Urethritis

Urethritis classically presents as acute urethral discharge following unprotected sex.

The two most important etiologic agents are Neisseria gonorrhoeae and Chlamydia trachomatis.

Increased risk is associated with new sex partner, multiple sex partners, or age under 25 years. Disease may be transmitted to infants from infected mothers, resulting in conjunctivitis, iritis, otitis media, or pneumonia.

Higher morbidity in untreated women (10% to 40%) than in men (1% to 2%).

Untreated gonococcal urethritis may disseminate, causing arthritis, meningitis, and endocarditis. Untreated nongonococcal urethritis may present with complications such as reactive arthritis or infertility.

Urethritis is usually a sexually transmitted disease that typically presents with dysuria, urethral discharge, and/or pruritus at the end of the urethra. Urethral discharge is the classic physical finding. If the urinalysis is positive for leukocyte esterase, the Gram stain of the discharge (≥2 white blood cells per oil immersion field) or sediment of the first-voided urine (≥10 white blood cells per high power field) reveals abnormal numbers of polymorphonuclear leukocytes, the diagnosis of urethritis is confirmed.[1]Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187. https://www.doi.org/10.15585/mmwr.rr7004a1 http://www.ncbi.nlm.nih.gov/pubmed/34292926?tool=bestpractice.com Urethritis is divided into 2 main categories: gonococcal, if Neisseria gonorrhoeae is isolated; nongonococcal (NGU), if N gonorrhoeae is not isolated. The most common causes of NGU include Chlamydia trachomatis and Mycoplasma genitalium. Urethritis may also result from trauma but this topic focuses on infectious causes.[Figure caption and citation for the preceding image starts]: Gonorrhea with penile meatal dischargeCDC Image Library; Susan Lindsley [Citation ends].