Description

• 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)

Epidemiology

Incidence

• 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

Risk Factors

• 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

General Prevention

• Use of male condoms, female condoms, or cervical diaphragms
• Abstinence or reduction in the number of sex partners
• Behavioral counseling

Commonly Associated Conditions