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Urethritis

Urethritides

Urethritis is a condition, characterized by inflammation of the urethra. Bacterial and viral infections are known to cause this disorder.


Presentation

Symptoms of urethritis are different for men and women. The following symptoms are experienced [6]:

Symptoms in men with urethritis

  • Experiencing burning sensation while urinating
  • Itching and burning sensation near the penis region
  • Blood in urine or semen
  • Pain during intercourse or while ejaculation
  • Development of fever
  • Lymph nodes in the groin region enlarge

Symptoms in women with urethritis

  • Development of abdominal pain, along with fever 
  • Increase in frequency of urination
  • Pain during intercourse
  • Discharge 
  • Burning sensation during urination
  • Pain in the pelvic region if the infection has spread to the pelvic area
Suprapubic Pain
  • Both cystitis and urethritis may present with pain or difficulty on urination (dysuria), frequency, urgency, and/or suprapubic pain or heaviness. A careful history may help differentiate between the two diseases.[clinicaladvisor.com]
Urethral Discharge
  • BACKGROUND/AIM: This study aimed to determine the prevalence of Mycoplasma genitalium infection among male patients with dysuria and/or urethral discharge.[ncbi.nlm.nih.gov]
  • Case 1: a 55-year-old man came to our observation in July 2012 referring a 5-day-history of intense dysuria and scant mucoid urethral discharge.[ncbi.nlm.nih.gov]
  • Microbiological examinations isolated Neisseria meningitidis in the urethral discharge by culture with the use of enzymatic profiles.[ncbi.nlm.nih.gov]
  • RESULTS: Twenty men were recruited into the study: 16 had purulent urethral discharge and 4 had asymptomatic urethral gonorrhoea.[ncbi.nlm.nih.gov]
  • The diagnosis of gonococcal urethritis was made by microscopic detection of typical gram-negative intracellular diplococci in cells of the urethral discharge.[ncbi.nlm.nih.gov]
Dysuria
  • Case 1: a 55-year-old man came to our observation in July 2012 referring a 5-day-history of intense dysuria and scant mucoid urethral discharge.[ncbi.nlm.nih.gov]
  • BACKGROUND/AIM: This study aimed to determine the prevalence of Mycoplasma genitalium infection among male patients with dysuria and/or urethral discharge.[ncbi.nlm.nih.gov]
  • BACKGROUND: Idiopathic bulbar urethritis (IBU) is characterized by hematuria   dysuria without infection. Symptoms result from inflammation of the bulbar urethra, distal to external sphincter.[ncbi.nlm.nih.gov]
  • The commonest symptoms are blood stained urethral discharge, urethral bleeding between episodes of micturition and dysuria. As the aetiology is poorly understood, there is no reliable means of treating this condition.[ncbi.nlm.nih.gov]
  • ‘The bacterium - which, when symptomatic, causes purulent discharge, dysuria, and urethritis - can also cause ascending infections leading to pelvic inflammatory disease and infertility.’[en.oxforddictionaries.com]
Urinary Retention
  • Procedures Patients with urethritis may undergo the following procedures: Catherization: In cases of urethral trauma; to avoid urinary retention and tamponade urethral bleeding Cystoscopy: In cases when catherization is not possible, for placement of[emedicine.medscape.com]
Urinary Incontinence
  • Urinary incontinence in women : how is urinary incontinence treated? Last updated 05.06.2012[netdoctor.co.uk]
  • Bilezikian (editors) (2004). "109: The Evaluation and Treatment of Urinary Incontinence". Principles of Gender-specific Medicine. 1. Gulf Professional Publishing. p. 1187.[en.m.wikipedia.org]
Painful Ejaculation
  • For women, symptoms include: Unusual vaginal discharge Pelvic and abdominal pain Pain with intercourse Frequent or urgent urination Fever and chills Stomach pain Itching Symptoms in men include: Blood in urine or semen Painful ejaculation Penile discharge[medicalnewstoday.com]
  • Painful ejaculation. Blood in semen (technically known as hematospermia) or urine (technically known as hematuria). Painful swelling in the scrotum (usually on one side).[phaa.com]
  • . - 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 - arthritis - characteristic[de.slideshare.net]

Workup

A preliminary physical examination would be carried out in men and women suffering from urethritis. In men, the abdomen, penis, scrotum and bladder will be examined. This would reveal tenderness and swelling in the penis region, abnormal discharge from penis and enlarged lymph nodes in the groin area.

