URETHRITIS - Disease Management

Urethritis is an infection of the urine passage or urethra. It is acquired through sexual intercourse with an infected partner and is, therefore, considered a sexually transmitted disease. It is caused by several different kinds of bacteria or other organisms. Chlamydia is the most common cause. Most cases of urethritis are caused by infection to the urethra but trauma or an irritant to the urethra can also cause urethritis. All patients who experience symptoms should be tested for both gonorrhea and chlamydia.

Urethritis can be infectious or post-traumatic. Post-traumatic urethritis can occur in 2-20% of patients with intermittent catheterization.

Classification

• Gonococcal (GC) urethritis due to infections of Neisseria gonorrhea
• Nongonococcal urethritis (NGU), which follows infection with Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, or Trichomonas vaginalis.

Causes

• Gonococcal urethritis (80% of cases)
• N gonorrhea
• Nongonococcal urethritis (50% of cases)
• Uurealyticum (40-60%)
• C trachomatis (30-40%)
• M homins (5-10%)
• T vaginalis (fewer than 5%)
• Rare infectious causes of urethritis include lymphogranuloma venereum, herpes genitalis, syphilis, mycobacterium, and typical bacteria (usually Gram-negative rods) associated with cystitis in the presence of urethral stricture.
• Sexual contact with a carrier of causative organisms

Risk Factors

• Promiscuous or unprotected sex
• History of other STD
• Multiple sexual partners

Signs and Symptoms

• Straining to urinate
• Urethral discharge
• Suprapubic discomfort
• Dysuria
• Dyspareunia
• Blood in the urine
• Vaginitis, cervicitis, cystitis in women
• Dysuria
• Tenderness, edema, and inflammation of the urethral malleus, especially in women
• Urethral itching or tenderness
• Proctitis, pharyngitis, conjunctivitis

DIAGNOSIS

• Differential Diagnosis
• Epididymitis
• Orchitis
• Reiter Syndrome
• Postgonococcal urethritis
• Other UTI- cystitis, epididymis, prostatitis
• Atrophy (in postmenopausal women)
• Venereal warts
• Stevens-Johnson syndrome
• Reiter's syndrome
• Congenital polyps

Investigations

• Urethral culture
• Endourethral culture
• Polymerase chain reaction assays
• Urinalysis
• Syphilis serology (VDRL test or rapid plasma reagin test) test
• Urethrogram
• Urethrocystoscopy
• Urine culture

TREATMENT

Goal

Eliminate the causative organism, and prevent further complications.

Pharmacological Treatment

Class of drugs used

• Fluoroquinolone
• Cephalosporins

Others

• Azithromycin, Tetracycline, Erythromycin, Minocycline, Spectinomycin, Metronidazole

PATIENT EDUCATION

Instruct patients regarding safe sex practices

Complications

In men

• Epididymitis
• Prostatitis

In women

• Pelvic inflammatory disease
• Increased risk of miscarriage, premature delivery.or ectopic (tubal) pregnancy
• Eye infection and pneumonia in infants born to women who were infected at the time of delivery.

General

• Stricture, stenosis, or abscess formation

Prognosis

In the majority of cases, a causative agent can be identified and appropriate treatment initiated. Chronic urethritis, despite the cause, can lead to urethral strictures requiring dilation or surgical correction.