Medical University of PlovdivMedical University of Plovdiv
Urology departmentUrology department
ssupervisionupervision :: Dr. A.IvanovDr. A.Ivanov
By : Medical studentBy : Medical student
Qais qassarQais qassar
• Inflammation of the urethra . Discharge +/- dysuria or may
• Urethritis usually resolves without complication, even if
untreated, yet it can result in urethral stricture, stenosis,
or abscess formation in rare cases.
• Recurrent urethritis may occur from reinfection,
therapeutic failure or "venereophobia"
• Urethritis is predominantly a disease of adolescent and
adult men. The prevalence is greatest in men younger
than 25 years.
• Urethritis is an inflammatory condition that can be infectious or posttraumatic
in nature. Infectious causes of urethritis are typically sexually transmitted and
categorized as either gonococcal urethritis (ie, due to infections with
Neisseria gonorrhoeae) or NGU (ie, due to infections with Chlamydia
trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, Mycoplasma
genitalium, or Trichomonas vaginalis).
• Rare infectious causes of urethritis include lymphogranuloma venereum,
herpes simplex virus types 1 and 2, adenovirus, syphilis, mycobacterial
infection, and bacterial infections that are typically associated with cystitis
(usually gram-negative rods) in the presence of urethral stricture. Other rare
but reported causes of urethritis include viral, streptococcal, anaerobic, and
• Posttraumatic urethritis can occur in 2%-20% of patients practicing
intermittent catheterization and following instrumentation or foreign body
insertion. Urethritis is 10 times more likely to occur with latex catheters than
with silicone catheters.
• Urethritis may be associated with other infectious syndromes, such as the following:
• Reactive arthritis
• Otitis media
• Urinary tract infection
• Burning on urination
• Frequent urination with only small amounts
of urine passed on each occasion
• Anal or oral infections
• Urgent need to urinate
• Bloody discharge from the penis
• Blood in the urine
• Yellowish discharge from the urethra
• Itching or irritation around the opening of
• Lower abdominal pain
• Painful sexual intercourse in women
Most patients with urethritis do not appear ill and do not present with signs of sepsis. The
primary focus of the examination is on the genitalia.
•Examination patients with urethritis includes the following:
•Inspect the underwear for secretions
•Penis: Examine for skin lesions that may indicate other STDs (eg, condyloma acuminatum,
herpes simplex, syphilis); in uncircumcised men, retract the foreskin to assess for lesions and
•Urethra: Examine lumen of the distal urethral meatus for lesions, stricture, or obvious urethral
discharge; palpate along urethra for areas of fluctuance, tenderness, or warmth suggestive of
abscess or for firmness suggesting foreign body
•Testes: Examine for evidence of mass or inflammation; palpate the spermatic cord, looking for
swelling, tenderness, or warmth suggestive of orchitis or epididymitis
•Lymphatics: Check for inguinal adenopathy
•Prostate: Palpate for tenderness or bogginess suggestive of prostatitis
•Rectal: During the digital rectal examination, note any perianal lesions
• Urethritis can be diagnosed based on the presence of one or more of the following:
• A mucopurulent or purulent urethral discharge
• Urethral smear that demonstrates at least 5 leukocytes per oil immersion field on microscopy
• First-voided urine specimen that demonstrates leukocyte esterase on dipstick test or at least 10 WBCs/hpf
• All patients with urethritis should be tested for Neisseria gonorrhoeae and C trachomatis. Laboratory
studies may include the following:
• Gram stain
• Endourethral and/or endocervical culture for N gonorrhoeae and C trachomatis
• Urinalysis: Not useful test in urethritis, except to help exclude cystitis or pyelonephritis
• Nucleic acid–based tests: For C trachomatis and N gonorrhoeae (urine specimens) and other Chlamydia
species (endourethral samples)
• Nucleic acid amplification tests (eg, PCR for N gonorrhoeae, Chlamydia species)
• KOH preparation: to evaluate for fungal organisms
• Wet mount preparation: To detect the movement/presence of Trichomonas
• STD testing for syphilis serology (VDRL) and HIV serology
• Nasopharyngeal and/or rectal swabs: For gonorrhea screening in men who have sex with men
• Pregnancy testing: In women who have had unprotected intercourse
• Imaging studies, specifically retrograde urethrography, are unnecessary in patients with
urethritis, except in cases of trauma or possible foreign body insertion.
• Procedures :
• Patients with urethritis may undergo the following procedures:
• Catherization: In cases of urethral trauma; to avoid urinary retention and tamponade urethral
• Cystoscopy: In cases when catherization is not possible, for placement of a catheter; to
remove foreign body or stone in the urethra
• Dilation of urethral strictures with filiforms and followers
• Placement of suprapubic tube: In severe cases of urethral trauma that prevent placement of
urethral catheters or in the absence of adequate facilities for emergent cystoscopy;
temporizing measure to divert urine and relieve patient discomfort
• Symptoms of urethritis spontaneously resolve over time, regardless of treatment. Administer
antibiotics that cover both GU and NGU. Regardless of symptoms, administer antibiotics to
the following individuals:
• Patients with positive Gram stain or culture results :
• All sexual partners of the above patients
• Patients with negative Gram stain results and a history consistent with urethritis who are not
likely to return for follow-up and/or are likely to continue transmitting infection
• Antibiotics used in the treatment of urethritis include the following:
• Complications, such as stricture, stenosis, or abscess formation, are quite rare. Concomitant
epididymitis or prostatitis is not uncommon.
• PID and tubo-ovarian abscess are known complications of urethritis in females that may
predispose to infertility. In addition, increasing evidence shows that genital chlamydial
infection in males may predispose to infertility. In addition, both Chlamydia and U urealyticum
can impair sperm and adversely affect semen parameters.
• All patients with uncomplicated urethritis spontaneously recover with or without treatment.
• Prevention: Educate at-risk patients on how to prevent disease recurrence.
• Educate patients on risks of other sexually-transmitted infections, including HIV.
• Try to find asymptomatic patients and symptomatic patients who are unlikely to seek
• Early diagnosis and treatment of infected individuals is essential.
• Evaluate and treat sexual partners of known infected persons.