URETHRITIS
Urethritis is inflammation of the urethra. It is usually due to an ascending infection in men. In women, it is usually associated with cystitis or vaginitis.
Types
1. Nongonococcal urethritis- Others-Bacterial urethritis,
2. Gonococcal urethritis- Post gonococcal.
Causes and Pathophysiology
1. Nongonococcal urethritis - A large number of cases are sexually transmitted by:
a. Chlamydia trachomatis [accounts for 23%-55% of cases]
b. Ureaplasma urealyticum and Mycoplasma genitalium [responsible for up to 1/3rd of cases]
c. Trichomonas vaginalis, and herpes simplex virus Jare other sexually transmitted organism causing urethritis in both men & women]
d. Incubation period 1-5 weeks depending on the organism; in some cases, infection may be sub-clinical for a period of time, particularly in men.
2.gonococcal urethritis caused by Neisseria gonorrhoeae, sexually transmitted [usually more virulent and destructive]
a. Incubation period usually 3-10 days.
b. Urethritis in homosexual men nongonococcal.] is more often gonococcal than
3. Gonococcal and nongonococcal urethritis can both be present
4. Non-sexually transmitted.
a. Bacterial urethritis - may be associated with UTI.
b. From trauma – Secondary to passage of urethral Ultrasound, repeated cystoscopy, indwelling catheter.
5. Post gonococcal urethritis occurs after treatment of gonococcal urethritis; another pathogen which was not treated proliferates.
Clinical Manifestations
1. Often asymptomatic.
2. Itching and burning around area of urethra.
3. Urethral discharge; may be scant or profuse; thin clear or mucoid or thick and purulent (gonococcal)
4. Dysuria and frequency.
5. Penile discomfort.
Diagnostic Evaluation
1. Gravis stain - [N. Gonorrhoeae is detected as gram +ve diplococci on microscopic examination of urethral discharge or urine)
2. Culture of urethral discharge (on selective medium]
3. Fluorescent Ab stain of urethral discharge to detect C. trachomatis and N.gonorrhoeae.
4. Wet mount microscopic examination of fresh urethral discharge - [trichomonads may be visible and motile.]
5. First voided urine for screening either +ve leukocyte esterase test by dipstick or >10WBC per high power field by microscopy indicates urethritis.
6. In rare cases, urethroscopy may be necessary to isolate a lesion such as warts caused by human papillomavirus (HPV).
Medical Management
1. Anti microbial therapy- tetracyclines, quinolones or erythromycin (class) antibiotics - effective for [most cases of] nongonococcal urethritis; Metronidazole (flagyl) is used for Trichomonas.
2. cephalosporins and a quinolones may be used to treat gonococcal urethritis.
Complications
[Depends on cause but may include:]
1. Prostatitis, epididymitis, urethral stricture, sterility [due to Vaso epididymal duet obstruction.]
2. Rectal infection pharyngitis, conjunctivitis, skin lesions, arthritis with gonococcal infection.
3. Long-term complications of these infections in women include pelvic inflammatory disease and infertility.
Nursing Management
1. Collect urethral swab of discharge, urine and blood as ordered for laboratory examination.
2. Use universal precautions when handling specimens.
3. Administer antibiotics as prescribed. [Monitor for and advise patient of S/E or allergic reactions].
4. Advise abstinence from sexual activity until treatment is complete and pure is established (usually 7-10 days).
5. Instruct the patient to avoid sexual activity with previous sexual partner until that person(s) has been tested and treated as well.
6. The use of condoms may prevent transmission but depends on technique.
