Urethritis Treatment in Nepal — Discharge, Dysuria & Causes Gonococcal vs Non-Gonococcal — Correct Diagnosis, Correct Treatment

What Urethritis Is

Urethritis is inflammation of urethra — tube that drains urine and, in men, semen. The typical presentation is urethral discharge (clear, white, or pus-like), burning or pain on urination, itching at opening, or increased urinary frequency. In men it is usually sexually acquired; main causes are gonorrhea (gonococcal) and a group of other infections including chlamydia, mycoplasma and trichomoniasis (non-gonococcal, NGU).

The distinction between gonococcal and non-gonococcal urethritis is not academic — organisms, treatment and partner implications differ. Purulent discharge and early onset after exposure suggest gonorrhea; milder, clear discharge with later onset is more typical of chlamydia or other NGU causes. But appearance alone is not reliable — laboratory diagnosis on correct specimen is what guides correct treatment.

A significant fraction of urethritis is "non-specific" — no organism is found on standard testing, though many such cases still respond to empirical treatment. Persistent or recurrent urethritis after treatment needs re-evaluation, not simply a repeat of same course.

The Causes — Gonococcal vs Non-Gonococcal

Gonococcal urethritis — caused by gonorrhea — typically produces more purulent discharge and earlier symptom onset after exposure. It is treated with ceftriaxone-based therapy; resistance makes self-treatment or incomplete courses genuinely risky.

Non-gonococcal urethritis (NGU) — larger group — is most often caused by chlamydia, and less commonly by mycoplasma genitalium, trichomoniasis, or other organisms. Chlamydial urethritis tends to produce milder, clearer discharge with a later onset; mycoplasma is a recognized cause of persistent and recurrent NGU that responds to specific therapy.

Non-infective causes also exist — chemical irritation, trauma, or catheterization — though in sexually active men with new-onset urethral symptoms, an infective cause is presumed until excluded.

How Urethritis Is Diagnosed

The examination looks for discharge (sometimes visible only on urethral stripping) and checks for signs that suggest complications — testicular pain or swelling suggesting epididymitis, or systemic symptoms suggesting a more complicated infection.

Laboratory diagnosis uses first-catch urine ( first part of stream, which flushes urethra) or a urethral swab for NAAT testing — identifying gonorrhea and chlamydia with high sensitivity. Additional testing for trichomoniasis or mycoplasma is considered in persistent or recurrent cases; microscopy can show white cells that confirm inflammation.

Treatment by Cause

Gonococcal urethritis is treated with ceftriaxone; chlamydial and most NGU with doxycycline or azithromycin-based therapy; mycoplasma-driven persistent cases may need specific sequencing that mycoplasma responds to. The correct drug for correct cause is why diagnosis comes first.

During treatment, abstain from sex until course is complete and partners are treated — treating only yourself invites reinfection. If symptoms persist after treatment, return for re-evaluation rather than repeating same course; persistent urethritis has a different workup (including mycoplasma testing and, sometimes, non-infective causes).

Complications & Red Flags

The main local complication in men is epididymitis — painful testicular swelling, which needs prompt assessment (and where testicular torsion must be excluded in sudden severe cases). Untreated infection can also contribute to urethral strictures over time and, rarely, reactive arthritis presentations.

Any fever with urethral symptoms, severe testicular pain, or symptoms in context of pregnancy or a high-risk exposure should be attended promptly rather than watched.

Urethritis Services & Costs

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