it: You can notify partners yourself, or you can ask your local health department for help. Many health departments offer anonymous partner notification services to handle this sensitive task for you.

Urethritis is far more than just painful urination; it is a serious sign of an infection that demands medical attention. Caused most often by common STIs like gonorrhea and chlamydia, it is highly curable with the right antibiotics. However, its often-silent nature, particularly in women, allows it to go untreated, leading to devastating complications like pelvic inflammatory disease and infertility. The keys to combating urethritis are prevention through consistent condom use, regular screening for sexually active individuals, and a commitment to prompt and responsible action when symptoms appear.

• Centers for Disease Control and Prevention (CDC). (2021). Sexually Transmitted Infections Treatment Guidelines, 2021. Retrieved from https://www.cdc.gov/std/treatment-guidelines/default.htm
• Mayo Clinic. (2023). Urethritis. Retrieved from https://www.mayoclinic.org/diseases-conditions/urethritis/symptoms-causes/syc-20378805
• British Association for Sexual Health and HIV. (2015). UK guideline for the management of non-gonococcal urethritis. https://www.bashh.org