Presentation
METHODS: The present study comprised 424 men with symptoms and signs compatible with acute urethritis. Their urethral swabs and first-voided urine underwent detection of the microorganisms. [ncbi.nlm.nih.gov]
Underlying anxiety may be present and if present should be discussed. Disclaimer The content of these treatment guidelines is for information purposes only. [mshc.org.au]
Men with Gonococcal urethritis may present with any combination of symptoms [ 12 ]. [omicsonline.org]
Entire Body System
- Pain
Symptoms of NGU in women can include: Discharge from the vagina Burning or pain when urinating (peeing) Abdominal pain or abnormal vaginal bleeding may be an indication that the infection has progressed to Pelvic inflammatory Disease (PID) Anal or Oral [std-gov.org]
Those who have symptoms may notice the following: discharge of pus from the penis eye pain and discharge frequent or painful urination pus-filled discharge from the penis rectal discomfort sore throat Gonorrhea that has spread to other parts of the body [medicineonline.com]
Untreated gonococcal or chlamydial urethritis in women is thought to cause ascending genitourinary infections, which may result in pelvic inflammatory disease, infertility, ectopic pregnancy, and chronic pelvic pain. [nmihi.com]
You can take acetaminophen or ibuprofen for pain, unless you were given a different pain medicine. [fairview.org]
- Inflammation
Nongonococcal Urethritis Definition Any inflammation of the urethra not due to gonorrhea, almost always contracted through sexual intercourse and found far more often in men. [medical-dictionary.thefreedictionary.com]
Complications of gonococcal urethritis in men include inflammation in the epididymis and testes (acute epididymoorchitis), inflammation of the lymph vessels in the penis (penile lymphangitis), prostatitis (inflammation of the prostate gland (prostatitis [nmihi.com]
William Pett, Published December 2018 Urethritis is an inflammation of the urethra, the tube through which urine (and, in men, semen) passes. This inflammation can be caused by several sexually transmitted infections. [aidsmap.com]
Your penis will be examined for signs of inflammation and you’ll be tested for chlamydia and gonorrhoea. [fpa.org.uk]
NGU Tests: A doctor can diagnose nongonococcal urethritis through visible urethral inflammation (swelling) in men, a urethral swab or oral swab, and a Pap smear for women. Relief spells (Rolaids?!) [thestdproject.com]
- Infertility
Reiter’s syndrome (arthritis) Conjunctivitis Skin lesions Discharge Nongonococcal urethritis in women can lead to: Pelvic Inflammatory Disease (PID) which can result in ectopic (tubal) pregnancy Recurrent PID may lead to infertility Chronic pelvic pain [thestdproject.com]
Pelvic inflammatory disease and infertility are possible consequences for female sexual partners. Urethral stricture disease is a possible long-term complication of urethritis in men. [academic.sun.ac.za]
Recurrent PID may lead to infertility. Chronic pelvic pain Urethritis Vaginitis Mucopurulent cervicitis (MPC) Spontaneous abortion (miscarriage) Men or Women Infections caused by anal sex might lead to severe proctitis (inflamed rectum). [ashasexualhealth.org]
Untreated infections can spread from the cervix to the fallopian tubes in women, where they can cause permanent scarring and infertility. [drugs.com]
Repeated episodes of PID are associated with an increased risk of infertility. [your.md]
- Unsafe Sexual Practices
The predisposing factors for urethritis are multiple sexual partners, unsafe sexual practices, a current sexually transmitted infection (STI), and recent urethral instrumentation. [infectiousdiseaseadvisor.com]
- Surgical Procedure
Admissions would be feasible for severe complications that may require intravenous antibiotics or surgical/procedural interventions or specialized consultations. Copyright © 2017, 2013 Decision Support in Medicine, LLC. All rights reserved. [infectiousdiseaseadvisor.com]
Respiratoric
- Pharyngitis
Numbers with pharyngeal infection very small. No males with rectal infection. Small sample size. Adverse events 14.6% overall. Of these 86% mild and 14% moderate. [bestbets.org]
Pharyngeal infection is important as a cause of sore throat due to pharyngitis, tonsillitis and gingivitis. It is also a principal origin of gonococcemia (see below for signs and symptoms of gonococcemia). [atsu.edu]
The use of new diagnostic techniques - rectal and pharyngeal testing using nucleic acid amplification testing (NAAT) - has also improved detection rates. The highest rates of gonorrhoea are amongst the young. [patient.info]
