Urethritis

Urethritis is a topic covered in the 5-Minute Clinical Consult.

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Basics

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 2016, there were 468,514 reported cases of gonorrhea, with a rate of 146 cases per 100,000 per population (18.5% rate increase since 2015) (1).
  • In 2016, there were 1,598,354 reported cases of Chlamydia trachomatis infection or 497 cases per 100,000 per population (17.6% rate increase since 2015) (1).
  • Chlamydia is the most commonly reported STD (1).
  • Rate of chlamydial infection in U.S. women was more than twice that of men, reflecting higher rates of screening (1).
  • Highest incidences of gonorrhea and chlamydia among young men and women, ages 15 to 24 years (>50% of all cases) (1)
  • Chlamydial infections are 5 times more likely in young adult women than gonococcal infections (1).

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 (2).
  • Sexually transmitted C. 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

ALERT
Annual chlamydia and gonorrhea screening is recommended for all sexually active women <25 years, women >25 years with risk factors, and all men who have sex with men. There is insufficient evidence to recommend testing all men <25 year (3)[A].

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