Urethritis is inflammation of the urethra. The most common causative agent is Chlamydia trachomatis. Frequency. Worldwide, 250 million cases are registered annually. Classification
- Nonspecific (bacterial, viral, caused by mycoplasmas, caused by chlamydia, mycotic)
- Specific (gonorrheal, trichomonas)
- Traumatic – urethritis is caused by the introduction of foreign bodies into the urethra, most often masturbation
- Caused by the presence of diseases of the urethra – strictures, cancer, etc.
- Metabolic – phosphaturia, oxaluria, uraturia
- Congestive – due to venous stagnation of blood in the mucous membrane of the urethra. Occur with frequent sexual intercourse, onanism, chronic constipation, hemorrhoids, etc.
- With the flow
- By localization
- Total. Risk factors
- Large number of sexual partners
- Having a history of sexually transmitted diseases
- Urolithiasis disease
- Instrumental examination of the urethra and bladder
- Bladder catheterization.
- Acute urethritis – severe subjective disorders: burning and pain during urination, copious discharge from the urethra, sponges of the urethra are bright red, swollen
- Torpid urethritis – subjective disorders are mild, may be absent: paresthesia, itching in the urethra, scanty discharge
- Chronic urethritis – with a duration of torpid urethritis for more than 2 months. The clinical picture is similar to that of torpid urethritis.
- Anterior urethritis – inflammation of the anterior urethra (up to the membranous section)
- Total urethritis is inflammation of the entire urethra. Dysuric disorders characteristic of prostatitis are added.
- Microscopy of discharge from the urethra. In the absence of discharge – scraping. The presence of more than 5 leukocytes in the field of view indicates the presence of urethritis
- Sowing discharge or scraping on nutrient media to determine the pathogen and its sensitivity to antibiotic therapy
- If chlamydial urethritis is suspected, serodiagnosis is performed
- Urethroscopy (contraindicated in acute urethritis): soft and hard infiltrates, morganitis, littreitis
- Two glass sample
- With anterior urethritis, the first portion is cloudy, the second is transparent
- With total – cloudy urine in both portions
- Urethrography is necessary for cicatricial strictures of the urethra.
Tactics of conducting
- Identification and treatment of sexual partners at the same time
- After the end of the treatment of venereal urethritis, patients are observed and control laboratory tests are carried out (in men for 1-2 months, in women – 3 months).
- Physical activity: in the acute period: bed rest, then without restrictions, with the exception of abstinence from sexual activity until the end of treatment
- Diet: spicy, salty foods, beer and other foods that contribute to venous congestion in the mucous membrane of the urethra are contraindicated.
- Antibacterial therapy
- For gonorrheal urethritis, the products of choice are a combination of ceftriaxone 250 mg once a day i.v. day for 7 days).
- For urethritis caused by Chlamydia trachomatis or Ureaplasma urealiticum, doxycycline hydrochloride 100 mg orally 2 r / day or tetracycline 500 mg orally every 6 hours for at least 7 days, and in case of relapses or complications within 21-28 days. Pregnant women are prescribed erythromycin 500 mg orally 4 times a day for 7 days.
- With trichomonas urethritis – metronidazole 250 mg orally 2-3 r / day for 7-10 days.
- With viral urethritis, patients and their sexual partners – tetracycline or erythromycin.
- With mycotic urethritis – ketoconazole 200 mg orally 2 r / day for 6 days.
- Local treatment – indicated for chronic urethritis
- Women – vaginal suppositories with antibacterial products
- For men – instillations into the urethra with 2% solution of protargol.
- Methyluracil 0.5 g 3 times a day for 2 weeks
- With the development of strictures of the urethra – bougienage, internal or external urethrotomy
- With the development of prostate abscesses – opening of the abscess.
- Inguinal lymphadenitis
- Prostatitis, sometimes prostate abscess
- Cicatricial narrowing of the vas deferens leading to infertility
- Cicatricial narrowing of the urethra (traditionally the bulbous part)
- With chlamydial urethra likely development of Reiter’s syndrome
- Women have pelvic inflammatory disease.
- A50-A64 Predominantly sexually transmitted infections
- N34 Urethritis and urethral syndrome