In women, the abdominal and pelvic would be thoroughly examined. The examination would reveal tenderness of urethra accompanied by tenderness in the lower abdominal region and abnormal discharge from the urethra [7].

In many instances, a digital rectal examination would also be carried out. Some additional tests would also be required to confirm the condition of urethritis. These would include a complete blood count, urine culture to test for presence of bacterial infections, urethral swab and tests for sexually transmitted diseases [8]. In addition to these tests, women would also require a pregnancy test and pelvic ultrasound for diagnosing urethritis.

Pyuria
  • The laboratory studies revealed anemia, neutrophilic leukocytosis, elevated erythrocyte sedimentation rate (ESR), hypoalbuminemia, negative rheumatoid factor, pyuria, proteinuria, and the presence of HLA-B27.[ncbi.nlm.nih.gov]
  • The diagnosis of pyuria in a patient with abacterial dysuria is of critical importance, since it suggests a chlamydial etiology and thus is a potentially treatable condition.[ncbi.nlm.nih.gov]
  • .  In women – - Cevicitis – mucopurulent cervical discharge - cervical erythema & edema with an area of ectopy - spontaneous or easily induced cervical bleeding - Urethritis – dysuria - frequency - pyuria 36. - Bartholoinitis - Endometritis – abnormal[de.slideshare.net]
  • The majority of patients with cystitis will have pyuria ( 10 WBCs per mm3) on microscopy; however, pyuria without symptoms and signs is not sufficient to make the diagnosis.[clinicaladvisor.com]

Treatment

The primary goal of treatment of urethritis includes eradication of infection, methods to prevent spread of infection and effective management of symptoms. The following methods are employed for treating urethritis [9]:

  • In case of bacterial infections, antibiotics are administered.
  • In order to relieve symptoms, non steroidal anti-inflammatory drugs are given for relieving the pain
  • If the condition does not subside with antibiotics, then a combination of various antibiotics may be required to treat the chronic form of urethritis [10].
  • Individuals are advised to refrain from sex during the treatment regime. It is also required that the partner also receives treatment if urethritis is caused due to infections.

Prognosis

If urethritis is diagnosed in the preliminary stages and appropriate treatment is initiated, then the condition recovers completely without causing further complications. However when the disease progresses to more advanced stages then a condition known as urethral stricture can develop. This primarily occurs when the disease continues for longer duration and the urethral tissue gets damaged. In women, if the infection spreads to the pelvic region, then it can lead to fertility problems [5].

Etiology

Bacterial and viral infections are the major factors contributing towards development of urethritis. The bacteria responsible for causing sexually transmitted disease also cause inflammation of the urethra. The normal microflora that is present in the genital regions can also cause urethritis if they gain entry into the urinary tract. Certain viruses such as the human papillomavirus, cytomegalovirus and herpes simplex virus also causes urethritis.

Individuals who are sensitive to the chemicals which are used in spermicides, creams or foams are also predisposed to develop urethritis. Females who are in their reproductive age, males above 35 years, those having multiple sexual partners and those who practice unsafe sex are at an increased risk of developing urethritis [2].

Posttraumatic urethritis may occur following catheterization or foreign body insertion.

Epidemiology

It has been estimated that about 4 million cases of urethritis occur in America each year. Gonococcoal urethritis strikes 700,000 individuals annually. The occurrence rate of gonococcal urethritis has undergone a significant decline from the year 2000. The incidence of nongonococcal urethritis is increasing and about 3 million cases occur annually. 

Statistics have also reported that across the globe, about 62 million and 89 million new cases of gonococcal and nongonococcal urethrtitis respectively occur each year [3].

Sex distribution
Age distribution

Pathophysiology

There are 2 basic phenomenons that give rise to the condition of urethritis. Infections and traumatic events like catheterization or foreign body insertion can favor development of inflammation of the urethra. Of these, infections are known to be the major causative factor. Bacteria that cause sexually transmitted diseases are the major organisms that are known to play foul.

