• Clinical science

Urethritis

Summary

Urethritis is an inflammation of the urethral mucosa that may be caused by various pathogens, most notably C. trachomatis, N. gonorrhea, and M. genitalium. Transmission primarily occurs as a result of unprotected sexual intercourse and it is especially prevalent in young, sexually active men. Patients typically present with urethral discharge, dysuria, and/or itching of the urinary meatus, although asymptomatic infections are common. Diagnostics include urine dipstick (pyuria, positive leukocyte esterase), staining of a urethral sample, and nucleic acid amplification testing of first-void urine. In gonococcal urethritis, Gram staining of the urethral swab demonstrates gram-negative diplococci and patients are treated with ceftriaxone and azithromycin; otherwise patients are treated with azithromycin or doxycycline for nongonococcal urethritis. Evaluation and treatment of all recent sexual partners is necessary to prevent recurrent infections.

Etiology

References:[1][2][3][4][5][6][7]

Clinical features

  • Dysuria
  • Burning or itching of the urethral meatus
  • Urethral discharge: purulent , cloudy, blood-tinged, or clear
  • Initial hematuria
  • General symptoms (e.g., fever, chills, or myalgia) are uncommon in urethritis and should raise suspicion for complications (see “Complications” below).

Urethritis, especially nongonococcal urethritis, may also be asymptomatic!
References:[8][2][5]

Diagnostics

Dysuria with urethral discharge and no organism on Gram staining of a urethral specimen suggest urethritis by C. trachomatis or M. genitalium!
References:[2][10]

Differential diagnoses

Because coinfection with other genitourinary tract infections is possible, the presence of one infection does not rule out urethritis.

The differential diagnoses listed here are not exhaustive.

Treatment

  • The initial therapy is usually empiric and, according to prior distinction based on microscopic urethral specimen evaluation, divided into either a GU or NGU regimen.
  • Patients should refrain from sexual activity for 1 week after initiation of therapy.
  • All sexual partners from the 2 months prior to diagnosis should be notified, evaluated for urethritis, and offered empiric treatment.
  • Repeat NAAT 3–6 months after completion of therapy.

Sexual partners should be treated simultaneously to avoid reinfection!
References:[1][2][10]

Complications


References:[2][5]

We list the most important complications. The selection is not exhaustive.

Prevention