Urethritis is infection and inflammation of the urethral lining caused by bacterial infections, and may involve the bladder, prostate, and reproductive organs. Urethritis can affect males and females of all ages; however, females are at higher risk due to proximity of urethral opening to anus and vagina, increasing the likelihood of bacterial contamination.

Sexually transmitted pathogens Chlamydia trachomatis, Neisseria gonorrhoeae (co-infection common), and herpes simplex are primary causes of urethritis, particularly in men; however, often no infection can be documented. Vaginitis triggered by Candida albicans or Trichomonas vaginalis, and bacterial vaginosis, are also contributing causes for women. In bacteria-negative cultures, urethritis and vaginitis account for most urinary disorders in women.

Of the organisms which cause nongonococcal urethritis (NGU), chlamydia is the most common and most serious, with 75% of infected women and 50% of infected men remaining asymptomatic. Left untreated, it can lead to permanent damage of reproductive organs in both men and women. Implications tend to be more severe in women due to the internal nature of the infection, which often goes without notice until complications arise.

• Bacteria and other organisms entering the urethra, including Chlamydia trachomatis, Neisseria gonorrhoeae, Ureaplasma urealyticum, Mycoplasma hominis, Candida albicans, Trichomonas vaginalis, and herpes viruses
• Bruising during sexual intercourse (women)
• Infection reaching the urethra via venous system from prostate gland or through the penis opening; in older men, classic urinary tract pathogens are a more common cause than STDs
• Bacterial infection following course of antibiotics
• Reiter's syndrome

• Unprotected sex
• History of sexually transmitted diseases
• Multiple sex partners, or sexual relations with individual who has multiple sex partners
• Urinary catheter or instrumentation
• Bacteria-resistant drugs
• Prior history of kidney stones, prostatitis, epididymitis, genital injury
• Reiter's syndrome, which has a genetic predisposition
• Increased caffeine intake

In both sexes but particularly women, the disease may be asymptomatic.

In men:

• Burning during urination
• Purulent or whitish-mucus urethral discharge
• Burning or itching around the penile opening

In women:

• Painful urination and/or unusual vaginal discharge
• Cervicitis
• Salpingitis
• Pelvic inflammatory disease

• Reiter's syndrome
• Gonorrhea
• Allergic reactions
• Other urinary tract infections

• Watery and thin discharge (Chl. trachomatis)
• Purulent discharge (N. gonorrhoeae)
• Inflammation of penile opening

• Presence of white blood cells in urine specimen
• Gram's stain of urethral discharge which shows ^>4 WBCs per HPF
• Intracellular gram-negative diplococci strongly suggests gonorrhea
• Absence of gram-negative cocci strongly suggests NGU (Gram's stains are less than 100% sensitive for chlamydial infections)
• Syphilis and HIV serology to rule out other STDs

• Unusual urethral/vaginal discharge in 50% to 75% of cases
• In males, possible inflammation and irritation at penis opening
• Urethral strictures

• Thorough medical and sexual history, including date of symptom onset and prior history of STDs
• Genital examination
• Evaluation of laboratory evidence for infection (Chl. trachomatis requires specimen of intracellular and urethral cellular material; collect specimen with calcium alginate swab inserted two to three cm into urethra)
• Evaluation of sexual partners may aid diagnosis in asymptomatic disease

Chl. trachomatis:

• Immunofluorescent testing
• Enzyme-linked immunoassay
• DNA probing of cervical samples

• Therapy must often be administered presumptively.
• Antimicrobial therapy directed against etiologies.
• Chlamydial disease may persist even after successful treatment of gonococcal component.
• Impress upon patient importance of treatment compliance.
• All sex partners should be treated.
• Sexual abstinence recommended until treatment regimen is completed, as disease can remain active even after symptoms have disappeared.

Urethritis:

• Tetracycline (500 mg qid for seven days)
• Erythromycin (500 mg qid for seven days; preferred in pregnancy)

N. gonorrhoeae:

• Ceftriaxone (250 mg IM once a day)
• Ofloxacin (400 mg once a day)
• Ciprofloxacin (500 mg once a day)

Chl. trachomatis:

• Doxycycline (100 mg bid for 10 days)
• Ofloxacin (300 mg orally bid for 10 days)

Trichomonas urethritis/vaginitis:

• Metronidazole (2 g orally once a day; contraindicated in pregnancy)
• Clindamycin (300 mg orally bid for seven days)

Herpes simplex:

• Acyclovir (400 mg orally tid for 10 days)
• Famciclovir (250 to 500 mg orally bid for 10 days)
• Valacyclovir (1,000 mg orally bid for 10 days)

Persistent/recurrent disease:

• Retreatment with antimicrobials

Nutrition, herbs, and homeopathic remedies are useful in fighting infection, relieving pain, and tonifying the urinary system.

