Urethritis
Introduction: The urethra in the male is part
of the ejaculatory
tract. Along the urethra has so-called periurethral glands, which
are microscopically small, but are all around the urethra that spans from the
level of the bladder to the exit of the urethra. These glands can get infected
with a variety of bacteria and viruses, most of which are transmitted sexually
from person to person. Common pathogens are: Chlamydia trachomatis, Neisseria
gonorrhea and herpes simplex (Ref. 3, p. 1326). Signs and symptoms: In
women the opening of the urethra is in close proximity to the vaginal entrance
and inflammatory conditions of the vagina can spill over into the lower end of
the urethra. A woman with a vaginitis from Candida albicans or from Trichomonas
vaginalis can experience painful voiding (called"dysuria" in medical
terms), which is one of the main symptoms of urethritis. However, associated
with these conditions, there is also a discharge from the vagina with a bad odor
and painful sex ("dyspareunia"). Sexually transmitted urethritis is
usually slower in onset and milder in terms of symptoms. When it produces dysuria,
there usually are no vaginal symptoms associated with it. Contrary to a UTI there
is usually no blood in the urine. When the urethritis is more established, there
is a pussy discharge, dysuria and more frequent voiding. In men the first sign
of urethritis might be a discharge from the opening of the urethra at the tip
of the penis. This is pussy when it is due to Neisseria gonorrhea, the cause of
gonorrhea. If it is due to "non specific urethritis" (meaning it is
not due to gonorrhea), it would be a whitish mucous discharge and would mostly
reveal Chlamydia trachomatis or else Ureaplasma urealyticum or Mycoplasma genitalium
in lab tests (Ref. 3, p.1326). Diagnostic tests:
In the past the only bacterium that could be cultured was Neisseria gonorrhea,
the cause of gonorrhea. However, in the last decade newer tests have become commercially
available allowing to actually diagnose many of the "non specific" or
nongonococcal urethritis cases. More than 50 % of these nowadays are due to Chlamydia
trachomatis. The likely reason is the long incubation time of 1 to 4 weeks before
persons know that "something is not right" and they see their physician.
By that time other partners may have been infected, which makes it difficult from
an epidemiological point of view to get a handle on the situation. The
physician can take a swab of the urethral entrance in the male, in the female
two swabs are often taken, one from the urethral opening and one from the opening
of the cervical canal as Chlamydia trachomatis likes to multiply in that mucous
environment. At the present time it is impractical to culture Ureaplasma urealyticum
or Mycoplasma genitalium. With herpes simplex virus infection there are
usually several other very painful small skin ulcerations around the genitalia,
also in the skin of the labia in women and the skin of the penis in men. A lab
test can be sent away and this will identify the virus usually as herpes simplex
virus, type 2 (or HSV-2). Treatment: It is important
to determine what the reason for the infection was. This is closely linked to
the diagnosis of the underlying pathogen that caused the condition. As mentioned
above, in most cases the cause is a sexually transmitted urethritis. Therapy in
these cases must be given to the patient and the sexual partner as well to interrupt
the infectious chain. In case there were multiple partners involved, these should
all be treated, although this is often impossible to do in practice (Ref. 4).
The following table has been compiled from data based on Ref. 3 and 4.
| Therapy
of urethritis caused by : | | Pathogen
isolated: | Therapeutic
agent of choice: | | Neisseria
gonorrhea | cefixime 400 mg or ciprofloxacin
500 mg orally (both single dose only) |
| Chlamydia trachomatis | doxycycline
100 mg twice daily for 7 days or azithromycin 1 Gm orally (single dose) |
| Ureaplasma urealyticum
| same treatment as for Chlamydia
trachomatis | | Mycoplasma
genitalium | same treatment as
for Chlamydia trachomatis | | herpes
simplex, type 2 (HSV-2) | acyclovir 400 mg
three times daily for 10 days; or: famciclovir 250 mg three times daily for 5
days; or: valacyclovir 1Gm twice daily for 10 days (all orally) |
| Candida albicans | fluconazole
200 mg once daily for 5 to 7 days | | Trichomonas
vaginalis | metronidazole 2 Gm orally as single
dose cures 95% of women, in men 500 mg twice per day orally for 7 days |
Another fact is that sexually transmitted urethritis, like
any other form of venereal disease, often involves more than one pathogen: two
common combinations are Neisseria gonorrhea and Chlamydia trachomatis as well
as Neisseria gonorrhea and Trichomonas vaginalis. This, apart from resistant pathogens,
is often the reason for treatment failures. However, with repeat cultures and
tests the physician can work this out to the benefit of the patient. |
