Urethritis Flashcards
what is the definition of urethritis?
Urethritis is usually a sexually transmitted disease that typically presents with dysuria, urethral discharge, and/or pruritus at the end of the urethra.
what is the epidemiology of urethritis?
More commonly NGU then GU (chlamydia vs gonorrhoea)
what is the aetiology of urethritis?
Causative organism of GU: N gonorrhoeae. Common causes of NGU: C trachomatis (15% to 50%) Mycoplasma genitalium (6% to 20%) Rare causes of NGU: Trichomonas vaginalis Yeasts Herpes simplex virus Adenovirus Other bacteria such as streptococci, mycobacteria, or anaerobes.
what are the risk factors for urethritis?
Ages 15 to 24 Female Men who have sex with men Low socio-economic status New or multiple sex partners Prior STD Inconsistent condom use
what is the pathophysiology of urethritis?
Neisseria gonorrhoeae can elude the immune system by changing the outer membrane antigens through genomic plasticity related to DNA mutation or recombination with related species.
Chlamydia trachomatis preferentially infects mucosal surfaces and epithelial cells. Because C trachomatis cannot synthesise adenosine triphosphate, it is an obligate intracellular pathogen. Infection leads to an acute inflammatory reaction with lymphocytic infiltration of the mucosa and submucosa. More severe disease results primarily from the immunopathological response.
what are the key presentations of urethritis?
Presence of risk factors
Urethral discharge
Urethral irritation or itching
Dysuria
what are the signs of urethritis?
Presence of risk factors
what are the symptoms of urethritis?
Urethral discharge Urethral irritation or itching Dysuria Orchialgia Epididymal tenderness or swelling Pelvic pain
what are the first line and gold standard investigations for urethritis?
Gram stain of urethral discharge and or urine sediment - ≥2 polymorphonuclear leukocytes per high power field plus documented urethral discharge diagnostic for urethritis; presence of gram-negative diplococci diagnostic for gonorrhoeal infection
NAAT - may diagnose Neisseria gonorrhoeae, Chlamydia trachomatis, or M genitalium
Culture of urethral discharge - chocolate agar positive for Neisseria gonorrhoeae; inoculate cell monolayers such as McCoy or Buffalo green monkey kidney for C trachomatis
Potassium hydroxide prep of urethral discharge - may detect fungal hyphae
HIV test - rule out
Venereal disease research lab - rule out syphilis
what are the differential diagnoses for urethritis?
UTI
Candida balanitis
Non-infectious urethritis
Nephrolithiasis
how is urethritis managed?
Gonorrhoea (not pregnant): Cephalosporin monotherapy (ceftriaxone) or gentamicin plus azithromycin, doxycycline adjunct Gonorrhoea (pregnancy): Cephalosporin monotherapy (ceftriaxone), azithromycin Not gonorrhoea (not pregnant): Doxycycline or azithromycin Not gonorrhoea (pregnant): Azithromycin or amoxicillin
how is urethritis monitored?
The US Centres for Disease Control and Prevention (CDC) recommends that a test of cure is not needed for people who receive a diagnosis of uncomplicated urogenital gonorrhoea who are treated with any of the recommended or alternative regimens. Men who are given a specific diagnosis of chlamydia, gonorrhoea, or trichomonas should be re-tested 3 months after treatment, as rates of re-infection are reported to be high, regardless of whether their sex partners were treated. Pregnant women should be re-tested to ensure cure, preferably with a nucleic acid amplification test (NAAT) such as ligase chain reaction or polymerase chain reaction of urethral discharge and/or urine sediment. Chlamydia test of cure is recommended 4 weeks after treatment, with a re-test at 3 months. Re-test for gonorrhoea is recommended at 3 months
what are the complications of urethritis?
Chronic NGU
Genitourinary abscess
Urethral stricture or fistula
what is the prognosis of urethritis?
Symptoms of urethritis should resolve within 3 days of antibiotic treatment. Recurrence is usually owing to reinfection or treatment failure.
