Urethritis in Children

How common is Urethritis in Children

Urethritis is a swelling (inflammation) of the urethra.

The urethra is the tube that drains urine from the bladder. It is important to get treatment for your child early. Delayed treatment may lead to complications.

Urinary tract infections (UTIs) are a common and potentially serious bacterial infection of childhood. History and examination findings can be non-specific, so a urine sample is required to diagnose UTI.

Sample collection in young precontinent children can be challenging. Bedside dipstick tests are useful for screening, but urine culture is required for diagnostic confirmation.

Antibiotic therapy must be guided by local guidelines due to increasing antibiotic resistance. Duration of therapy and indications for imaging remain controversial topics and guidelines lack consensus. 

• Urethritis of childhood affecting male children was first described by Williams and Mikhael in 1971.
• The cause of urethritis in some children is unknown and described as idiopathic urethritis (IU).
• Association with dysfunctional elimination syndrome and immunological conditions like Reiter’s syndrome has been described but scientific data is lacking.
• The first series of IU in male children included 19 boys diagnosed on clinical grounds after exclusion of bacterial infection.
• Since then various articles have been published on this topic; however, treatment of IU in male children still remains as a challenge.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) and antibiotics have been tried without much success.

What are the causes?

Urethritis in Children may be caused by:

• Prolonged contact of the genital area with chemicals in the bath, such as bubble bath, shampoo, and harsh or perfumed soaps. This is the most common cause of urethritis before puberty and is often seen in girls.
• Germs that spread through sexual contact, if your child is sexually active. This is a common cause of urethritis after puberty. This may include bacterial or viral infections.
• Injury to the urethra. Injury can happen after a thin, flexible tube (catheter) is inserted into the urethra to drain urine or after medical instruments or foreign bodies are inserted into the area.
• A disease that causes inflammation. This is rare.

What increases the risk?

Poor Hygiene

• Inadequate cleaning of the genital area
• Wiping back to front in girls, introducing fecal bacteria into the urethra
• Use of irritating soaps, bubble baths, or perfumes

2. Urinary Tract Anomalies

• Congenital anatomic abnormalities (e.g., hypospadias, posterior urethral valves)
• Vesicoureteral reflux (VUR)

3. Infections

• Bacterial infections (E. coli and other fecal flora)
• Viral infections (e.g., adenovirus may cause urethritis with hemorrhagic cystitis)
• STIs (in adolescents: Chlamydia, Gonorrhea) — often via sexual activity or, rarely, perinatal transmission

4. Irritants and Trauma

• Bubble baths, soaps, detergents, or tight clothing
• Local trauma (e.g., bicycle straddle injury)
• Catheterization or instrumentation of the urethra

5. Voiding Dysfunction

• Holding urine for long periods
• Incomplete emptying of the bladder
• Overactive bladder or constipation, which can affect bladder dynamics

6. Foreign Bodies

• Insertion of objects into the urethra (accidental or intentional)

7. Sexual Abuse (Must Be Considered)

• Especially in prepubertal children with unexplained urethritis or genital symptoms

8. Immunosuppression or Chronic Illness

• E.g., diabetes mellitus, steroid use, HIV

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Important Clinical Note

• In boys, noninfectious causes are more common before puberty.
• In girls, due to a shorter urethra, ascending infections from the perineum are more likely.

What are the symptoms?

Symptoms of this condition include:

• Pain with urination.
• Frequent urination.
• Urgent need to urinate.
• Fever.
• Poor feeding, vomiting, and fussiness in younger children.
• Itching and pain in the vagina or penis.
• Discharge coming from the penis.

However, girls rarely have symptoms.

How is this diagnosed?

This condition is diagnosed based on your child’s medical history and symptoms as well as a physical exam. Tests may also be done. These may include:

• Urine tests.
• Swabs from the urethra.

Lifestyle

• When bathing your child:
  • Avoid adding perfumed soaps, bubble bath, and shampoo to your child’s bath water.
  • Bathe your child in plain warm water to soothe the area.
  • Minimize your child’s contact with soapy water in the bath.
  • Shampoo your child in a shower or sink instead of in a tub.
  • Rinse the vaginal area after bathing.
• If your child is a girl, teach her to wipe from front to back after using the toilet.
• Have your child wear cotton underwear. Not wearing underwear when going to bed can help.

How is this treated?

Treatment for this condition depends on the cause:

• Urethritis caused by a bacterial infection is treated with antibiotic medicine.
• Urethritis caused by irritation can be treated with home care.

Idiopathic urethritis in male children can be successfully managed with steroid instillation, especially in grade I and II.

Idiopathic urethritis grade III will need steroid instillation, but treatment of scarring and stricture will necessitate longer duration of treatment. In children with Idiopathic urethritis and systemic symptoms (grade IV), oral steroids may be required.

If your child is sexually active, any sexual partners must also be treated.

