URETHRITIS
Urethra is the tube like organ that carries urine from the body. It empties urine from the urinary
bladder.
Urethritis is the swelling, irritation and inflammation of the urethra .Based on its etiology it can
be classified as:
i.
Gonococcal urethritis
Caused by gonococcal micro-organisms including Neisseria gonorrhea
ii.
Non-gonococcal urethritis
Caused by non-gonococcal microbes including Chlamydia trachomatis, fungi, herpes simplex
virus and mycoplasma species
iii.
Non-specific urethritis caused by an unidentified pathogen
Causes
Infectious causes of urethritis include viruses or bacteria that causes urinary tract infections and
sexually transmitted infections. Viral causes of urethritis include herpes simplex virus and
cytomegalovirus.
Non-infectious causes of urethritis include:
Injury, catheterization, dehydration, urethral stricture and sensitivity to chemicals used in
manufacturing spermicides or contraceptive creams
Risk factors
i.
ii.
iii.
iv.
Females in reproductive years
Males between 20 to 30 years of age
Having multiple sexual partners
History of sexually transmitted diseases (STDs)
Clinical manifestations
Most patients are usually asymptomatic. However, urethritis usually presents with:
i.
ii.
iii.
iv.
v.
vi.
vii.
Discharge from the penis and female urethra. May be blood tinged, yellowish or greenish
Tender and swollen penis
Urethral itching with voiding
Orchalgia. Pain in the testicles
Tender and enlarged lymph nodes in the groin area
Tender and swollen lower abdomen in females
Tenderness of the urethra in females
viii.
Dysuria in men. Usually worse with the first morning void
Assessment and diagnostic tools
A comprehensive history taking including social and sexual history. A physical examination is
usually performed, with more attention on the abdomen, bladder area, penis and scrotum. Inspect
for skin lesions, underwear for secretions and evidence of mass or inflammation on testes.
Palpate for tenderness
Women will have an abdominal and pelvic examination
Tests including complete blood count. C- reactive protein test, pelvic ultrasound in women,
pregnancy test urinalysis and urine culture maybe done.
In addition to these gonorrhea, chlamydia and other STIs may be tested for.
Management
The goal of treatment is to eliminate cause of infection and prevent the spread of infection.
Antibiotic therapy is key in treatment of urethritis including:
i.
ii.
iii.
iv.
v.
Azithromycin,
Ceftriaxone
Gentamicin,
Cefixime
Doxycycline.
Offer patient education about the condition including:
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



Refraining from sexual intercourse for one week after starting antibiotic therapy and
until all sexual partners are rerated,
Avoid urethral irritants such as perfumed soaps and lotions,
Limit number of sexual partners and always use barrier devices when engaging in
sexual intercourse, infections can spread through oral, vaginal and anal intercourse.
Instruct patient to avoid high risk behaviors predisposing to the disease including
intercourse at a young age, drug use and unprotected sex
Maintaining proper personal hygiene
If not treated promptly can result in bladder infection, epididymitis and infection to the testicles
and prostate glands, cervicitis in females and pelvic inflammatory disease