Urethritis is an inflammation of the urethra, which is that small channel that allows the passage of urine from the bladder to the outside, during urination. Urethritis can affect people of any age, both female and male. However, the greatest incidence is recorded precisely in men, since from an anatomical point of view they have a longer urethra; therefore, the possibility that one of its sections may be affected by inflammation is greater. Unlike the female urethra, which in adulthood is on average between 3 and 5 cm long, the male urethra measures about 15-20 cm, since it extends from the bladder to the apex of the penis. Furthermore, remember that in humans, in addition to allowing the outflow of urine, the urethra also conveys the sperm towards the outside during ejaculation.
There is no one cause of urethritis that is the same for everyone, but there are several possible causes responsible for the inflammation of the urethra. In any case, precisely on the basis of the causes of origin, it is possible to distinguish the various forms of urethritis into two large groups. On the one hand we have infectious urethritis, that is caused by the proliferation of microorganisms in the urethra; on the other hand we have the forms of non-infectious urethritis that depend on other factors. In the first group, that is, in that of infectious urethritis, a further distinction must be made between gonococcal urethritis, which are associated with gonorrhea, and non-gonococcal urethritis, therefore caused by microorganisms other than Neisser's gonococcus. Let's now take a step back and begin by describing the forms of non-infectious urethritis. As I had anticipated, in these cases the urethritis does not depend on the infection of pathogens. Instead, they are often related to small local trauma, caused for example by the introduction of a catheter, by the presence of kidney stones or by activities such as cycling. non-infectious urethritis can sometimes result from irritation from overly vigorous sexual intercourse or from certain personal hygiene products, such as soaps, douches, deodorants, or spermicides. There are also urethritis, so-called allergic, in which the disorder is due to particular allergens, toxins or the use of certain drugs to which the individual is sensitized.
As for infectious urethritis, this can be caused by various pathogens, such as Neisser's gonococcus (which is a bacterium), Chlamydia trachomatis which is another bacterium, Trichomonas vaginalis which is instead a parasitic protozoan, Mycoplasma genitalium or "Ureaplasma urealyticum, both bacteria. The responsible microorganisms can colonize the urethra by penetrating from the outside or reaching it from other parts of the body. For example," incorrect intimate hygiene and sexual intercourse favor the ascent of pathogens from the " external along the urethra. In other cases, however, the pathogens reach the urethra via the blood (therefore transported by the blood from distant foci of infection) or from nearby organs, such as prostate, ureter, kidneys or bladder. The infection can also be sustained by germs already present in the urethra, which take advantage of a decline in the body's defenses to proliferate; for this reason they are defined opportunistic pathogens. The colonization and proliferation of microorganisms can also be favored by particular local anatomical conditions, such as the presence of narrowing of the urethra or some problems in the bladder neck. Among all the microorganisms listed above, gonococcal urethritis is probably the more known and widespread form of urethritis. In this case, the inflammation is sustained by Neisser's gonococcus, which is responsible for a disease known as gonorrhea, blenorrhagia or more simply discharge. Gonococcal urethritis manifests itself, at first, with itching, pain and burning when passing urine. The latter is also often cloudy, with traces of blood and pus. As we will see later, if the gonococcal infection becomes chronic, it can give rise to various complications.
As for the symptoms common to the various forms of urethritis, both infectious and non-infectious, I recall the appearance of urethral pain and burning. These symptoms become more intense during the emission of urine and during sexual intercourse. Furthermore, in men, urethritis can manifest itself with itching, burning and redness of the urinary meatus (ie of the orifice located at the top of the penis). In women, however, problems of difficult and painful urination can be accompanied by back pain, vaginal discharge and bleeding after sexual intercourse. Especially in men, infectious urethritis can typically also manifest itself with the loss of a urethral secretion. Generally, a clear discharge indicates a "non-gonococcal urethritis. When, on the other hand, there is a urethral loss of purulent material, therefore greenish-yellow, abundant and dense, it is probably a gonococcal urethritis, which is therefore also known as discharge. Finally, I remember that in some cases patients affected by urethritis do not develop obvious symptoms or disorders.These individuals, defined as healthy carriers, are still able to transmit the disease even if they do not show symptoms.
A neglected urethritis can become chronic and give rise to serious complications. For example, chronic infections or repeated trauma can cause the so-called urethral stricture, in practice the urethra shrinks due to the deposit of scar tissue. This obstruction can compromise normal urinary outflow, fueling the original problems. Another possible complication is the extension of the infection to nearby structures.For example, if neglected, urethritis can develop into cystitis, which is inflammation of the urinary bladder, or pyelonephritis, which is the far more dangerous inflammation of the kidneys. In addition, men can have complications such as epididymitis, orchitis and prostatitis, while women can develop cervicitis or pelvic inflammatory disease (PID), with serious consequences on future fertility.
The diagnosis of urethritis is based on a urological examination, which is then completed by a series of analyzes to identify the microorganism responsible for the infection. More precisely, to ascertain the causes of urethritis, it is necessary to proceed with urine culture and with urethral swabs; in practice, the presence of the bacterium is searched for in the urine or in a sample taken by inserting a kind of cotton swab into the urethra. Also in the laboratory, especially for chronic forms, the so-called antibiogram is performed, which is a test in which one evaluates which antibiotic is more effective against the bacterial strain isolated from the sample, thus enabling the outcome of the diagnostic investigations to undertake a targeted and effective drug therapy.
Urethritis, in general, has a benign course, provided it is treated appropriately. The goals of therapy are to improve symptoms, eliminate the causative agent and avoid the spread of infection. As we have seen, the treatment of infectious urethritis involves the use of antibiotic drugs or mild urinary tract antiseptics. Drinking a lot of water can help, because urine has a washing action on pathogens, which favors their elimination externally. In the presence of urethritis, always under medical advice, phytotherapy can also be useful, with extracts of cranberry, bearberry and mannose. To reduce the risk of repeated infections, sexual intercourse should be avoided until the disease resolves. It should be noted that the doctor may extend antibiotic therapy to the sexual partner as well, and this is also important when the partner does not have any symptoms or complaints. This precaution allows, in fact, to prevent the spread of infection and new episodes of urethritis. As for non-infectious urethritis, the therapy aims to remove or manage the factor that causes the irritation process. In this sense, a dietary correction could be useful, avoiding irritating foods such as pepper, chilli and hot spices, limiting or abolishing alcohol, avoiding artificial sweeteners and trying to regularize the intestine, increasing the intake of liquids and fibers . Finally, in all cases of particularly painful and annoying urethritis, it is possible to combine them with anti-inflammatory drugs, such as ibuprofen, to reduce painful symptoms.
