小结
定义
尿道炎通常是一种性传播疾病，其典型表现包括排尿困难、尿道分泌物和/或尿道末端瘙痒。尿道分泌物是典型的体格检查发现。如果尿液分析显示白细胞酯酶呈阳性，分泌物革兰染色（发现每个油浸视野中白细胞 ≥2 个）或首次尿的尿沉渣检查结果（每高倍视野中白细胞 ≥10 个）显示多形核白细胞数量异常，则可确诊为尿道炎。[1] 尿道炎分为两大类：如果分离出淋病奈瑟菌，则为淋菌性尿道炎；如果未分离出淋病奈瑟菌，则为非淋菌性尿道炎（non-gonococcal urethritis, NGU）。NGU 的最常见病因为沙眼衣原体和生殖支原体。尿道炎也可由外伤导致，但本专题重点讨论感染性病因。[Figure caption and citation for the preceding image starts]: 伴有宫颈炎和阴道分泌物的淋病CDC 图像库/Susan Lindsley [Citation ends].
病史和体格检查
关键诊断因素
- 存在的危险因素
- 尿道分泌物
- 尿道刺激症状或瘙痒
- 排尿困难
其他诊断因素
- 睾丸痛
- 无附睾触痛和/或肿胀
- 无盆腔疼痛（女性）。
- 无脓疱疹或瘀点样皮疹
- 无关节炎
- 无眼部炎症
危险因素
- 15-24 岁
- 女性
- 男男性行为者
- 新的或多个性伴侣
- 既往或目前患有性传播疾病
- 避孕套使用行为模式不一致
- 包皮环切
诊断性检查
首要检查
- 尿道分泌物和/或尿沉渣革兰氏染色
- 核酸扩增试验 (NAAT)
- 尿道分泌物培养
- 尿道分泌物的氢氧化钾涂片检查
- HIV 检查
- 梅毒检测
需考虑的检查
- 尿液分析和培养
- 尿道分泌物湿片镜检（女性）
- 针对阴道毛滴虫的尿液或尿道/阴道拭子 NAAT 检测和培养
- 针对其他病原体的 NAAT
治疗流程
初期革兰氏染色提示淋病；非妊娠期女性
初期革兰氏染色提示淋病：妊娠期女性
初期革兰氏染色不提示淋病：非妊娠期女性
初期革兰氏染色未提示淋病：妊娠期女性
复发性或顽固性尿道炎
撰稿人
作者
Sheldon Morris, MD, MPH
Assistant Professor
Division of Infectious Diseases
Department of Medicine
UCSD Antiviral Research Center
Division of Family Medicine
Department of Family and Preventive Medicine
UCSD La Jolla Family and Sports Medicine
San Diego
CA
利益声明
SM has completed a National Institutes of Health contract for research study on the Visby Medical Sexual Health Test. SM is an author of a number of references cited in this topic.
鸣谢
Dr Sheldon Morris would like to gratefully acknowledge Dr Christina Bailey, a previous contributor to this topic.
利益声明
CB declares that she has no competing interests.
同行评议者
Vani Dandolu, MD, MPH
Associate Professor
Ob/Gyn and Urology
Director
Division of Urogynecology
Associate Residency Program Director
Temple University Hospital
Philadelphia
PA
利益声明
VD declares that he has no competing interests.
Khalil Ghanem, MD, PhD
Assistant Professor of Medicine
Associate Fellowship Program Director
Division of Infectious Diseases
Johns Hopkins University School of Medicine
Baltimore
MD
利益声明
KG declares that he has no competing interests.
Christopher Fairley, PhD
Professor of Sexual Health
University of Melbourne
Director
Melbourne Sexual Health Centre
Carlton
Victoria
Australia
利益声明
CF is an author of a number of references cited in this topic. CF has received programme grants of 6 figures US$.
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