Urethritis: what it is, what causes it and how it is treated

Urethritis refers to inflammation of the urethra — the channel through which urine is passed from the bladder. It presents as burning or pain when urinating, a frequent urge to urinate and discomfort in the intimate area, and often develops as a result of a bacterial infection, usually sexually transmitted.

When you experience burning on urination, a more frequent need to go or persistent discomfort in the intimate area, is your first thought that you've caught a chill? A bladder infection isn't always the answer. Every woman's anatomy is different, and some of us have a shorter urethra. That's why certain women are more prone to urinary tract infections and inflammation. Urethritis is one of the conditions that can cause similar symptoms — in this article we discuss the signs that help you recognise it and the treatment options available.

What is urethritis? 

You're probably wondering what urethritis actually is and why it's so easily confused with the familiar bladder infection.

According to the medical literature, urethritis is inflammation of the urethra, the narrow channel that carries urine from the bladder to the outside of the body. Most often it develops as a result of a bacterial infection, usually transmitted during sexual intercourse. However, it can also be triggered by irritation or local injury.

We women frequently mistake the symptoms for those of a bladder infection. Both conditions can cause burning on urination and a frequent urge to go — which is precisely why it's important to see a doctor for a correct diagnosis and treatment.

Depending on how long symptoms last and how they progress, urethritis may be acute, when it appears suddenly and lasts only a short time, or chronic, when the symptoms persist or keep recurring.

• Urethritis is inflammation of the urethra, the channel through which urine is passed.
• It may be acute or chronic, depending on the duration and development of symptoms.
• The symptoms resemble those of a bladder infection, which is why the two conditions are easily confused.

Types of urethritis 

Specialists distinguish two main types of urethritis, according to the microorganism causing the infection: gonococcal urethritis and non-gonococcal urethritis (NGU).

Gonococcal urethritis

Gonococcal urethritis is caused by the bacterium Neisseria gonorrhoeae, the organism responsible for gonorrhoea, one of the most common sexually transmitted infections. The infection is passed on through unprotected vaginal, oral or anal intercourse and can cause:

• intense burning on urination
• unusual vaginal discharge
• lower abdominal pain in women

Left untreated, the bacterium can spread to the reproductive organs and lead to complications such as pelvic inflammatory disease (PID).

Non-gonococcal urethritis (NGU)

Non-gonococcal urethritis (NGU) includes all forms of urethritis not caused by Neisseria gonorrhoeae.

The most common cause is infection with Chlamydia trachomatis, but the inflammation can also be triggered by Mycoplasma genitalium, Trichomonas vaginalis or various Ureaplasma species. NGU can also arise from irritation caused by urinary catheters, perfumed intimate care products or other local injury, without a bacterial infection necessarily being present.

The symptoms are usually less pronounced than in gonococcal urethritis, but treatment is just as important in order to prevent complications and the transmission of infection to sexual partners.

Causes and risk factors 

Urethritis can have both infectious and non-infectious causes. And since treatment depends on the cause, a first step towards recovery is knowing the risk factors for urethritis and identifying the trigger in your own case.

Infectious causes 

Most cases of urethritis are caused by infection. Sexually transmitted infections such as Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Trichomonas vaginalis are the most common culprits.

But urethritis isn't always a sexually transmitted condition. Bacteria from the gut flora, particularly Escherichia coli (E. coli), can enter the urinary tract and trigger inflammation of the urethra — especially in women, whose urethra is shorter and situated close to the anus.

Non-infectious causes 

The urethra can also become inflamed without any infection. Non-infectious causes include the insertion of a urinary catheter, local injury following certain medical procedures, and the use of perfumed intimate care products, spermicides or lubricants containing irritant ingredients.

Even significant friction during intercourse can cause temporary irritation of the urethra and symptoms resembling urethritis.

Risk factors 

Certain factors can increase your susceptibility to urethritis, whatever the cause:

• unprotected sex or multiple sexual partners
• previous sexually transmitted infections such as gonorrhoea, chlamydia or trichomoniasis
• inadequate intimate hygiene, particularly if you wipe from back to front
• use of perfumed products for intimate care
• having a urinary catheter
• the menopause, as oestrogen levels fall and the lining of the urethra and vagina becomes drier
• young age and frequent sexual activity

Can hormonal fluctuations and menstruation influence the appearance of symptoms?

Hormonal fluctuations, particularly the drop in oestrogen before your period and after the onset of the menopause, can make the lining of the urethra and vagina more sensitive and prone to irritation.

If, during your period, you also use perfumed pads or tampons that retain moisture and alter your intimate pH, these factors can intensify burning and discomfort on urination where inflammation is already present. This is precisely why it's advisable to use gentle, fragrance-free period products that genuinely protect your body and your intimate health.

It's important to draw a distinction, however: menstruation itself does not cause urethritis. It can only intensify symptoms or contribute to local irritation if you aren't using suitable period products.

Urethritis in women: why they are more susceptible

Because of the anatomical features of the urinary tract, women develop urethritis more frequently than men.