Patients who undergo catheterization and instrumentation are at an increased risk of contracting urethritis. Individuals who use latex catheterization are 10 times more likely to develop the condition than those who make use of silicone catheterization. In addition to these factors, individuals suffering from certain infectious syndromes such as otitis media, pneumonia, reactive arthritis, prostatitis, urinary tract infection, epididymitis and proctitis are also at an increased risk of suffering from urethritis [4].

Prevention

Practicing safe sex is one of the major methods of preventing urethritis. In addition, following various ways to promote good urinary tract health would also go a long way in preventing the onset of urethritis. Individuals are advised to drink plenty of fluids and urinate shortly after intercourse. Such a practice would help in flushing out bacteria from the urinary system [11].

Summary

Urethra is a tube that is responsible for carrying urine and the removal of fluids from the body. Therefore, individuals suffering from urethritis, experience painful urination. The condition of urethritis, usually occurs due to inflammation caused by sexually transmitted diseases. In other words, individuals with sexually transmitted diseases are at an increased risk of contracting such a type of condition. Males and females are equally affected; however, it is thought that females have higher chances of being affected [1].

Patient Information

  • Definition: Urethritis is a condition, characterized by inflammation of the urethra due to infection or underlying disease conditions. Males and female are at an equal risk of developing the condition.
  • Cause: Bacteria that cause sexually transmitted disease also favor the development of urethritis. In addition, injury and allergic reaction to spermicidal can also increase the risk of inflammation of urethra.
  • Symptoms: Common symptoms include burning sensation while urinating, pain during intercourse, abnormal discharge from the genital organs, blood in urine, abdominal pain and fever accompanied by chills.
  • Diagnosis: A preliminary physical examination would be carried out for diagnosing urethritis. In addition, blood tests and urine culture tests are also indicated. A urethral or vaginal swab would also be required for analyzing presence of infections.
  • Treatment: Antibiotics form the major part of the treatment regime if infections are the cause. Other medications to relieve the symptoms would also be required. 

References

Article

  1. Johnson LF, Lewis DA. The effect of genital tract infections on HIV-1 shedding in the genital tract: a systematic review and meta-analysis. Sex Transm Dis. Nov 2008;35(11):946-59.
  2. Bradshaw CS, Tabrizi SN, Read TR, et al. Etiologies of nongonococcal urethritis: bacteria, viruses, and the association with orogenital exposure. J Infect Dis 2006; 193:336.
  3. CDC. National overview of sexually transmitted diseases (STDs), 2012. 
  4. Lee YS, Lee KS. Chlamydia and male lower urinary tract diseases. Korean J Urol. Feb 2013;54(2):73-7.
  5. Centers for Disease Control and Prevention. CDC Division of AIDS, STD, and TB. Gonococcal Isolation Surveillance Project (GISP) Annual Report - 2007. Atlanta, Ga: Centers for Disease Control and Prevention.
  6. Frenkl T, Potts J. Sexually Transmitted Infections: Part II - Associated Vaginitides and Urethritides. AUA Update Series. 2006;25:17-9.
  7. William M. McCormack. Urethritis. In: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Disease, 7, Gerald L Mandell, John E. Bennet, and Raphael Dolin. (Eds), Elsevier, 2010. Vol I, p.1485.
  8. Orellana MA, Gómez-Lus ML, Lora D. Sensitivity of Gram stain in the diagnosis of urethritis in men. Sex Transm Infect 2012; 88:284.
  9. Manhart LE, Gillespie CW, Lowens MS, Khosropour CM, et al. Standard Treatment Regimens for Nongonococcal Urethritis Have Similar but Declining Cure Rates: A Randomized Controlled Trial. Clin Infect Dis. Jan 3 2013;
  10. Mena LA, Mroczkowski TF, Nsuami M, Martin DH. A randomized comparison of azithromycin and doxycycline for the treatment of Mycoplasma genitalium-positive urethritis in men. Clin Infect Dis 2009; 48:1649.
  11. Ochsendorf FR. Sexually transmitted infections: impact on male fertility. Andrologia. Apr 2008;40(2):72-5.

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Last updated: 2017-08-09 17:52