Urethritis

Classically presents as acute urethral discharge following unprotected sex.

The 2 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, Bolan GA; Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015 Jun 5;64(RR-03):1-137. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6403a1.htm http://www.ncbi.nlm.nih.gov/pubmed/26042815?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, Mycoplasma genitalium, and Ureaplasma urealyticum. The term postgonococcal urethritis refers to the occurrence of NGU after curative treatment for gonococcal urethritis.[2]Martin DH, Bowie WR. Urethritis in males. In: Holmes KK, Sparling PF, Mardh P, et al., eds. Sexually transmitted diseases. 3rd ed. New York, NY: McGraw-Hill; 1999:833-45.[3]McCormack WM, Rein MF. Urethritis. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and practice of infectious diseases. 6th ed. Pennsylvania: Churchill Livingstone; 2005:1347-57. 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].[Figure caption and citation for the preceding image starts]: Gram stain of urethral exudate showing gram-negative diplococci and polymorphonuclear leukocytesAdapted from Public Health Image Library, CDC; Jacobs N, 1974 [Citation ends].