Urethritis

Urethritis
Classification and external resources
ICD-10	N34.
ICD-9	597 099.4
DiseasesDB	27902
eMedicine	med/2342
MeSH	D014526

Urethritis is inflammation of the urethra. The main symptom is dysuria, which is painful or difficult urination.

Causes

The disease is classified as either gonococcocal urethritis, caused by Neisseria gonorrhoeae, or non-gonococcal urethritis (NGU), most commonly caused by Chlamydia trachomatis. NGU, sometimes called non-specific urethritis (NSU), has both infectious and non-infectious causes.

Other causes include:

• Adenovirus
• Uropathogenic Escherichia coli (UPEC)
• Herpes simplex
• Mycoplasma genitalium
• Reiter's syndrome
• Trichomonas spp.

Symptoms

In men, purulent discharge usually indicates a urethritis of gonococcal nature, while clear discharge indicates urethritis of non-gonococcal nature. Urethritis is difficult to diagnose in women because discharge may not be present, however, the symptoms of dysuria and frequency may be present.

Diagnosis

Usually, the patient undresses and puts on a gown. With male patients, the physician examines the penis and testicles for soreness or any swelling. The urethra is visually examined by spreading the urinary meatus apart with two gloved fingers, and examining the opening for redness, discharge and other abnormalities. Next, a cotton swab is inserted 1–4 cm into the urethra and rotated once. To prevent contamination, no lubricant is applied to the swab, which can result in pain or discomfort. The swab is then smeared onto a glass slide and examined under a microscope. A commonly used cut-off for the diagnosis of urethritis is 5 or more polymorphonuclear leukocytes per HPF, but this definition has recently been called into doubt.

The physician sometimes performs a digital rectal exam to inspect the prostate gland for swelling or infection.

Treatment

A variety of drugs may be prescribed based on the cause of the patient's urethritis. Some examples of medications based on causes include:

• Ceftriaxone - Gonorrhea
• Clotrimazole (Mycelex) - Trichomonial
• Fluconazole (Diflucan) - Monilial
• Metronidazole (Flagyl) - Trichomonial
• Nitrofurantoin - Bacterial
• Nystatin (Mycostatin) - Monilial
• Co-trimoxazole, which is a combination of Sulfamethoxazole and Trimethoprim in a ratio of 5 to 1 (Septrin, Bactrim) - Bacterial

Proper perineal hygiene should be stressed. This includes avoiding use of vaginal deodorant sprays and proper wiping after urination and bowel movements. Intercourse should be avoided until symptoms subside.

Prevention

Risk of some causes of urethritis can be lessened by avoiding:

• unprotected sex (or any sex)
• chemicals that could irritate the urethra; this could include detergents or lotions as well as spermicides or contraceptives.
• irritation caused by manual manipulation of the urethra

See also

• Urinary tract infection

References

ar:التهاب الإحليل