- infection-induced swelling and irritation (inflammation) of the urethra

Urethra is the tube that carries urine from the bladder so it can be expelled from the body. Semen also passes through the male urethra.

Cause: Infection = the urethra to becomes irritated and inflamed. Etiological classification: Gonococcal Urethritis: Neisseria gonorrhoeae- shorter incubation period; the onset of dysuria and purulent discharge is abrupt. Non-gonococcal Urethritis: Chlamydia trachomatis- longer incubation period; onset of either dysuria or, less commonly, a mucopurulent discharge, is subacute. Patients with NGU are much more likely to be asymptomatic Non-specific Urethritis: both infectious and non-infectious causes Posttraumatic urethritis can occur in 2%-20% of patients practicing intermittent catheterization and following instrumentation or foreign body insertion. Urethritis is 10 times more likely to occur with latex catheters than with silicone catheters.

Bacteria

*E. coli and other bacteria present in stool *Gonococcus. It is sexually transmitted and
causes gonorrhea.

*Chlamydia trachomatis. It is sexually

transmitted and causes chlamydia Virus

*Herpes simplex virus *Cytomegalovirus

Risks for Urethritis include: Being a female in the reproductive years Being male, ages 20 - 35 Having many sexual partners High-risk sexual behavior (such as anal sex without a condom) History of sexually transmitted diseases

Frequency

Worldwide, approximately 62 million new cases of gonococcal urethritis and 89 million new cases of NGU are reported each year. (2009, DOH)

Signs & Symptoms: Main symptom: painful or difficulty in urination (Dysuria)

Frequent or urgent need to urinate Difficulty starting urination itching, pain, or discomfort when a person is not urinating. Pain during sex Discharge from the urethral opening of vagina/penis In men, blood in the semen or urine Fever

Diagnosis
Medical History = symptoms Physical examination, including the abdomen, bladder area, genitals and rectum. Discharge from the penis Tender and enlarged lymph nodes in the groin area Tender and swollen penis Complete blood count (CBC) C-reactive protein test Pelvic ultrasound (women only) Pregnancy test (women only) Urinalysis, gram stain and urine cultures Examination of any discharge under a microscope = cystoscopy

Treatment

Antibiotics: Eliminate the cause of infection and prevent the spread of infection Adoxa, Monodox, Oracea, Vibramycin (doxycycline) Rocephin (ceftriaxone) Zithromax, Zmax (azithromycin) Urethritis due to trichomonas infection (called trichomoniasis) Flagyl (metronidazole) Tindamax (tinidazole) Urethritis due to herpes simplex virus can be treated with: Famvir (famciclovir) Valtrex (valacyclovir) Zovirax (acyclovir) Paiin relievers (NSAIDs or Pyridium, which works on the urinary tract) along with antibiotics. Avoid sex or use condoms during sex. If an infection is the cause of the inflammation, your sexual partner must also be treated. Urethritis caused by trauma or chemical irritants is treated by avoiding the source of injury or irritation. Urethritis that does not clear up after antibiotic treatment and lasts for at least 6 weeks is called chronic urethritis. Different antibiotics may be used to treat this problem.

Outlook (Prognosis)
With the correct diagnosis and treatment, urethritis usually clears up without any complications. However, urethritis can lead to permanent damage to the urethra (scar tissue called urethral stricture) and other urinary organs in both men and women. Prevention:

Good personal hygiene Practicing safer sexual behaviors such as monogamy and using condoms

 Possible Complications
Men with urethritis are at risk for the following complications: Bladder infection (cystitis) Epididymitis Infection in the testicles (orchitis) Prostate infection (prostatitis)
After a severe infection, the urethra may become scarred and then narrowed (urethral stricture).

Women with urethritis are at risk for the following complications: Bladder infection (cystitis) Cervicitis Pelvic inflammatory disease (PID- an infection of the uterus lining, fallopian tubes, or ovaries)