Recurring Urethritis: Causes, Treatments, and Next Steps

Q: Recurring Urethritis: Causes, Treatments, and Next Steps

Y： Hello, further examination of urethral discharge can be conducted, including cultures, and appropriate antibiotics can be administered based on the drug response. <br>Temporarily, if it is unclear whether there is an infection, long-term use of cranberry (juice, dried fruit, o

Recurrent urethritis?

Hello Doctor, last July I had unprotected intercourse with someone I wasn't familiar with, and since then I've been experiencing symptoms of urethritis.
I went to the hospital immediately for a check-up and treatment.
The test results showed it was not gonorrhea, but non-gonococcal urethritis, and there were no other sexually transmitted infections.
I was prescribed Minocycline and co-trimoxazole for two weeks, and I felt like I had recovered.
However, after a period of masturbation (about once a week), the urethritis would recur.
The day after masturbation, I would start to notice white discharge accompanied by a genital odor.
I had to see the doctor again, and for the second time, I took Minocycline for a week, and the symptoms disappeared, but they recurred again due to masturbation.
For the third time, I switched to Doxycycline for two weeks, and now I'm on my fourth course of Doxycycline.
Each time I take the medication, the symptoms disappear within two days, but I still diligently finish the course...
Why can't I seem to get better? I'm concerned that I might be infected with a highly resistant strain of Chlamydia, or that the cause of the infection could be Mycoplasma or Ureaplasma with high resistance to tetracyclines.
Could you please advise me on what tests to undergo or what treatment methods to consider? I'm really struggling with this urethritis, and it's affecting my mood and my ability to engage with women.

Y, 20~29 year old female. Ask Date: 2013/02/02

Dr. Xu Weikai reply Urology

Y: Hello, further examination of urethral discharge can be conducted, including cultures, and appropriate antibiotics can be administered based on the drug response.
Temporarily, if it is unclear whether there is an infection, long-term use of cranberry (juice, dried fruit, or tablets) can be utilized as treatment and maintenance for urinary tract infections.
If there are any unclear points, feel free to ask again for further discussion and research.
Online responses should only be used as a reference; if necessary, it is still important to seek medical care at a healthcare facility.
This message is from Dr.
Hsu Wei-Kai, Chief of Urology, Taitung Hospital, Department of Health, Executive Yuan, expressing concern for you.

Reply Date: 2013/02/02

More Info

Recurring urethritis can be a frustrating and distressing condition, especially when it seems to persist despite treatment. Based on your description, it appears that you have been experiencing recurrent episodes of urethritis since your initial encounter last July. You've undergone multiple courses of antibiotics, including Minocycline and Doxycycline, which have provided temporary relief but have not resolved the underlying issue.

Possible Causes of Recurring Urethritis
1. Infection with Resistant Organisms: One possibility is that you may be dealing with a resistant strain of bacteria. As you mentioned, certain organisms like Mycoplasma or Ureaplasma can be difficult to treat and may not respond well to standard antibiotics. These organisms can lead to chronic inflammation and recurrent symptoms.

2. Non-Infectious Causes: It's also important to consider non-infectious causes of urethritis, such as irritation from soaps, lotions, or even frequent masturbation. Sometimes, physical irritation can mimic the symptoms of an infection.

3. Underlying Conditions: Conditions such as prostatitis or urethral strictures could also contribute to recurrent symptoms. Inflammation of the prostate can lead to similar symptoms and may require a different treatment approach.

4. Sexual Practices: Engaging in sexual activities without proper protection can increase the risk of infections. If you are engaging in activities that may introduce bacteria into the urethra, this could be a contributing factor.

Recommended Next Steps
1. Comprehensive Testing: Given your history, it would be prudent to undergo a more comprehensive evaluation. This could include:
- Urine Culture: A culture can help identify the specific bacteria causing your symptoms and determine if they are resistant to the antibiotics you have been taking.

- Testing for Mycoplasma and Ureaplasma: These tests can help identify if these organisms are present and contributing to your symptoms.

- Prostate Examination: A digital rectal exam and possibly a prostate-specific antigen (PSA) test can help rule out prostatitis.

2. Consider Alternative Antibiotics: If resistant organisms are suspected, your doctor may consider prescribing a different class of antibiotics or a longer course of treatment. Sometimes, a combination of antibiotics may be necessary to effectively treat resistant infections.

3. Lifestyle Modifications:
- Hydration: Increasing your water intake can help flush out bacteria from the urinary tract.

- Avoid Irritants: Be mindful of soaps, lotions, or other products that may irritate the genital area.

- Safe Sexual Practices: Using protection during sexual activities can help prevent the introduction of bacteria.

4. Follow-Up Care: Regular follow-up with your healthcare provider is essential. If symptoms persist despite treatment, further evaluation may be necessary, including imaging studies or referral to a urologist for specialized care.

Conclusion
Recurring urethritis can be challenging to manage, but with the right approach, it is possible to identify the underlying cause and develop an effective treatment plan. It’s important to communicate openly with your healthcare provider about your symptoms and concerns. They can guide you through the necessary tests and treatments to help alleviate your symptoms and improve your quality of life. Remember, you are not alone in this, and seeking help is the first step towards recovery.

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