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SEXUALLY TRANSMITTED DISEASES: URETHRITIS

Urethritis is an inflammation of the urethra characterized by mucopurulent or purulent urethral discharge, dysuria, or urethral pruritis. It is usually caused by infection, and patients are asymptomatic in about 50% of cases. The organisms causing urethritis in men typically cause cervicitis in women. However, over 20% of infected women may have urethral infection only.

Urethritis is usually caused by sexually transmitted organisms. Gonococcal urethritis is caused by N. gonorrhoeae, which is isolated in 20% of men with urethritis. In contrast, nongonococcal urethritis may be caused by C. trachomatis, U. urealyticum, Mycoplasma genitalium, M. hominis, Trichomonas vaginalis, and herpes simplex virus. C. trachomatis is isolated in 30% to 50% of nongonococcal urethritis cases.

 

Clinical Findings

Patients with urethritis may complain of a mucopurulent or purulent urethral discharge, dysuria, or urethral pruritis. Male patients with urethritis may present with prostatitis symptoms such as weak urinary stream, perineal pain, and ejaculatory pain. A sexual history of recent contacts is also important. Nongonococcal urethritis tends to have a more insidious onset and milder symptoms. In cases of gonococcal infection, 3% of patients will develop generalized symptoms such as fever, rash, and polyarthritis.

Men with symptoms of urethritis should have a thorough genital examination. The penis should be assessed for lesions suggestive of warts or herpes. Erythema of the distal urethra may be noted. If there is no spontaneous urethral discharge, the glans penis should be gently squeezed to express fluid. Any fluid should be collected for microscopic examination. Inguinal lymphadenopathy may be present. If there are symptoms suggestive of prostate involvement, a rectal examination should be performed. This is important because prostate involvement may necessitate prolonged antibiotic therapy.

Fever, a pustular or papular rash, and tenosynovitis are signs of gonococcemia. Reiter's syndrome is an autoimmune response that is often seen in cases of urethritis, especially with C. trachomatis infection. Reiter's syndrome manifests as synovitis, non-articular bone pain (especially the heel), iritis, conjunctivitis, and ulcerations of the oral or genital mucosae.

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