Urethritis

Urethritis

Urethritis is inflammation of the urethra. The most common causative agent is Chlamydia trachomatis. Frequency. Worldwide, 250 million cases are registered annually. Classification

• • infectious
  • Nonspecific (bacterial, viral, caused by mycoplasmas, caused by chlamydia, mycotic)
  • Specific (gonorrheal, trichomonas)
  • Non-infectious
  • Traumatic – urethritis is caused by the introduction of foreign bodies into the urethra, most often masturbation
  • allergic
  • 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
  • Spicy
  • Torpid
  • Chronic
  • By localization
  • Front
  • Total. Risk factors
  • Large number of sexual partners
  • Having a history of sexually transmitted diseases
  • Urolithiasis disease
  • Diabetes
  • Instrumental examination of the urethra and bladder
  • Bladder catheterization.

Clinical picture

• • 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.

Research methods

• • 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.

Treatment:

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).

General recommendations

• • 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.

Drug therapy

• • 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.
  • Immunotherapy
  • Methyluracil 0.5 g 3 times a day for 2 weeks
  • Autohemotherapy.

Surgery

• • With the development of strictures of the urethra – bougienage, internal or external urethrotomy
  • With the development of prostate abscesses – opening of the abscess.

Complications

• • Inguinal lymphadenitis
  • Epididymitis
  • Cuperite
  • 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.

See also Bacterial vulvovaginitis, Vulvovaginitis candida, Pelvic inflammatory disease, Gonococcal infection, Prostatitis, Urogenital chlamydia, Epididymitis

ICD

• • A50-A64 Predominantly sexually transmitted infections
  • N34 Urethritis and urethral syndrome