Acquisition of pharyngeal gonorrhoea via sweets passed by mouth. Genitourin Med 73, 146. [Google Scholar] Dowsett, S. A. & Kowolik, M. J. ( 2003 ; ). Oral Helicobacter pylori : can we stomach it? Crit Rev Oral Biol Med 14, 226 –233. [mic.microbiologyresearch.org]
Testing for pharyngeal chlamydial infection is not recommended. HIV Prevention There is evidence that the intact urethral endothelium is an important barrier to infection. [aafp.org]
- Sore Throat
Most (90%) are asymptomatic, but some people might have a sore throat. [std-gov.org]
Those who have symptoms may notice the following: discharge of pus from the penis eye pain and discharge frequent or painful urination pus-filled discharge from the penis rectal discomfort sore throat Gonorrhea that has spread to other parts of the body [medicineonline.com]
Oral infections are usually asymptomatic (express no symptoms), but they may occasionally result in a sore throat. 2,3 How Is It Treated? If you a urethral infection becomes a concern, please see a health care provider. [soc.ucsb.edu]
Musculoskeletal
- Arthritis
Complications common to both sexes - - Disseminated gonococcal infection (DGI) - Acute arthritis-dermatitis syndrome – acute arthritis, tenosynovitis, dermatitis or combination of these findings. - Gonococcal arthritis - Meningitis - Endocarditis [slideshare.net]
Reactive arthritis is characterized by NGU, anterior uveitis, and arthritis and is strongly associated with the gene for HLA-B27. Rare but serious complications of DGI include arthritis, meningitis, and endocarditis. [emedicine.medscape.com]
Complications of C trachomatis include Reiter's syndrome (reactive arthritis). Reactive arthritis consists of conjunctivitis, urethritis (or in females’ cervicitis), arthritis and psoriasis-like mucocutaneous lesions. [atsu.edu]
Urethritis associated with reactive arthritis will often recur. External resources American Urological Association 1000 Corporate Blvd. [drugs.com]
Urethritis is also seen as one of the elements of reactive arthritis (formerly Reiter’s syndrome). The other elements are uveitis, arthritis, and commonly skin and mucous membrane lesions. [infectiousdiseaseadvisor.com]
Skin
- Dermatitis
Complications common to both sexes - - Disseminated gonococcal infection (DGI) - Acute arthritis-dermatitis syndrome – acute arthritis, tenosynovitis, dermatitis or combination of these findings. - Gonococcal arthritis - Meningitis - Endocarditis [slideshare.net]
Psychiatrical
- Fear
Urethritis can occur in a continuum with concomitant seminal vesiculitis and epididymitis. [24] Recurrent urethritis may occur from reinfection, therapeutic failure or "venereophobia," an old term describing fear of recurrence where men can induce urethral [emedicine.medscape.com]
Neurologic
- Confusion
This may be confused with a urine infection. Soreness, irritation or itch inside the penis. A feeling of wanting to pass urine frequently. [berkeleyplacesurgery.nhs.uk]
- Seizure
Potential drug interactions for the medications used to treat urethritis include: blood-thinning medications heart medications seizure medications Medication can often treat urethritis quickly. [healthline.com]
Urogenital
- Urethral Discharge
Gonococcal urethritis (GCU) usually presents with severe dysuria and profuse mucopurulent urethral discharge. The external meatus is often erythematous and oedematous. [ijdvl.com]
Incubation period: 1 to 10 days or more Clinical findings: (1) dysuria, often described as burning (2) urethral discharge that may be mucoid and/or purulent A small percent of men may be asymptomatic and may go unrecognized. [meducator3.net]
Physical exam of the male may reveal a urethral discharge. Women rarely exhibit any urethral discharge. Tests : A thin urogenital swab is inserted into the urethra to obtain a specimen. [nmihi.com]
Manifestations Urethral discharge. Dysuria. Urethral itching or meatal erythema. Often asymptomatic. [canada.ca]
Clinical presentation Symptoms Considerations Urethral discharge Gonorrhoea - usually copious and purulent. More common in MSM and Indigenous populations. Non-gonococcal urethritis - usually less discharge. [sti.guidelines.org.au]
- Dysuria
Patients with gonococcal urethritis usually had symptoms of both dysuria and discharge of short duration; patients with nongonococcal urethritis had variable symptoms of longer duration (P < 0.0005). [annals.org]
Discharge +/- dysuria or may be asymptomatic. 6. [slideshare.net]
Men complain of glassy or purulent discharge from the urethra, Dysuria and burning in the urethra. Women complain of vaginal discharge, dysuria or abdominal pain (sign of progression to pelvic inflammatory disease). [urology-textbook.com]