Follow these instructions at home:

Medicines

• Give over-the-counter and prescription medicines only as told by your child’s health care provider.
• If your child was prescribed antibiotic medicine, have your child take it as told by his or her health care provider. Do not stop giving the antibiotic even if your child starts to feel better.

General instructions

• Have your child drink enough fluid to keep his or her urine clear or pale yellow.
• It is up to you to get your child’s test results. Ask your child’s health care provider, or the department that is doing the test, when your child’s results will be ready.
• Talk to your child about safe sex if your child is sexually active.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• Your child has a fever.
• Your child’s symptoms are not better in 24 hours.
• Your child’s symptoms get worse.
• Your child has abdominal or pelvic pain (in females).
• Your child has eye redness or pain.
• Your child has joint pain.

Get help right away if:

• Your child who is younger than 3 months has a temperature of 100°F (38°C) or higher.
• Your child has severe pain in the belly, back, or side.
• Your child vomits repeatedly.

What is the prognosis of Urethritis in Children?

The prognosis of urethritis in children is generally favorable, particularly for idiopathic and uncomplicated cases.

The majority of children recover fully, often with resolution of symptoms even without aggressive intervention.

Here are the key points regarding prognosis:^[1][2][3]

• Self-Limiting Nature: Idiopathic urethritis can be self-limiting and benign in many children, with symptoms resolving spontaneously in a significant proportion of cases, especially when only mild symptoms are present.^[4][1]
• Treatment Response: Steroid instillation for idiopathic urethritis in children demonstrates good short-term symptom relief, but in some studies, long-term symptom-free survival did not differ significantly compared to observation alone. Recovery rates with steroid treatment range between 57–95%; about 66% of untreated cases also resolved without therapy.^[4]
• Complications: While rare, untreated or severe urethritis may progress to complications such as urethral stricture, particularly in cases with prolonged inflammation or posterior involvement. Most children do not develop these complications if actively managed.^[5][3]
• Extra-Urethral Involvement: Severe or grade IV cases with extension beyond the urethra may require oral steroids for symptom control, but outcomes are still generally good, with resolution in up to 95% of cases in reported series.^[5]
• Associated Conditions: Complications such as epididymitis, ascending infection, or upper urinary tract involvement are unusual but require prompt treatment if they occur.^[3][5]

Overall, the long-term outlook for children with urethritis is excellent, especially with appropriate diagnosis and management. Routine follow-up is essential to monitor for rare complications like strictures. Most children do not experience long-term sequelae if managed appropriately.^[1][3][5]

Summary

• Urethritis is a swelling (inflammation) of the urethra.
• This condition is caused by chemicals in your child’s bath. These chemicals include perfumed soaps, shampoo, and bubble bath. In sexually active children, this condition can be caused by germs that are spread through sexual contact.
• Your child’s symptoms may include painful, frequent, and urgent urination.
• Avoid adding perfumed soaps, bubble bath, and shampoo to your child’s bath water.

References

1. Tokar B. Childhood and adolescent idiopathic urethritis. J Pediatr Urol. 2020;16(3):320.e1-320.e8.
2. Urethritis. In: StatPearls. StatPearls Publishing; July 8, 2025. https://www.ncbi.nlm.nih.gov/books/NBK537282/
3. Urethritis: Practice Essentials, Pathophysiology, Etiology. Medscape. Updated June 7, 2024. https://emedicine.medscape.com/article/438091-overview
4. Canmemis A, Ulukaya Durakbasa C, Akyol G. Idiopathic urethritis in pediatric males: A 13-year experience with and without steroid injection. North Clin Istanb. 2025;12(1):144-150. doi: 10.14744/nci.2025.74429
5. Jayakumar S, Pringle K, Ninan GK. Idiopathic urethritis in children: Classification and treatment with steroids. J Indian Assoc Pediatr Surg. 2014;19(3):143-146. doi: 10.4103/0971-9261.136464
6. Urethral Syndrome: Causes, Symptoms & Treatment. Cleveland Clinic. Updated June 2, 2025. https://my.clevelandclinic.org/health/diseases/24300-urethral-syndrome
7. Urethritis: Causes, Symptoms, Diagnosis & Treatment. Cleveland Clinic. Updated June 2, 2025. https://my.clevelandclinic.org/health/diseases/22858-urethritis
8. Chemical Urethritis in Children: Care Instructions. MyHealth Alberta. Updated October 24, 2024. https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=bo1325
9. Urethritis Treatment & Management. Medscape Reference. https://emedicine.medscape.com/article/438091-treatment
10. Moralioglu S, Cerrah-Celayir A, Bosnali O. Clinical features and long-term outcomes of idiopathic urethrorrhagia. Turk J Pediatr. 2015;57(4):380-384.
11. Jayakumar S, Pringle K, Ninan GK. Idiopathic urethritis in children: Classification and treatment with steroids. J Indian Assoc Pediatr Surg. 2014 Jul;19(3):143-6. doi: 10.4103/0971-9261.136464. PMID: 25197191; PMCID: PMC4155630. https://pmc.ncbi.nlm.nih.gov/articles/PMC4155630/