Urethritis

Urethritis typically presents as dysuria and acute urethral discharge following unprotected sex. Women with urethritis may have associated cervicitis or vaginitis, presenting with vaginal discharge and/or bleeding.

The most common etiologic agents are Neisseria gonorrhoeae and Chlamydia trachomatis.

Increased risk is associated with age between 15 and 24 years, new or multiple sex partners, unprotected sex, and prior or current sexually transmitted infection (STI).

Disease may be transmitted from infected mothers to infants at birth; pregnant women with urethritis need a test of cure and close monitoring for continued risk.

Antibiotic therapy is the mainstay of treatment.

Untreated gonococcal urethritis (GU) may disseminate, causing arthritis, meningitis, and endocarditis. Untreated nongonococcal urethritis (NGU) may present with complications such as reactive arthritis or infertility.

Inflammation of the urethra, usually caused by a STI or, less often, by trauma or a chemical irritant. Urethritis typically presents as dysuria, urethral discharge, and/or pruritus at the end of the urethra. Urethral discharge is the classic physical finding. Women may have associated cervicitis or vaginitis, presenting with vaginal discharge and/or bleeding.[1]Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187. https://pmc.ncbi.nlm.nih.gov/articles/PMC8344968 http://www.ncbi.nlm.nih.gov/pubmed/34292926?tool=bestpractice.com ​​[2]Government of Canada. STI-associated syndromes guide: urethritis. Jun 2026 [internet publication]. https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/canadian-guidelines/sti-associated-syndromes/urethritis.html [3]Smolarczyk K, Mlynarczyk-Bonikowska B, Rudnicka E, et al. The impact of selected bacterial sexually transmitted diseases on pregnancy and female fertility. Int J Mol Sci. 2021 Feb 22;22(4):2170. https://www.mdpi.com/1422-0067/22/4/2170 http://www.ncbi.nlm.nih.gov/pubmed/33671616?tool=bestpractice.com ​​ 

Clinical diagnosis of urethritis may be based on observation of urethral discharge on exam, along with abnormal numbers of polymorphonuclear leukocytes on Gram stain of urethral discharge, or microscopy of urine sediment, or positive urine leukocyte esterase test.[1]Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187. https://pmc.ncbi.nlm.nih.gov/articles/PMC8344968 http://www.ncbi.nlm.nih.gov/pubmed/34292926?tool=bestpractice.com ​​

Urethritis is categorized as GU if N gonorrhoeae is isolated; NGU if N gonorrhoeae is not isolated. The most common etiologic agents in NGU are C trachomatis and Mycoplasma genitalium.[1]Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187. https://pmc.ncbi.nlm.nih.gov/articles/PMC8344968 http://www.ncbi.nlm.nih.gov/pubmed/34292926?tool=bestpractice.com ​​

This topic focuses on infectious causes of urethritis.[Figure caption and citation for the preceding image starts]: Gonorrhea with penile meatal dischargeCDC Image Library; Susan Lindsley [Citation ends].