Urethritis
In medicine, urethritis is "inflammation involving the urethra. Similar to cystitis, clinical symptoms range from vague discomfort to painful urination (dysuria), urethral discharge, or both."[1]
Cause and etiology
Common causes are Neisseria gonorrhoeae and Chlamydia trachomatis. Other causes are called "nonchlamydial, nongonoccocal urethritis" and may include Ureaplasma urealyticum, Mycoplasma genitalium, Trichomonas vaginalis, herpes simplex virus, and adenovirus.[2]
Diagnosis
Urethritis is diagnosed according to clinical practice guidelines if:[2]
- "Mucopurulent or purulent discharge."
- "Gram stain of urethral secretions demonstrating >5 WBC per oil immersion field. The Gram stain is the preferred rapid diagnostic test for evaluating urethritis. It is highly sensitive and specific for documenting both urethritis and the presence or absence of gonococcal infection. Gonococcal infection is established by documenting the presence of WBC containing GNID (Gram-negative intracellular diplococci)"
- "Positive leukocyte esterase test on first-void urine or microscopic examination of first-void urine sediment demonstrating >10 WBC per high power field."
Regarding gonococcal urethritis, 95% have a positive urethral smear (5 or more polymorphonuclear leucocytes per high powered field).[3]
Regarding chlamydial urethritis, 82% have a positive urethral smear (5 or more polymorphonuclear leucocytes per high powered field).[3]
Regarding nongonococcal urethritis,[4]
- 37% report dysuria
- 42% report a discharge
- 59% will have a discharge on examination
12% of males with nongonococcal urethritis will have no signs or symptoms.[4] 70%[4] to of these will have a positive urethral smear (5 or more polymorphonuclear leucocytes per high powered field). The remaining 30% have pyuria in the first-passed urine.
Treatment
The United States Centers for Disease Control and Prevention have published clinical practice guidelines for treatment.[2]
References
- ↑ Anonymous (2024), Urethritis (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ 2.0 2.1 2.2 Workowski KA, Berman SM (August 2006). "Sexually transmitted diseases treatment guidelines, 2006". MMWR Recomm Rep 55 (RR-11): 1–94. PMID 16888612. [e]
- ↑ 3.0 3.1 Geisler WM, Yu S, Hook EW (October 2005). "Chlamydial and gonococcal infection in men without polymorphonuclear leukocytes on Gram stain: implications for diagnostic approach and management". Sex Transm Dis 32 (10): 630–4. PMID 16205305. [e]
- ↑ 4.0 4.1 4.2 Horner PJ, Thomas B, Gilroy CB, Egger M, Taylor-Robinson D (October 2002). "Do all men attending departments of genitourinary medicine need to be screened for non-gonococcal urethritis?". Int J STD AIDS 13 (10): 667–73. DOI:10.1258/095646202760326408. PMID 12396535. Research Blogging.