Inflammation of the urethra (urethritis)

Inflammation of the urethra (urethritis)

The urethra is the connection between the bladder and the outside world. Although the urinary stream regularly flushes possible pathogens out, germs can still migrate up the urethra; urethritis is the result. Infectious urethritis is one of the most common consequences of sexually transmitted diseases. There are also other causes of inflammation of the urethra. Symptoms can manifest themselves differently in men and women. What helps with urethritis?


Urethritis: who is at risk?

Urethritis can affect men and women equally. It can occur alone or in combination with other inflammations of the kidneys and urinary tract. Particularly susceptible are:

  • People whose urethra has already been damaged, for example, by a narrowing or bulging
  • Patients with a weakened immune system, for example, due to cancer, diabetes mellitus or chronic inflammation

What forms and causes of urethritis are there?

  • Specialists distinguish specific from non-specific urethritis:
    • Specific urethritis (gonorrheic urethritis): This inflammation of the urethra is caused by an infection with the gonorrhoea pathogen Neisseria gonorrhoeae (gonococci), transmitted during sexual intercourse.
    • Non-specific urethritis (non-gonococcal urethritis): This form is also often triggered by germs (50 per cent chlamydia), but also other bacteria, viruses and fungi), which are mainly transmitted during sexual intercourse or, for example, as part of an examination such as a cystoscopy can become. However, non-specific urethritis can also have other causes. It can be acute or chronic.

Acute urethritis: how does it develop?

  • In the acute form, there are three development mechanisms:
    1. An infection caused by pathogens that come from outside and travel up the urethra (“ascending infection”)
    2. An inflammation caused by germs that are already above the urethra in the bladder, prostate or kidneys and migrate downwards (“descending infection”)
    3. a rare allergic inflammation caused by contraceptives such as suppositories or ointments placed in the vagina

Other causes of urethritis

  • The chronic or recurring form can be caused by particularly resistant pathogens, an acute infection that has not been adequately treated or reinfection by the sexual partner. 
  • In women, after menopause or after the removal of the ovaries, the lack of estrogen can lead to changes in the mucous membrane of the vagina and urethra, which can also cause inflammatory reactions (senile urethritis).
  • In the case of Reiter’s disease, urethritis is one of the typical symptoms, along with inflammation of the joints and the conjunctiva. 
  • Other causes of the chronic form are:
    • Mechanical stimuli (e.g. if a bladder catheter is constantly in place)
    • chemical stimuli (example from cancer drugs that are excreted in the urine)
    • Radiation (in cancer treatment)
  • A urethra that has been damaged in this way is then more susceptible to germs and therefore to urethritis.

How does urethritis manifest itself?

  • The man’s urethra is about 25 to 30 centimeters long, the woman’s only three to four centimeters long. It’s no wonder that inflammation of the urethra occurs more frequently in men and usually causes more symptoms, while in women the germs more often travel directly to the urinary bladder and are more likely to cause inflammation there ( cystitis ).
  • Urethritis can cause different symptoms in men and women and is not always easy to recognize.

Symptoms and signs of urethritis

  • The symptoms vary depending on the pathogen, form and gender. It is estimated that in a quarter of cases (especially in women) there are no or barely noticeable symptoms, which is why the germs are often passed on unnoticed. In addition to the usual symptoms, pelvic pain can also occur.
  • Typical inflammation is  discharge,  which tends to be purulent in an acute form and whitish-glassy in a chronic form. Other symptoms of urethritis include:
  • Fever and general symptoms also occur rarely . In senile urethritis, bladder weakness (urinary incontinence) and itching in the vagina can also occur; the discharge, however, is missing.

Urethritis: how is the diagnosis made?

  • First, the doctor – for example, the family doctor or the urologist – will ask about the exact symptoms and the history, especially about diseases, examinations and treatments of the urinary system.
  • During the physical examination, which often reveals a reddened urethral opening, a swab is taken from the urethra using a small wire loop. If necessary, this secretion is examined under the microscope and incubated on a culture medium to detect the pathogens.
  • Research is also carried out in urine for signs of inflammation and germs. Further tests (e.g. blood test, urogram, cystoscopy) depend on the findings and the suspected diagnosis.

Therapy: What helps with urethritis?

  • Medications play an essential role in the treatment of urethritis. How urethritis is treated depends on the cause. Germs are combated with appropriate antibiotics or antifungal agents. The sexual partner must also be treated to avoid a “ping-pong effect” (i.e. mutual reinfection). It is advisable to avoid sexual intercourse until the infection has cleared up.
  • In senile urethritis, estrogen-containing suppositories may be indicated.

Home remedies for urethritis

  • But home remedies and some hygiene measures can also help to support therapy or prevent urethritis. Studies have shown that cranberry or cranberry juice prevents germs from adhering to the urethra and bladder mucosa. For patients who are prone to repeated infections of the urinary tract, drinking the juice regularly could have a positive effect on the course of the disease.

Use of medicinal plants

  • Various medicinal plants are used in folk medicine, which can be drunk as tea and are sometimes also available as ready-made medicines. Classic medicinal herbs for urethritis include:
    • Field horsetail
    • Bearberry leaves
    • Birch leaves
    • Nettle
    • Goldrute
    • rose hip
    • Hauhechel
    • Wacholder
  •  Cantharis is often used in homoeopathy.

Prevent urethritis – this is how it works!

  • Other “home remedies” for prevention include:
    • emptying the bladder after sexual intercourse
    • avoiding hypothermia
    • the avoidance of excessive genital hygiene
    • the intake of more than two litres of fluid daily
  • However, the effectiveness of these measures has yet to be tested in studies.

What is the course and prognosis?

  • If an infection is treated promptly, the prognosis is good. The germs may spread further if the therapy starts too late or not at all – for example, due to a lack of symptoms. Abscesses, infections of the kidneys, epididymis, prostate, uterus, fallopian tubes or ovaries can occur, or even acute urinary retention as a result of the inflammatory processes, scarring and narrowing of the urethra or adhesions of the fallopian tubes, and infertility can occur.
  • Pregnant women can transmit the germs to their child during childbirth, which – in the case of chlamydia and gonococci – can lead to severe conjunctivitis in the newborn. Some germs are also suspected of increasing the risk of premature rupture of membranes and miscarriage.

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