• Eliminate any known food allergens. Food allergies can be tested for using an IgG ELISA food allergy panel, or by an elimination diet.
• Eliminate refined foods, fruit juices, caffeine, alcohol, and sugar, which may compromise immune function and irritate the urinary tract.
• Cranberries and blueberries contain substances that inhibit the adhesion of bacteria to the urinary tract.
• Vitamin C (1,000 mg tid) stimulates immune system and acidifies urine, which inhibits bacterial growth.
• Beta-carotene (25,000 to 50,000 IU/day) is necessary for immune function and mucous membrane integrity.
• Zinc (30 to 50 mg/day) supports immune function.

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, it is important to ascertain a diagnosis before pursuing treatment. Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups/day. Tinctures may be used singly or in combination as noted.

Herbal therapy should be instituted at the first sign of symptoms and continued for three days beyond resolution of symptoms. Treatment of infectious urethritis is best accomplished through teas because of the flushing action of the additional fluid intake. Combine two herbs from each of the following categories and drink 4 to 6 cups/day.

Urinary antiseptics are antimicrobial and include the following.

• Uva ursi (Arctostaphylos uva ursi)
• Buchu (Agathosma betulina)
• Thyme leaf (Thymus vulgaris)
• Pipissewa (Chimaphila umbellata)

Urinary astringents tone and heal the urinary tract and include the following.

• Horsetail (Equisetum arvense)
• Plantain (Plantago major)
• Cleavers (Galium aparine)

Urinary demulcents soothe the inflamed urinary tract and include the following.

• Corn silk (Zea mays)
• Couch grass (Agropyron repens)
• Marshmallow root (Althaea officinalis) is best used alone in a cold infusion. Soak 1 heaping tbsp. of marshmallow root in one quart of cold water overnight. Strain and drink during the day in addition to the other urinary tea.

For advanced or recurrent infections, prepare a tincture of equal parts of goldenseal (Hydrastis canadensis) and coneflower (Echinacea purpurea). Take 30 drops four to six times/day in addition to the urinary tea.

For noninfectious urethritis or for urethritis with severe pain and spasm, add kava kava (Piper methysticum) to any of the above formulas.

A periwash may be helpful in reducing pain with urination. Place 1 tsp. of the coneflower/goldenseal tincture in an 8-oz. peri bottle. Fill with water. Rinse off after each urination.

An experienced homeopath should assess individual constitutional types and severity of disease to select the correct remedy and potency. For acute prescribing use 3 to 5 pellets of a 12X to 30C remedy every one to four hours until acute symptoms resolve.

• Staphysagria for urinary infections associated with sexual intercourse
• Apis mellifica for stinging pains that are exacerbated by warmth
• Cantharis for intolerable urging with "scalding" urine
• Sarsaparilla for needing to stand to urinate, with burning after urination

May be helpful in enhancing immune function.

• Recurrent or persistent symptoms require careful reevaluation and re-treatment with antimicrobials when urethral discharge tests positive or demonstrates increased numbers of polymorphonuclear leukocytes.
• Monitor general condition/medications.
• Encourage patient self-care.
• Monitor closely for treatment compliance, particularly for STD-related urethritis.

Treat patient's sexual partner(s) if STD-related.

• Wipe from front to back following bowel movement, wash genitalia with soapy water, shower rather than bath (for women only).
• Drink eight glasses of water daily.
• Protected sex with latex condom when outside of a monogamous relationship

• When left untreated, gonococcal urethritis—common in men—may cause urethral stricture with increased risk of periurethral abscess; may perforate the peritoneal scrotum, causing urethral fistula.
• Untreated chlamydia increases risk of acquisition/transmission of HIV, causes pelvic inflammatory disease (PID) in women, and—in men—affects the testicles, which leads to complications and possible infertility.
• Infection spread to ureters/kidneys

• When associated with low-grade infection and treated appropriately, seldom produces long-term illness; however, recurrence is common.
• STDs or NGU can be effectively treated with antibiotic medication. When asymptomatic or left untreated, complications—including infertility—may result, and disease transmission to sex partners is inevitable.

NGU:

• Permanent damage to reproductive organs/infertility in both sexes.
• Difficulties during pregnancy, premature delivery, low birth weight.
• Ear, eye, and lung infections in newborns. (Resultant neonatal conjunctivitis can permanently damage eyesight.)
• Nutritional guidelines are safe to follow in pregnancy. Herbal therapies should be used only with physician supervision.
• Avoid tetracyclines.

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