Causes and Treatment of An Itchy Urethra in Men

Understanding Urethritis and Ways to Prevent It

Doctor placing multiple test stick into urine sample
Doctor placing multiple test stick into urine sample. Getty Images/IAN HOOTON/SPL

An itchy urethra or discharge from the urethra is usually from a medical condition called urethritis. It is not a disease itself but a symptom of an infection who origin can include bacteria, viruses, and protozoa. 

What is Urethritis?

Urethritis is an inflammation of the urethra, the tube that carries urine from the bladder to the outside of the body. But why does it become inflamed? The most common cause of urethritis is from a sexually transmitted infection, usually Neisseria gonorrhoeae or Chlamydia trachomatis, which causes gonorrhea and chlamydia, respectively. 

Other causes of infectious urethritis include the Trichomonas species, Mycoplasma genitalium, and viruses like adenovirus or herpes simplex virus (HSV). 

Urethritis can also sometimes present with no obvious cause. This type of condition is referred to as non-specific urethritis (or NSU). NSU is usually caused by bacteria which live inside a sexual partner's mouth, vagina, rectum or penis and is passed to a man's penis during unprotected sex.

Having an untreated NSU in a man with HIV can increase the risk of forward transmission. This is because any inflammation of the urethra draws immune cells to the site of infection. This, in turn, draws HIV the site as it preferentially targets these very same cells for infection. 

In doing so, the concentration of HIV in urethral tissue can be far higher than in the person's blood. This is even true for individuals on therapy with undetectable viral loads.

Treating NSU, therefore, becomes even more imperative in HIV-positive men, as is the avoidance of unprotected sex during an NSU episode.

What Are The Symptoms Of Urethritis?

One or all of these symptoms may be present in case of urethritis, including:

  • urethral discharge that is pus-like – this discharge can be expressed by squeezing the penis
  • itching or tingling of the penis or urethra
  • pain or burning with urination 
  • pain and burning is typically localized near the meatus (the point where the urethra exits the body)

It's important to note that urethritis can mimic other medical conditions in men, like inflammation of the prostate, testicles, or scrotum. It can also mimic a urinary tract infection. It's important to seek care and advice from a physician to ensure a proper diagnosis and treatment plan.

How is Urethritis Diagnosed and Treated?

After testing a person's urethral discharge and urine, a doctor will prescribe an antibiotic if an infection is present. If the diagnosis is unclear, a person may be referred to a urologist for additional evaluation. Also, a doctor may test for other sexually transmitted infections, like HIV, syphilis, or hepatitis B.

According to the Centers for Disease Control and Prevention, it's important that men diagnosed with urethritis as a result of chlamydia, gonorrhea, or trichomonas return for a follow-up appointment three months after completion of antibiotic therapy for repeat testing due to the high rates of re-infection.

Additionally, all of the sexual partners of person diagnosed with urethritis from a sexually transmitted infection should be referred for evaluation and treatment. Sex should be avoided until a person and his partner have been appropriately treated.

Precautions Before Infection, During Treatment, and After Treatment

There are precautions to take that will reduce your risk of getting urethritis and help you fully recover if diagnosed with urethritis. 

  • When you begin antibiotics for urethritis, ensure that your sexual partner(s) is also evaluated and treated by a doctor.
  • Even if you are feeling better and the symptoms have disappeared, take your antibiotic as prescribed until it's all gone.
  • Do not have sex until your treatment is complete and your discharge has completely resolved and gone away.
  • Always use condoms for vaginal, anal, and oral sex.
  • Follow-up with your doctor sooner than 3 months if your symptoms re-appear.

Sources

Brill, J. "Diagnosis and Treatment of Urethritis in Men." American Family Physician. April 1, 2010; 81(7):873-878.

Centers for Disease Control and Prevention. "Diseases Characterized by Urethritis and Cervicitis." Retrieved November 25, 2016.. 

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