Incubation period: 1 to 10 days or more Clinical findings: (1) dysuria, often described as burning (2) urethral discharge that may be mucoid and/or purulent A small percent of men may be asymptomatic and may go unrecognized. [meducator3.net]
In another such study discharge was present in 82 percent of cases and dysuria in 53 percent [ 13 ]. [omicsonline.org]
- Pelvic Pain
Reiter’s syndrome (arthritis) Conjunctivitis Skin lesions Discharge Nongonococcal urethritis in women can lead to: Pelvic Inflammatory Disease (PID) which can result in ectopic (tubal) pregnancy Recurrent PID may lead to infertility Chronic pelvic pain [thestdproject.com]
Pelvic inflammatory disease was a clinical diagnosis where clinicians used the following standardized criteria: sexually active woman at risk for STIs who experienced pelvic or lower abdominal pain and had at least one of the following signs on pelvic [journals.lww.com]
Untreated gonococcal or chlamydial urethritis in women is thought to cause ascending genitourinary infections, which may result in pelvic inflammatory disease, infertility, ectopic pregnancy, and chronic pelvic pain. [nmihi.com]
[…] urinating Fever and chills Frequent or urgent urination Pelvic pain Pain with intercourse Vaginal discharge The health care provider will examine you. [medlineplus.gov]
Persistence of pain, discomfort, and irritative voiding symptoms beyond 3 months should alert the clinician to the possibility of chronic prostatitis or chronic pelvic pain syndrome in men. [antimicrobe.org]
- Urinary Urgency
If men have prostatic involvement, they may also complain of nocturia and urinary urgency. Common to both sexes is urethral tenderness, erythema, and pruritis. [infectiousdiseaseadvisor.com]
Urgency and increases in urinary frequency are less common in patients with urethritis/urethral syndrome or “external dysuria”. [atsu.edu]
- Painful Ejaculation
suprapubic region or back. - Painful ejaculation. 32. Proctitis – repetitive anal intercourse or by lymphatic spread from posterior urethra. - Rectal pain - Discharge - mucopurrulent - Bleeding 33. Reiter’s syndrome – urethritis - conjuctivitis [slideshare.net]
Workup
[…] followers Placement of suprapubic tube: In severe cases of urethral trauma that prevent placement of urethral catheters or in the absence of adequate facilities for emergent cystoscopy; temporizing measure to divert urine and relieve patient discomfort See Workup [emedicine.medscape.com]
Urine
- Pyuria
Among patients in whom N. gonorrhoeae was eradicated, pyuria and clinical symptoms, respectively, disappeared in 92.6% (162/175) and 98.9% (173/175) of patients without concomitant C. trachomatis and in 78.6% (22/28) and 71.4% (20/28) with C. trachomatis [ncbi.nlm.nih.gov]
Acute urethral syndrome Dysuria, frequency Pyuria syndrome > 7 days No bacteria of symptom PID Lower abdominal pain, adenexal tenderness on pelvic examination evidence of MPC often present Cervical gramstaining positive for gonococcus, endometritis on [slideshare.net]
Children with urethritis Sexual abuse must be considered if there are symptoms of unexplained pyuria in prepubertal boys or young males who are not sexually active (see Sexual Abuse in Peripubertal and Prepubertal Children chapter). [canada.ca]
[…] presence of urethral discharge, a positive leukocyte esterase test result in first-void urine, or at least 10 white blood cells per high-power field in first-void urine sediment. 16 If no discharge is present, first-void urine should be tested to document pyuria [aafp.org]
Microbiology
- Chlamydia
RESULTS: Among the 822 patients tested, 29.2% had chlamydia, gonorrhea, or both infections; 13.8% were infected with chlamydia alone, 12.1% were infected with gonorrhea alone, and 3.3% were infected with both. [ncbi.nlm.nih.gov]
Most Frequent Cause of urethritis in heterosexual men Nongonococcal Urethritis (NGU) Organisms that can cause NGU and their likelihood Chlamydia Trachomatis (15-40%) Ureaplasma urealyticum (10-30%) Mycoplasma genitalium (15-25%) Trichomonas vaginalis [quizlet.com]
The infection is most often due to Chlamydia trachomatis, the organism that causes chlamydia. Those that aren't caused by Chlamydia trachomatis are usually due to another bacterium, Ureaplasma urealyticum. [medical-dictionary.thefreedictionary.com]
Causes (Pathogens) of Non-Gonococcal Urethritis Chlamydia trachomatis: Most often cause of NGU. Chlamydia are gram-negative obligate intracellular pathogens, urethritis is caused by serotypes D–K. [urology-textbook.com]
