What is it?

Urethritis is an infection of the inside of the penis. The two most important causes are gonorrhea and chlamydia. There are other causes of urethritis as well, not all of which require treatment.

Causes and symptoms

Gonorrhea, a bacteria that causes a white or yellow pus discharge, mild to severe burning when urinating and itching inside the head of the penis. Symptoms usually begin in two to six, though sometimes men have no symptoms at all.

Chlamydia, a bacteria-like organism that causes milder symptoms than gonorrhea (a white or clear discharge with mild burning). Symptoms can take seven to 21 days to start. However, in up to 30 per cent of cases, there are no symptoms at all.

Trichomonas is an organism passed on during vaginal sex. Men generally have no symptoms but can carry trichomonas inside the penis and transmit it to female partners. Sometimes it causes a slight discharge or itching inside the head of the penis.

Non-specific urethritis (NSU). If you have symptoms but nothing shows up in your lab tests, you may have non-specific urethritis (NSU). “Non-specific” means you have an infection, but the lab can’t tell what is causing it.

• In many cases, NSU is probably caused by chlamydia. This is hard to prove, however, since chlamydia doesn’t always show up in lab tests.

• Other minor organisms and bacteria can be picked up from a partner’s vagina or anus, or from the throat (e.g. strep bacteria). These organisms may cause symptoms but they are not considered dangerous, so the lab often doesn’t test for them. Treatment may be given for the symptoms, though they sometimes clear up on their own.

• Temporary symptoms may result from other causes like too much alcohol, spicy foods, reactions to soaps or cosmetics, stress or minor damage from rough sexual activity.

How you get it

These infections are passed on during sexual contact between the penis and the rectum, throat or vagina. You can pass them on even if you have no symptoms. You can also transmit them to your eyes via your fingers, though this rarely happens.

Gonorrhea and chlamydia cannot survive outside the body, so you can’t pick them up from shared towels, toilet seats or locker rooms. However, women can pick up trichomonas this way.

Complications

If you don’t get treated early, gonorrhea and chlamydia can occasionally lead to complications such as arthritis, infections of the prostate, and scarring of the tubes connected to the testicles (epididymitis), resulting in sterility. Women can suffer serious complications as well.

Testing

Your doctor will take a sample from your penis using a thin cotton swab. If you go to an STD clinic, the doctor will look at the sample under a microscope in order to tell whether you have an infection. A microscopic exam is the only way to detect trichomonas. The sample will then be sent to a lab for testing. Try not to urinate for two hours before getting tested, since you might wash away the organism causing the infection. Make sure your doctor takes a swab test before treating you, since it is important to know the exact cause of your infection.

Treatment

Antibiotics will cure all the above infections. Gonorrhea is usually treated with Suprax, other infections with doxycycline or Zithromax. Men whose regular female partners have trichomonas should be tested and treated with Flagyl. Be sure to take all your medication regardless of how soon symptoms clear up. Otherwise the infection might return, and you could infect other partners.

Don’t treat yourself with old, leftover antibiotics. What works for a sore throat will not clear up urethritis! Taking medications without knowing the proper dosage leads to the development of resistant strains of bacteria. Besides, if you treat yourself, it may be impossible for your doctor to find out the cause of the infection. Finally, some antibiotics, such as doxycycline, actually become toxic when they are old.

Follow-up

If you tested positive for gonorrhea or chlamydia, you must get a follow-up test after treatment because medications may not completely work, even when symptoms appear to have cleared up. Don’t have sex again until a follow-up test shows the infection is gone. Tell your partners to get tested and treated.

Prevention

Condoms, properly used, will prevent transmission of the bacteria that cause urethritis. Use latex condoms and water-soluble lube only. If the condom breaks, urinating immediately after having sex and washing your penis might help but this practice is much less reliable than using a condom.