Urethritis

From Anvita Health Wiki

Contents 1 Introduction 2 Etiology 3 Clinical-manifestations 4 Laboratory 5 Differential-diagnosis 6 Management 7 More General Terms 8 Additional Terms 9 References

Introduction

• Inflammation of the urethra.

Etiology

• common causes

• Neisseria gonorrhoeae
• Chlamydia trachomatis
• Ureaplasma urealyticum

• less common causes

• viral

• Herpes simplex (may be particulary painful) [3]
• condylomata accuminata

• bacterial

• coliforms ( colonic bacteria)
• Mycoplasma

• fungal

• Candida
• Rhinosporidium

• parasitic

• Trichomonas vaginalis
• schistosomes

• no infectious etiology found in 20-65% of cases [3]

Clinical-manifestations

• general

• urethral discharge

• mucoid or mucopurulent
• clear, brown, yellow, white, green
• profuse, yellow mucopurulent discharge suggests gonococcus
• scantly, mucoid clear or white discharge suggests Chlamydia

• urethra meatal crusting & erythema
• dysuria
• urethral itch
• urethral tenderness

• associated manifestations of specific etiologies

• Herpes simplex: regional lymphadenopathy
• Chlamydia trachomatis

• conjunctivitis
• Reiter's syndrome
• epididymitis
• incubation period is 1-5 weeks, generally 2-3 weeks

• Neisseria gonorrhoeae

• incubation period 2-8 days

Laboratory

• gram stain of urethral discharge

• > 5 WBC/ hpf (oil)
• presence of bacteria

• urinalysis

• first 10-15 mL of urine
• > 20 WBC/ hpf in spun specimen

• culture of urethral discharge
• test for Chlamydia

• antigen detection tests
• nucleic acid hybridization

Differential-diagnosis

• urethral foreign body or calculi

• pain is usually intermittent
• may be bloody discharge
• may be palpable

• clinical manifestation of systemic disorder

• Stevens-Johnson syndrome
• Wegener's granulomatosis
• tumor

• chemical irritation of the urethra

• soaps

• congenital anomalies

Management

• Neisseria gonorrhea:

• primary therapy

• ceftriaxone 125 mg IM
• cefixime 400 mg PO
• ciprofloxacin 500 mg PO
• ofloxacin 400 mg PO
• penicillin-sensitive strains

• amoxicllin 3 g PO
• ampicillin 3.5 g PO
• penicillin G 4.8 million units IM distributed in 2 sites
• probencid 1 g PO along with agent

• follow primary therapy with:

• azithromycin 1 g PO once
• doxycycline 100 mg PO for 7 days
• erythromycin 500 mg PO QID for 7 days (pregnancy)

• non- gonococcal urethritis

• doxycycline 100 mg PO BID for 7 days
• tetracycline 500 mg PO QID for 7 days
• azithromycin ( Zithromax) 1 g PO once
• ofloxacin ( Floxin) 300 mg PO BID for 7 days (other quinolones may not be effective)
• erythromycin 500 mg PO QID for 7 days
• amoxicillin 500 mg PO TID for 120 days
• clindamycin 450 mg PO QID for 10 days
• sulfisoxazole 500 mg PO QID for 10 days

• patient education

• urethritis is sexually transmitted
• affected individuals may be asymptomatic ( carriers)
• partners should be referred for treatment
• Chlamydia & Ureaplasma rarely cause serious sequelae in men
• Chlamydia infection in women

• infertility secondary to tubal occlusion
• ectopic pregnancy
• chronic pelvic pain
• infection may be transmitted to fetus

• follow-up

• asymptomatic patients after course of antibiotics

• test of cure for Chlamydia after 3 weeks

• false negative may result if tested sooner

• persistence of symptoms after course of antibiotics

• consider course of erythromycin of ofloxacin if tetracycline was used
• consider metronidazole 2 g PO once if Trichomonas vaginalis is suspected
• referral to urology

More General Terms

• urologic disease

Additional Terms

• urinary tract infection (UTI)

References

1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 552-553
2. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 318
3. Bradshaw CS et al, Etiologies of nongonococcal urethritis: Bacteria, viruses, and the association with orogenital exposure. J Infect Dis 2006, 193:336 PMID: [1]
4. National Guideline Clearinghouse
   - Diseases characterized by urethritis and cervicitis. Sexually transmitted diseases treatment guidelines 2006. Centers for Disease Control and Prevention ngc-guideline: [2]
   - Chlamydial urethritis and cervicitis. (Finnish Medical Society Duodecim) ngc-guideline: [3]
   - Urethritis. In: Guidelines on urological infections. European Association of Urology ngc-guideline: [4]
   - 2007 UK national guideline on the management of non-gonococcal urethritis British Association for Sexual Health and HIV ngc-guideline: [5]

urethritis