This document discusses urethritis in women, which is characterized by urethral inflammation that can result from infectious or non-infectious causes. Common symptoms include dysuria, urethral pruritus, and mucopurulent discharge. Infectious causes include Chlamydia, gonorrhea, Mycoplasma genitalium, and other STDs. Treatment depends on the suspected cause but may include azithromycin, doxycycline, or ceftriaxone. Non-infectious causes can be irritants, injury, or structural abnormalities like urethral diverticula. Diagnosis involves urine testing and cultures, and sometimes imaging like MRI.

1. Urethritis in women
Gloria Monsalve M.D.

2. Urethritis, as characterized by
urethral inflammation, can result from
infectious and noninfectious
conditions.
● Dysuria.
● Urethral pruritus.
● Mucoid, mucopurulent, or
purulent discharge.

3. Cystitis vs Urethritis
Send UA, Urine culture
Sterile Pyuria
High Suspicion for chlamydial
infection of the urethra.
Or other STDs

4. Etiology
Can result from infectious and noninfectious conditions.
Several organisms can cause infectious urethritis.
These include the human papillomavirus (HPV), the herpes simplex virus (HSV), and the cytomegalovirus
(CMV).
They are gonococcal urethritis and nongonococcal urethritis.

5. --Chlamydia infection, has long been thought to be responsible for many cases of dysuria in women with
negative urine cultures.
-- N. gonorrhoeae and Mycoplasma genitalium are well established as clinically important infectious
causes of urethritis.
--Enteric bacteria have been identified as an uncommon cause, and might be associated with insertive
anal intercourse
Horner PJ, Hay PE, Thomas BJ, Renton AM, Taylor-Robinson D, Hay PE. The role of Chlamydia trachomatis in urethritis and urethral
symptoms in women. Int J STD AIDS. 1995;6(1):31–4[Published erratum appears in Int J STD AIDS 1995;6(2):148]

6. Diagnostic Considerations
- Gram-negative intracellular diplococci on
urethral smear is indicative of gonorrhea
infection.
- M. genitalium, which can be sexually
transmitted, (15%–25% of NGU).
However, FDA-cleared diagnostic tests
for M. genitalium are not available.
- Pt with Urethritis should be tested for
chlamydia and gonorrhea even if point-
of-care tests are negative for evidence of
GC.

7. Chlamydia trachomatis
Frequently asymptomatic in females, but can present with dysuria, discharge or pelvic inflammatory
disease.
Chlamydia screening is recommended for all females ≤ 25 years
Treatment:
Azithromycin – 1 g po x 1
Doxycycline – 100 mg po BID x 7 days

8. As dual therapy, ceftriaxone and azithromycin should be administered together on
the same day.
● Ceftriaxone 250 mg IM in a single dose
If ceftriaxone is not available:
● Cefixime 400 mg orally in a single dose

9. Nongonococcal Urethritis
● M. genitalium can be found in the vagina, cervix, and endometrium and, like chlamydial and
gonococcal infections.
● Commonly asymptomatic.
● M. genitalium can be detected in 10%–30% , is more common among women with cervicitis than
those without this syndrome.
Doxycycline regimen recommended for treatment of urethritis is largely ineffective against M. genitalium.
1-g single dose of azithromycin was significantly more effective against M. genitalium than doxycycline

10. Non-infectious irritants, such as a contraceptive gel.
Injury, such as from a catheter, or other kinds of genital trauma.
Structural urethral abnormalities –Urethral diverticula or strictures.

11. Urethral diverticulum
A urethral diverticulum is a localized outpouching of the urethral mucosa into the surrounding non-urothelial
tissues.
Prevalence: 1 to 5 percent of women.
●Postvoid dribbling (4 to 31 percent)
●Dysuria (9 to 55 percent)
●Dyspareunia (6 to 24 percent)
MRI as the first line imaging study for patients with a suburethral mass and symptoms consistent with a
urethral diverticulum.

12. References
2015 Sexually Transmitted Diseases Treatment Guidelines