In many areas, free home self-sampling tests are available for chlamydia and gonorrhoea. [fpa.org.uk]
Treatment
Twenty-eight patients (2.3%) did not respond to treatment; treatment was successful in 1,140 patients (92.7%) after only one dose, and in 62 (5.0%) after two doses. The overall rate of treatment success was 97.7%. [ncbi.nlm.nih.gov]
The Social Hygiene Clinic of Department of Health offers check up, treatment and counseling. A referral is not required, and all information are kept confidential. You should follow medical advice on treatment. [chp.gov.hk]
This is a potentially serious matter because of the possibility that extensive use of single-dose azithromycin for treatment of C. trachomatis or for presumptive treatment of NGU might lead to the development of widespread resistance in M. genitalium [academic.oup.com]
Prognosis
Prognosis NGU is completely curable with proper antibiotic treatment. Untreated, NGU can lead to sterility in both men and women, inflammation of the mouth of the uterus, and infections of the woman's internal sexual organs. [medical-dictionary.thefreedictionary.com]
Prognosis is typically very good if the diagnosis is made early and treated properly. [infectiousdiseaseadvisor.com]
What Is the Prognosis for Urethritis? When treated early, simple urethritis has few complications. If allowed to progress, you may develop a bladder infection, kidney infection, or infection involving your testicles or prostate. [emedicinehealth.com]
Prognosis If gonococcal urethritis is diagnosed and treated quickly and correctly, there usually is complete recovery. [drugs.com]
Prognosis All patients with uncomplicated urethritis spontaneously recover with or without treatment. [emedicine.medscape.com]
Etiology
Navy, and the University of Washington; and a review of case-control studies of the etiology of NGU, conducted in London and Seattle. [link.springer.com]
Thus, the notion that NGU of chlamydial or mycoplasmal etiology can be dealt with by a single antibiotic, namely azithromycin, has had considerable clinical appeal. [academic.oup.com]
Causes of Urethritis It is most commonly of bacterial etiology. Although classified as STD, urethritis is not always caused by sexual activity. On basis of etiology, urethritis can be classified as Gonococcal and Non-Gonococcal urethritis. [condom-sizes.org]
Etiology The etiology of most cases of NGU is not known however, Chlamydia trachomatis serovars D-K is a frequent cause (15%--55% of cases). The prevalence differs by age group, with fewer infections associated with this organism among older men. [atsu.edu]
Ongoing controversies regarding etiology, diagnosis, treatment N/A Copyright © 2017, 2013 Decision Support in Medicine, LLC. All rights reserved. [clinicaladvisor.com]
Epidemiology
This paper presents a preliminary analysis of a cohort study of the epidemiology of NGU, conducted by the U.S. Public Health Service, the U.S. [link.springer.com]
Epidemiology Increasing incidence, nowadays more frequent than gonorrheal urethritis. Causes (Pathogens) of Non-Gonococcal Urethritis Chlamydia trachomatis: Most often cause of NGU. [urology-textbook.com]
Sex partner of the patient is always given the same treatment even if there is no clinical or laboratory evidence of urethritis (epidemiological treatment). [ijdvl.com]
Epidemiology of Helicobacter pylori : acquisition, transmission, population prevalence and disease-to-infection ratio. Br Med Bull 54, 39 –53. [CrossRef] [Google Scholar] Fisk, P. & Riley, V. ( 1995 ; ). [mic.microbiologyresearch.org]
Epidemiology Humans are the only known host and infection is almost always via sexual contact. There are about 300,000-500,000 reported cases/year in the U.S. [atsu.edu]
Pathophysiology
Pathophysiology Urethritis is an inflammatory condition that can be infectious or posttraumatic in nature. [emedicine.medscape.com]
Prevention
Prevention & Expectations What can be done to prevent the infection? Many cases of gonorrhea can be prevented by following safer sex guidelines. Prompt treatment of the infected person and any sexual partners will prevent further spread. [medicineonline.com]
How is NGU prevented? NGU is best prevented by consistent and correct latex male condoms. [stdclinic.ie]
What can be done to prevent the spread of NGU? There are a number of ways to prevent the spread of NGU: Limit your number of sex partners. Use a condom. Carefully wash genitals after sexual relations. [health.ny.gov]
Rein, Public Health Image Library, Center for Disease Control and Prevention, USA, www.cdc.gov. [urology-textbook.com]
This is to prevent re-infection. This factsheet is due for review in December 2021 [aidsmap.com]