Urethritis

The disease is classified as either gonococcal urethritis, caused by Neisseria gonorrhoeae, or non-gonococcal urethritis (NGU), most commonly caused by Chlamydia trachomatis. NGU, sometimes called nonspecific urethritis (NSU), has both infectious and noninfectious causes. Urethritis is part of triad of reactive arthritis.

Other causes include:[1][2]

• Adenoviridae
• Uropathogenic Escherichia coli (UPEC)
• Herpes simplex
• Cytomegalovirus
• Mycoplasma genitalium[3]
• Reactive arthritis
• Trichomonas vaginalis[4]
• Ureaplasma urealyticum
• Methicillin-resistant Staphylococcus aureus[5]
• Group B streptococcus[6]

In female patients, urethritis can be caused by pelvic inflammatory disease.[7] In males, the penis and testicles may show signs of pain and swelling. The urethra is visually examined by spreading the urinary meatus apart with two gloved fingers, and examining the opening for redness, discharge and other abnormalities. Next, a cotton swab is inserted 1–4 cm into the urethra and rotated once. To prevent contamination, no lubricant is used, and so the dry swab may cause some pain or discomfort. The swab is then smeared onto a glass slide and examined under a microscope. A commonly used cut-off for the diagnosis of urethritis is 5 or more granulocytes per high-power field, but this definition has recently been called into doubt.[8] The physician sometimes performs a digital rectal examination to inspect the prostate gland for swelling or infection.

A urinary tract infection may cause similar symptoms.

Factors that increase the likelihood of developing urethritis include sexual intercourse (particularly unprotected intercourse), inserting objects into or otherwise mishandling the urethra manually , and coming into genital contact with various chemicals, such as lotions, spermicides and certain other contraceptives. Even clothing washed in strong detergent can be an irritant.

Chlorhexidine has a wide spectrum of anti-bacterial activity encompassing gram positive and negative bacteria. Rinsing with 15 ml of a 0.12% or 10 ml of 0.2% chlorhexidine solution for 30 seconds produced large and prolonged reductions in salivary bacterial counts within 7-h of its use. Hence, it would seem logical to postulate that rinsing with chlorhexidine before oral sex will be effective for prevention of urethritis caused by retrograde entry of bacteria from the oral cavity into the urethra during unprotected insertive oral intercourse.[9]

A variety of drugs may be prescribed based on the cause of the patient's urethritis. Some examples of medications based on causes include:[2] azithromycin, doxycycline, erythromycin, levofloxacin, metronidazole, ofloxacin, or tinidazole.

Proper perineal hygiene should be stressed. This includes avoiding use of vaginal deodorant sprays and proper wiping after urination and bowel movements. Intercourse should be avoided until symptoms subside.