The female urethra is around 3–4 cm long, considerably shorter than the male urethra, which makes it easier for bacteria to enter the urinary tract. The urethral opening lies very close to the vagina and anus, which can facilitate the transfer of bacteria from the perineal area to the urethra.

Sexual activity can also increase the risk of urethritis. During intercourse, bacteria may be pushed towards the urethra, and sexually transmitted infections can be passed on through unprotected vaginal, anal or oral contact. This is the main reason it's recommended to urinate after sex and to use a condom for protection.

Intimate hygiene also plays an important role — which is why developing the right habits and using gentle products is essential. For daily cleansing of the vulva, use only water and an antibacterial intimate gel, supplemented if necessary with gentle intimate wipes for a quick refresh during the day.

If you wash excessively or, conversely, have poor hygiene, use vaginal douches or perfumed products, or wipe from back to front, all these habits increase your risk of irritation in the genital area, can disturb the balance of the vaginal flora and encourage the transfer of bacteria — particularly Escherichia coli — to the urethra.

Urethritis, bladder infection or urinary tract infection: what's the difference? 

Urinary tract infection is an umbrella term for infections that can occur anywhere along the urinary tract: urethra, bladder, ureters, kidneys. Urethritis affects the urethra alone, while cystitis is inflammation of the bladder, usually caused by bacteria such as Escherichia coli.

But how do you tell whether you have urethritis or a bladder infection? How do you distinguish between the two until you can see a doctor for an official diagnosis? Here are some pointers:

There are also important differences in the symptoms. With urethritis, the burning usually occurs at the very moment of urinating, and there may be discharge from the urethra, especially if a sexually transmitted infection is the cause. With cystitis, the dominant feature is the constant sensation of needing to urinate even though the bladder is almost empty, often accompanied by pain in the lower abdomen.

Symptoms 

With urethritis, the symptoms in women differ slightly from those commonly seen in men. The characteristic sign, however, is almost always burning on urination.

There are also cases — for instance with Chlamydia trachomatis infections — in which the condition causes no symptoms at all, which contributes to delayed diagnosis and the transmission of infection to partners.

Symptoms in women

In women, pain or burning on urination and frequent urination, even of small amounts of urine, are, according to medical publications, the clearest and most common symptoms.

The findings of a 2021 study involving patients aged between 23 and 82 with urethritis showed that an urgent and frequent need to urinate was the most common symptom, with a prevalence of 51.7%.

In addition, you may notice:

• a sudden, strong urge to urinate
• unusual discharge from the urethra or vagina: whitish, yellowish or mucopurulent
• discomfort or tenderness around the urethra
• pain during intercourse (dyspareunia)
• bleeding between periods or after intercourse, particularly if the infection has also reached the cervix.

Symptoms in men

In men, the symptoms are usually more pronounced and include:

• intense burning on urination
• whitish, yellowish or greenish discharge from the urethra, most visible in the morning
• itching or burning in the urethra
• frequent urination or the feeling of being unable to empty the bladder completely
• pain or tenderness in the penis
• pain on ejaculation
• blood in the urine or semen — rare, but possible in severe infections.

Is urethritis contagious? What about your partner?

Whether urethritis is contagious depends on the cause of the condition.

If the inflammation is caused by a sexually transmitted infection such as Chlamydia trachomatis, Neisseria gonorrhoeae or Mycoplasma genitalium, then yes. The infection is contagious and can be passed on through vaginal, anal or oral intercourse.

Urethritis triggered by Escherichia coli, a urinary catheter or local irritation is not sexually transmissible.

If your doctor establishes that your urethritis is caused by a sexually transmitted infection, both you and any partners you've had sexual contact with should be tested and treated at the same time — regardless of whether symptoms are present. Otherwise there's an increased risk of reinfection once you resume your sex life. During treatment, it's recommended that you:

• Avoid all sexual contact until treatment is complete.
• Take the medication exactly as prescribed and don't stop the antibiotics early.
• Inform all your recent sexual partners so that they too can be tested and treated if necessary.

As a rule, medical guidelines do not recommend retesting sooner than 3 weeks after treatment, in order to avoid false positive results. The follow-up test is usually carried out around 3 months after completing the course.

Diagnosis: what tests are carried out for urethritis?

Diagnosis is based primarily on your symptoms and medical history, including information about when the symptoms began, recent sexual contacts, use of a urinary catheter or previous urinary tract infections.

Depending on the clinical suspicion, your doctor may recommend further tests to determine the exact cause. The most common tests for urethritis include:

• Urinalysis, which shows the presence of white blood cells, red blood cells or other changes indicating inflammation or infection of the urinary tract.
• Urine culture, to identify the bacteria growing in the urine and determine their sensitivity to antibiotics.
• NAAT (PCR) tests, to detect bacteria such as Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium in urine or via a urethral or vaginal swab.
• Urethral swab, to identify bacteria or other microorganisms, particularly where there is visible discharge from the urethra.

If you also have vaginal discharge, unusual bleeding or lower abdominal pain, your doctor may also recommend a gynaecological examination to check whether the infection has spread to other organs of the reproductive system.

