It tends to be noticed first thing in the morning — a small amount of discharge, or a stain on the underwear, or a stinging sensation partway through the first urination of the day. Sometimes it is only a vague irritation at the tip that is difficult to describe. Whatever form it takes, it is one of the more alarming things a man can notice, and it produces a familiar response: wait a few days and see whether it settles.
Symptoms of this kind usually indicate urethritis, meaning inflammation of the urethra, the tube that carries urine and semen out through the penis. In most cases the cause is a sexually transmitted infection, and in most cases it is readily treatable. What does not work is waiting, because the symptoms can settle while the infection continues.
What Causes It
Two organisms account for a large proportion of cases. Gonorrhoea classically produces a more pronounced discharge, often thick and yellow or green, along with noticeable burning, and tends to appear within days of exposure. Chlamydia more often produces a thinner, clearer discharge and milder discomfort, and may take longer to appear. These descriptions are tendencies rather than rules, and they overlap enough that no clinician diagnoses by appearance alone.
Other organisms are also common causes, including Mycoplasma genitalium and Trichomonas, and are increasingly tested for where symptoms persist. Herpes can cause urethral symptoms, usually with pain that is out of proportion to any visible discharge. In a minority of cases urethritis is not sexually transmitted at all and follows irritation, a urinary tract infection, or occasionally catheter use.
Importantly, all of these can also produce no symptoms whatsoever, which is why a man who has had symptoms resolve on their own should not treat that as evidence he is clear.
Why It Should Not Be Left
Untreated urethritis has consequences beyond discomfort. The infection can travel to the epididymis at the back of the testicle, producing epididymitis — a painful, swollen, tender scrotum that is considerably harder to deal with than the original symptom and can, in some cases, affect fertility. It can spread further in uncommon circumstances, with gonorrhoea occasionally causing joint infection.
Transmission continues throughout. Chlamydia and gonorrhoea in a female partner frequently cause no symptoms and are leading causes of pelvic inflammatory disease and tubal infertility, so an untreated infection in a man carries real consequences for someone else.
There is also the matter of antibiotic resistance. Gonorrhoea has become progressively harder to treat, and treatment recommendations have changed several times in recent years. This is one of several reasons why taking leftover antibiotics from a previous course, or something obtained from a friend, is a poor approach — the wrong drug at the wrong dose may suppress symptoms without clearing the infection while contributing to resistance.
What Assessment Involves
The visit is short. A physician will ask about the symptoms and their timing, and about recent sexual contact and what kind, since that determines which sites need testing — a urine sample will not detect a throat or rectal infection. Testing is typically a urine sample, sometimes with a swab of any discharge present, and blood tests for syphilis and HIV are usually offered at the same time because co-infection is common.
Treatment is with antibiotics, chosen according to what is found or, where symptoms clearly warrant it, started before results return and adjusted afterward. Gonorrhoea is generally treated with an injection alongside an oral antibiotic. Sexual partners require testing and treatment regardless of whether they have symptoms, and abstaining from sex until both people have completed treatment is what prevents the infection passing back and forth.
The main reason men delay is embarrassment rather than the symptom itself. It is worth saying that this is among the most routine presentations in men’s health, that it is assessed without commentary on how it was acquired, and that the entire matter is usually resolved within a week or two of walking in.
Dr. Raymond Nash assesses and treats urethritis and other sexually transmitted infections at Grande Prairie Men’s Medical Clinic, confidentially. Appointments can be made at gpmm.clinic or by calling (587) 416-8296. This is general information and does not take the place of an individual medical assessment.