Description

• Urethral inflammation marked by painful urination, pruritus, hematuria, and/or discharge
• Usually a result of an STI or, less commonly, autoimmune disorders (Reiter syndrome), trauma, or chemical irritation
• Complications such as urethral stricture in men or pelvic inflammatory disease (PID) in women may occur if untreated.
• System(s) affected: Renal/Urologic

Epidemiology

• In 2011, 1.4 million new cases of chlamydia and 321,000 cases of gonorrhea were reported by the CDC. Prevalence varies by region, with highest incident in southern US; racial discrepancies include an 8× higher rate for African Americans and a 2.7× higher rate for Hispanic patients compared with whites (1,2).
• Predominant age: 15–24 years, sexually active, following trends for STI
• Predominant sex: Men report symptoms more frequently, but similar incidence is likely.

Risk Factors

• Multiple sexual partners and unprotected intercourse
• African American, Native American, or Hispanic ethnicity
• History of STIs, bacterial vaginosis, recurrent candidiasis
• Excessive use of chemical lubricants or powders

General Prevention

• Safer sex techniques and treatment of all partners
• Abstinence
• Avoidance of excessive lubricants, powders, or chemical irritants

Etiology

• Predominantly Neisseria gonorrhoeae and Chlamydia trachomatis infection, increased transmission among HIV-positive persons
• Less common infectious agents, including:
  • Ureaplasma urealyticum
  • Trichomonas vaginalis
  • Herpesvirus
  • Mycoplasma genitalium
  • Viral: Conflicting data on HPV, herpes simplex
• Noninfectious causes (generally rare): Foreign bodies, soaps, shampoos, douches, spermicides, urethral instrumentation

Commonly Associated Conditions

ALERT
Patients with any suspected STI should undergo testing for syphilis, hepatitis B and C, Trichomonas, and HIV.