Treatment: how is urethritis treated? 

Treatment of urethritis depends first and foremost on the cause of the inflammation.

If a bacterial infection is the trigger, your doctor will prescribe an antibiotic — depending on the organism identified or the likely cause: macrolides, tetracyclines or cephalosporins. The regimen and its duration are determined by the doctor alone, individually for each patient.

Once you've started treatment, you should complete the full course, even if the symptoms subside after just a few days. Stopping antibiotics early only allows the infection to persist and encourages a relapse.

• For urethritis caused by sexually transmitted infections, your sexual partner must also be treated and complete the full course prescribed by the doctor.
• For infections with Chlamydia trachomatis and Neisseria gonorrhoeae, retesting is generally recommended after around 3 months to detect any reinfection.

If symptoms persist after treatment or recur, you may have persistent or recurrent urethritis. Your doctor may then recommend further tests to identify resistant bacteria or a non-infectious cause.

During treatment there are several things you can do at home to ease your symptoms. Drink plenty of fluids to help flush bacteria out through the urine, wear cotton underwear and avoid tight clothing that can worsen irritation, avoid all sexual intercourse until your course is complete, and steer clear of perfumed intimate care products. Instead, use gentle products with a pH suited to the intimate flora.

Bear in mind, however, that although these measures can relieve unpleasant symptoms, they never replace antibiotic therapy when urethritis is caused by a bacterial infection.

Complications if left untreated

If you don't treat urethritis promptly, you risk the infection spreading to other organs of the urinary tract or reproductive system — which increases your susceptibility to complications and relapses.

In women, the bacteria can travel up from the urethra through the uterus to the fallopian tubes, causing pelvic inflammatory disease (PID). This can in turn lead to chronic pelvic pain, ectopic pregnancy and infertility.

In men, the infection can spread to the epididymis and cause epididymitis — inflammation with pain, swelling of the scrotum and sometimes fever. Left untreated, it can affect fertility.

Prevention and intimate hygiene 

Gentle intimate hygiene can lower your risk of urethritis, but it won't prevent every case — particularly not those caused by sexually transmitted infections.

The good news is that you can combine several measures to prevent urethritis. Certain habits reduce both the risk of sexually transmitted infections and the risk of imbalances in the intimate area that can lead to inflammation of the urethra:

• Use condoms to reduce the risk of sexually transmitted infections.
• Urinate after intercourse to flush bacteria out of the urethra.
• Drink plenty of fluids to support regular urination.
• Avoid perfumed intimate care products and vaginal douches, which can cause irritation and disturb the flora.
• Wipe from front to back after using the toilet, to limit the transfer of bacteria from the anal area to the urethra.

Frequently asked questions about urethritis

Still have questions about urethritis? Would you like to know more about the symptoms, causes and treatment? In this section you'll find brief answers to the most common questions, which we hope will help you understand the condition better and protect yourself effectively.

What is urethritis?

Urethritis is inflammation of the urethra, the channel through which urine leaves the body. It can be caused by bacterial infections — including sexually transmitted infections — as well as by local irritation.

What are the symptoms of urethritis in women?

The most common symptoms are burning on urination, a frequent urge to urinate, discomfort in the intimate area and unusual discharge.

Is urethritis the same as a urinary tract infection (bladder infection)?

No. Urethritis is inflammation of the urethra, whereas cystitis is inflammation of the bladder. Both can cause burning on urination, but in most cases the causes and treatment differ.

Is urethritis contagious?

Only certain forms of urethritis are contagious. Those caused by sexually transmitted infections such as chlamydia or gonorrhoea can be passed on during intercourse. Urethritis resulting from local irritation is generally not contagious.

What tests are carried out for urethritis?

Your doctor may recommend urinalysis, a urine culture, PCR/NAAT tests for sexually transmitted infections and, in certain cases, a urethral swab.

How is urethritis treated?

Treatment is prescribed by your doctor according to the cause. If the urethritis is caused by bacteria, the antibiotics recommended by the specialist on the basis of the test results are used.

How long does it take for urethritis to clear up?

How long full recovery takes depends on the cause of the infection and the treatment chosen. Symptoms may improve within a few days of starting treatment, but it's important to complete the prescribed course in full to avoid relapses and complications.

Why are women more susceptible to urethritis?

Women have a shorter urethra than men, and it also lies closer to the vagina and anus — which makes it easier for bacteria to reach the urinary tract.

What happens if urethritis isn't treated?

Left untreated, urethritis can lead to complications, such as the spread of infection to the reproductive organs, pelvic inflammatory disease in women or epididymitis in men.

How can I prevent urethritis?

Preventive measures include using a condom every time you have sex, drinking plenty of fluids, urinating after intercourse and avoiding irritant products in the intimate area.

Can menstruation cause urethritis?

No, menstruation is not a direct cause of urethritis. However, the hormonal changes and local irritation during this time — particularly if you use perfumed period products — can increase discomfort or sensitivity in the intimate area.

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