- Inflammation of the urethra
- Common manifestation of sexually transmitted infection (STI)
- Frequently associated with dysuria, pruritus, and/or urethral discharge; classified as gonococcal (caused by Neisseria gonorrhoeae) and nongonococcal (caused by other bacteria, or less commonly autoimmune disorders [Reiter syndrome], trauma, or chemical irritation)
- In 2020, gonorrhea increased 5.7% to >677,000 cases—the highest number reported since 1991.
- In 2020, chlamydia decreased 13% to >1.6 million cases.
- Chlamydia is the most commonly reported STD.
- Rate of gonorrhea increased in both men and women during 2019–2020, but increases were greater among women compared to men, potentially reflecting higher rates of screening.
- Highest incidences of gonorrhea and chlamydia among young men and women, ages 15 to 24 years (61% of all cases)
- Chlamydial infections are 5 times more likely to occur in young adult women than gonococcal infections.
- In 2020, there were 133,945 reported cases of syphilis: the number of primary and secondary syphilis cases—the most infectious stages of syphilis—increased 6.8% to >41,655 cases.
Etiology and Pathophysiology
- Most common cause is infection via sexual transmission of N. gonorrhoeae, a gram-negative diplococcus.
- N. gonorrhoeae is a gram-negative diplococcus which interacts with nonciliated epithelial cells → cellular invasion → inflammation, neutrophil production, bacterial cell phagocytosis.
- Sexually transmitted Chlamydia trachomatis infection is the most common cause of nongonococcal urethritis.
- Other established pathogens:
- Mycoplasma genitalium
- Trichomonas vaginalis
- Ureaplasma urealyticum
- Herpes simplex virus (rare)
- Adenovirus (rare)
- Noninfectious causes (less common)
- Chemical irritants (i.e., soaps, shampoos, douches, spermicides)
- Foreign bodies
- Urethral instrumentation
- Age 15 to 24 years
- New sex partner
- One or more sex partner(s)
- History of or coexisting STI
- Sex partner with concurrent partner(s)
- Inconsistent condom use outside of a mutually monogamous relationship
- Exchanging sex for money or drugs
- Member of population with increased prevalence of infection, including incarcerated populations, military recruits, and economically disadvantaged populations
- Use of male condoms, female condoms, or cervical diaphragms
- Abstinence or reduction in the number of sex partners
- Behavioral counseling
Commonly Associated Conditions
Annual chlamydia and gonorrhea screening is recommended for all sexually active women aged ≤24 years and women aged >25 years with risk factors (B recommendation). There is insufficient evidence to recommend screening in men (1).
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