Causes of Urethritis
The most common and prevalent cause of urethritis is infection from bacteria that enter the urethra through the skin around the opening to the urethra. Common bacteria that cause urethritis include: (7)
- Gonococcus causes gonorrhea and is sexually transmitted.
- Sexually transmitted chlamydia is caused by Chlamydia trachomatis.
- In and around the stool are bacteria.
- Urethritis can also be caused by herpes simplex viruses (HSV-1 and HSV-2). Trichomonas is also responsible for urethritis. This single-celled organism is transmitted through sexual contact.
- Chlamydia and gonorrhea are typically confined to the urethra when it comes to sexually transmitted infections. The inflammation may also extend into the reproductive organs of women, causing pelvic inflammatory disease (PID).
- Sometimes gonorrhea and chlamydia can cause epididymitis, an infection of the epididymis, the tube that surrounds the testes. Epididymitis and PID can both result in infertility.
Women’s urethral discharge causes
A urethral discharge can indicate a number of conditions. Among the most common are infections caused by bacteria transmitted having sex, hormonal changes during a woman’s cycle, as well as food and drug allergies.
Common causes include:
- Bacterial infection caused by gonococcus bacteria acquired through sexual contact. The illness is known as gonococcal urethritis.
Less common causes:
- A urethra infection can also result from infection with other organisms, typically acquired during anal, oral, or vaginal sex. The condition is also known as nonspecific urethritis or non-gonococcal urethritis.
- An infection with Chlamydia trachomatis is often associated with gonococcal urethritis.
- Sexual activity transmits an organism called Trichomonas vaginalis, a parasite.
- Herpes simplex is a virus-based infection that can also be sexually transmitted.
- A yeast infection can spread from the vagina to the urethra.
- coli, which is present in feces and is easily spread through the urethra to the rectum.
Types of causes with the least frequency:
- External irritants
- Clothing that is too tight rubs against the skin.
- A soap, detergent, lotion, spermicide, etc.
- A rough or vigorous sexual activity.
- Bad hygiene.
- Hormonal changes due to the monthly variation in estrogen levels. The lining of the urethra is thinner at some points, making it more prone to irritation and infection.
- Using a catheter may irritate or injure the urethra, which may allow bacteria to penetrate the mucous membranes.
- A urethral diverticulum is a pouch or pocket that forms along the outside of the urethra. Urine fills these pouches, but they do not drain properly, resulting in bacteria growing and causing urethritis symptoms.
- There is no medical advice on this list and it may not be an accurate reflection of what you have.
Male urethritis classification
- Gonococcal urethritis – caused due to Neisseria gonorrhoeae.
- Non-gonococcal urethritis (NGU) – a condition caused by organisms other than N. gonorrhea and non-infectious agents.
- Recurrent or persistent urethritis – occurring in 10%-20% of cases of NGU.
Non-gonococcal causes of urethritis
- Chlamydia trachomatis and Mycoplasma genitalium are the most common organisms implicated. The prevalence of Chlamydia and M. genitalium is higher in younger patients with NGU (although the association with M. genitalium is not as strong) as well as those who have dysuria and/or urethral discharge.
- Typically, both organisms do not co-exist in the same individual with NGU, but in some studies, up to 10% of men have suffered from dual infections.
- Bacteria are more prevalent in men with urethral discharge than those without.
- 30-80% of the time, neither C. trachomatis nor M. genitalium are detected in patients with NGU. Increasing age and the absence of urethritis symptoms increase the likelihood of pathogen-negative NGU.
- Trichomonas vaginalis appears to be rare in the UK and more prevalent in non-white ethnic groups. Men over 30 have a greater risk of vaginalis isolation, which is not always symptomatic.
- NGU has been inconsistently associated with ureaplasmas. Ureaplasma urealyticum (biovar 2) and Ureaplasma parvum (biovar 1) were not distinguished in earlier studies. It has become increasingly evident that only U. urealyticum (biovar 2) poses a significant health threat to men, but not U. parvum. Acute NGU may be caused by U. urealyticum in 5-10% of cases.
- The number of cases attributed to urinary tract infections may be as high as 6.4%, according to a single study.
- Approximately 2-4% of patients with symptoms have adenoviruses, which are often linked with conjunctivitis.
- Type 1 and 2 of the Herpes simplex virus are uncommon causes of NGU (2%-3%).
- Neisseria meningitides, Epstein Barr virus, Candida, Haemophilus spp., urethral strictures, and foreign bodies have also been reported in rare cases and may account for a small percentage of NGUs.
- NGU caused by organism-negative bacteria (also known as idiopathic urethritis) is still unclear and was recently reviewed. There are almost certainly some cases that are non-infectious, but there are currently no tools to distinguish between them.
Recurrent or persistent urethritis causes
Causes are likely multifactorial, but not always identifiable. However, U. urealyticum (tetracycline-resistant), M. genitalium (20%-40% of cases), and T. vaginalis may be involved.
Epidemiology
The most common genitourinary medicine (GUM) condition diagnosed and treated in men in the UK is urethritis. Each year, more than 80,000 cases are diagnosed. Gonococcal urethritis is less common than NGU. The most common age group for chlamydia is 15-24 years old. In the UK, it is the most common sexually transmitted disease. The number of new cases diagnosed in any clinical setting in 2009 was 217,570. The number was 7% higher than in 2008. (8)
Gonorrhea:
- According to GUM clinics in England, 29,291 cases of gonorrhea were diagnosed in 2013. This represents an increase of 15% over 2012. In the last ten years, gonorrhea prevalence has steadily increased, particularly among men.
- The number of men having sex with men (MSM) has increased disproportionately. 63% of gonorrhea diagnoses occurred in MSM in 2013, a 26% increase over the previous year. The cause of the rise in testing was thought to be a combination of more men coming forward and a rise in sexually unsafe behavior.
- Nucleic acid amplification testing (NAAT) for rectal and pharyngeal has also improved detection rates through the use of new diagnostic techniques.
- Gonorrhea is more prevalent among young people. Heterosexual men aged 15-24 accounted for 56% of gonorrhea cases in 2013 (8,122/14,647).