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?

Risk factors of Urethritis in Children include having poor hygiene.

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.

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.

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.

Idiopathic urethritis (IU) is a known entity in the childhood and adolescent age groups and is described as blood spotting of the underwear in these populations. Typically, IU presents clinically as terminal void haematuria or blood spotting, accompanied with dysuria, occasional suprapubic pain and rarely constitutional symptoms. Sometimes IU may progress to formation of urethral strictures. It carries a high morbidity because of its chronicity and recurrent course, which often persists to puberty. In spite of no single aetiology being confirmed, several treatment approaches have shown some efficacy. Although no consensus has yet been established, the consideration of previous authors’ experience and expertise may contribute to the development of a possible unified algorithm.