Definition

Urethritis is a condition characterized by inflammation or irritation of the urethra, the final canal for expelling urine from the bladder. It is commonly caused by infection, which is classified into two types: gonococcal urethritis and nongonococcal urethritis. Gonococcal urethritis results from infection with the bacterium Neisseria gonorrhoeae and is classified as a sexually transmitted disease. Both men and women can experience gonococcal urethritis, though it is more frequently diagnosed in men due to the male urethra serving as a passage for both urine and semen.

Causes

The cause of gonococcal urethritis is infection with the bacterium Neisseria gonorrhoeae. This bacterium spreads primarily through sexual intercourse, involving contact with infected organs such as the penis, vagina, anus (anal), or mouth (oral). Transmission can also occur during childbirth from an infected mother to her newborn baby, resulting in symptoms typically appearing in the baby's eyes, known as gonococcal conjunctivitis. It's important to note that transmission cannot occur through objects previously used by others, such as clothing or toilet seats, as the bacteria cannot survive for long outside the body.

Risk factor

The primary risk factor for gonococcal urethritis is engaging in sexual intercourse. This condition is prevalent among sexually active young women and men. The risk of gonococcal urethritis increases under the following conditions:

• Engaging in sexual activity with new partners whose health status is unknown
• Having sexual partners who have multiple partners
• Having more than one sexual partner oneself
• Previous history of sexually transmitted infections
• Previous history of gonorrhea infection
• Low educational, social, or economic status

Symptoms

The symptoms of gonorrheal urethritis are typically characteristic and more prominent in the genital area, although some cases, especially in women, may occur without symptoms. Symptoms usually appear approximately one week after infection, with slight differences between men and women.

In men, symptoms may include:

• Painful urination.
• Discharge of pus from the tip of the urethra or penis, which can be white, yellow, or green.
• Pain and swelling in one of the testicles.

In women, symptoms may include:

• Painful urination.
• Increased abnormal vaginal discharge.
• Vaginal bleeding between periods or after sexual intercourse.
• Abdominal and pelvic pain.
• Pain during sexual intercourse.
• Fever (in some cases only)

In addition to the urethral tract, gonorrhea can also affect other organs, leading to varying symptoms depending on the affected area:

• Rectum and/or anus: Symptoms may include itching or pain, discharge of pus, and, occasionally, bloody stools.
• Eyes: Symptoms may include eye pain, light sensitivity, and pus discharge from one or both eyes.
• Throat: Symptoms may include a sore throat and swollen lymph glands in the neck.
• Joints: Infected joints may feel warm, appear red and swollen, and be painful, especially during movement. The knee joint is commonly affected.

Diagnosis

The diagnosis of gonococcal urethritis involves assessing symptoms and examination results. The doctor will carefully evaluate the symptoms, considering any relevant risk factors. A physical examination will be conducted to observe any discharge from the urethra and confirm the reported pain. Laboratory tests will then be performed to confirm the cause of the disease, including:

• Urine test or urinalysis: This test aims to detect bacteria in the urine, as bacteria from the urethra may be expelled with urine.
• Swab test of the infected area: Samples will be taken from the urethral opening, vagina, throat, or anus to identify the infecting bacteria through gram staining and bacterial culture. In cases of gonococcal urethritis, the bacteria Neisseria gonorrhoeae will be detected.
• Blood test: Additional tests for other sexually transmitted infections, such as HIV and syphilis, may be requested by the doctor if there are high-risk factors.

Management

Gonorrheal urethritis can be effectively managed and treated with antibiotics. Due to Neisseria gonorrhoeae bacteria developing resistance to previously commonly used antibiotics, current treatment involves a combination of two types of antibiotics. This condition may also coincide with other sexually transmitted infections such as Chlamydia. Antibiotics are typically administered through injections (ceftriaxone) and oral tablets (azithromycin or doxycycline). The dosage and duration of medication will be adjusted by the examining doctor, and pain relievers such as Paracetamol may be prescribed to alleviate symptoms.

Treatment will also be provided to partners to reduce the risk of reinfection. Symptoms usually start to decrease once treatment begins. However, it's important to complete the full course of antibiotics even if symptoms disappear. During treatment, it's advisable for both you and your partner to abstain from sexual intercourse.

Complications

Gonorrheal urethritis poses significant risks of complications if left untreated, with differences in complications between males and females due to the varied organs that can be affected. However, potential complications for anyone with untreated gonorrheal urethritis may include:

• Joint inflammation, as the gonorrheal infection can spread to other parts of the body.
• Increased risk of HIV/AIDS.

Complications that can occur in males with gonorrheal urethritis include:

• Epididymitis, an infection of the epididymis, the tube that carries sperm out of the body. This condition can lead to infertility.
• Urethral stricture, which is narrowing of the urethra.
• Swelling around the penis.
• Prostatitis, inflammation of the prostate gland.

Complications that can occur in females with gonorrheal urethritis include:

• Pelvic Inflammatory Disease (PID): This condition occurs when the infection ascends to the uterus and fallopian tubes, potentially leading to infertility.
• Ectopic pregnancy: This type of pregnancy occurs outside the uterus and can pose serious risks to both the mother and the baby.
• Complications in babies born to mothers with gonorrhea during pregnancy: Babies may experience blindness, inflammation, and infection in the head at birth.

Prevention

Gonorrheal urethritis can be prevented by abstaining from sexual intercourse, and the risk can also be reduced by having only one sexual partner. If this is not possible, there are several ways to prevent this disease, including:

• Using condoms during sexual intercourse.
• Avoiding intimate relationships with more than one partner.
• Ensuring that you and your partner regularly undergo screenings for sexually transmitted infections.
• Avoiding sexual contact with individuals who are experiencing sexually transmitted diseases.
• Undergoing routine screenings for gonorrhea if you have risk factors.

When to see a doctor?

Consult to doctors, dermatologists and genitals (Sp.KK) or dermatologists (Sp.DV) if there are any of the above symptoms you experience. If your partner experiences these symptoms, you should take treatment. Symptoms will only appear 1 week after infection. Proper treatment will reduce the risk of this disease recurring. Go to the doctor immediately if the symptoms are felt to be severe or not improving even though you have been treated.

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