Persistent Urethritis: Recurrence and Treatment Options

Urethritis is not improving?

Hello Doctor: I visited the clinic on November 23 due to discharge, and after a urinalysis, I was diagnosed with non-gonococcal urethritis.
I took doxycycline for a week, and my symptoms improved, so I returned for a follow-up and discontinued the medication.
However, a few days later, the symptoms reappeared, so I returned on December 7 and was prescribed a different antibiotic, ceflour, but it was ineffective.
On December 14, I switched back to doxycycline, and my symptoms improved again.
A week later, I had a urinalysis, which showed bacteria but normal results for other parameters.
I continued taking doxycycline until December 28, and I had no symptoms.
However, a few days later, I noticed a very small amount (about a drop) of non-transparent discharge when squeezing the glans, and there were red spots on the glans and the corona.
Could this be a recurrence? Should I return for a follow-up? Should I consider changing antibiotics? Can a urethroscopy identify the issue?

L, 20~29 year old female. Ask Date: 2021/01/03

Dr. Li Xinyi reply Urology

It sounds like the gonorrhea has not been cured, and it may require out-of-pocket injections to resolve the issue.
This is because gonorrhea is sometimes not easily diagnosed, similar to what you may have heard about "false negatives." It is important to consider whether there has been any risky sexual behavior and whether condoms were used consistently, including during oral sex.
If proper protection was not used, there is still a possibility that the gonorrhea has not been cured.
Without a diagnosis or evidence, it cannot be treated through insurance, and it may be necessary to pay for injections to see if there is any improvement.

Reply Date: 2021/01/03

More Info

Persistent urethritis can be a challenging condition to manage, especially when it recurs despite treatment. Your experience with multiple courses of antibiotics, including doxycycline and ceflour, indicates that you are dealing with a resistant or persistent infection. Here are some insights and recommendations based on your situation.

Understanding Recurrence
1. Persistent Infection: The recurrence of symptoms after treatment may suggest that the initial infection was not fully eradicated. This can happen for several reasons, including antibiotic resistance, incomplete treatment, or the presence of a different pathogen that was not targeted by the antibiotics used.

2. Antibiotic Resistance: It's crucial to consider that the bacteria causing your urethritis may have developed resistance to the antibiotics you have been prescribed. This is particularly common with repeated use of the same class of antibiotics. If you have been using doxycycline frequently, it might be beneficial to switch to a different class of antibiotics.

3. Non-Bacterial Causes: Sometimes, urethritis can be caused by non-bacterial factors, such as irritation from soaps, lotions, or even friction during sexual activity. If you have ruled out bacterial causes, it may be worth considering these factors.

Treatment Options
1. Re-evaluation: Given that you are still experiencing symptoms, it is advisable to return to your healthcare provider for a thorough re-evaluation. This may include repeat urine cultures to identify the specific bacteria and their sensitivities to antibiotics.

2. Antibiotic Change: If the cultures indicate resistance to doxycycline or ceflour, your doctor may prescribe a different antibiotic that is effective against the identified bacteria. Options may include azithromycin or a fluoroquinolone, depending on the culture results.

3. Urethroscopy: A urethroscopy can be a useful diagnostic tool to visualize the urethra and identify any structural abnormalities, strictures, or other issues that may be contributing to your symptoms. If there are any lesions or abnormalities, they can be addressed during this procedure.

4. Symptomatic Treatment: In the meantime, you may benefit from symptomatic treatments such as anti-inflammatory medications or topical treatments to alleviate discomfort.

Follow-Up Care
1. Monitoring Symptoms: Keep track of your symptoms, including any changes in discharge, pain, or irritation. If you notice any worsening or new symptoms, it is essential to seek medical attention promptly.

2. Sexual Activity: If you are sexually active, it may be wise to abstain until your symptoms are fully resolved and you have been cleared by your healthcare provider. This can help prevent reinfection or transmission to partners.

3. Lifestyle Modifications: Consider lifestyle changes that may help reduce irritation, such as avoiding irritants (like scented soaps), wearing breathable cotton underwear, and maintaining good hygiene.

Conclusion
In summary, your situation requires careful management and possibly a change in treatment strategy. Persistent urethritis can be complex, and it is essential to work closely with your healthcare provider to identify the underlying cause and appropriate treatment. Regular follow-ups and open communication with your doctor will be key in resolving your symptoms and preventing future recurrences.

Similar Q&A

Understanding Persistent Urethritis: Causes and Treatment Options

I had unprotected sexual intercourse in early May. A week later, I noticed a discharge from my genital area upon waking up, along with itching in the urethra. When I slightly squeezed the urethra, I experienced a sharp pain. I went to the hospital for a urinalysis and bacterial c...

Dr. Du Shixi reply Urology
Hello: 1. In addition to taking medication, it is important to pay attention to lifestyle. After finishing the medication, you should return for a follow-up appointment to confirm that there is no infection; otherwise, it is easy for the condition to recur. 2. Generally, it is no...

Understanding Recurrent Urethritis: Causes and Treatment Options

Hello Dr. Hsu: My condition has been ongoing for 4 to 5 years. It started with white discharge from the urethra (very white), but there was no pain. After consulting a doctor, I was diagnosed with urethritis, and I was prescribed antibiotics for 14 days, which improved the condit...

Dr. Xu Weikai reply Urology
Mark: Hello, your situation cannot be classified as a recurrence, but rather as a recurrent infection. It is best to identify the factors contributing to the infection, such as whether your sexual partner has a vaginal infection or if there are issues with the sterilization of co...

Understanding Persistent Urethral Inflammation and Treatment Options

Hello, doctor. I would like to ask how long it generally takes to recover from urethritis caused by non-sexual contact. I have been suffering from urethritis for two weeks, and prior to this, I had no unsafe sexual encounters, not even with my girlfriend. I occasionally masturbat...

Dr. Du Shixi reply Urology
Hello: If there has been no unsafe sexual contact, urethritis should completely resolve with 7-10 days of treatment, so it may not be a typical case of urethritis. It is recommended to continue seeing the same urology department to identify the underlying cause. Remember to drink...

Understanding Recurrent Urethritis: Symptoms, Diagnosis, and Treatment Options

Hello, I have been troubled by recurrent urethritis for the past two to three years. My past symptoms include: 1. Urethritis has recurred frequently, and I have visited clinics to see doctors and take medication. 2. During recurrences, the pain lasts a long time and is quite seve...

Dr. Li Xinyi reply Urology
This does require attention, as it indicates potential lapses in perineal hygiene, which can lead to recurrent bladder infections. Commonly overlooked factors include insufficient fluid intake, holding in urine, insomnia, and stress leading to decreased immunity, as well as menst...