Urethritis

Inflammatory process of the urethra that, despite the progress of antibiotic therapy, continues to proliferate due to:

• Insufficient information.
• Inappropriate treatments.
• Misdiagnosis or insufficient diagnosis.
• Slow course in women, which makes it an ideal reservoir for permanent contamination.

Why is it produced?

They are classified according to the cause in:

• Gonococcal urethritis: produced by Neisseria gonorrhoeae. It is a gram-negative diplococcus, with a typical coffee bean appearance, whose only natural host is humans. The usual presentation of gonorrhea is acute urethritis in men and cervicitis in women.
• Non-gonococcal urethritis: the most common causative agent is Chlamydia Trachomatis followed by Ureaplasma urealyticum. Other germs associated with urethritis are: Mycoplasma genitalium, Mycoplasma hominis, Bacteroides urealyticum, staphylococcus, E. Coli, candida, herpes simplex, trichomonas …

Gonorrhea is quite contagious, especially from a man affected to a healthy woman. The nucleus of transmitters is made up of adolescents with few economic resources, who live alone in large cities and in sexual promiscuity. The disease is spread by carriers with few or no symptoms.

The gonococcus affects the columnar epithelium and to a lesser extent the transitional epithelium. The infection occurs by extension on the mucosa of the urethra penetrating the submucosa through crypts and glands, through the epithelial cells or between them. Factors dependent on the germ and the state of the host seem to be related to the rise of the infection and the passage to the blood.

The gonococcus in men causes urethritis while in women it causes cervicitis.

Non-gonococcal urethritis (UNG) is seen in higher socioeconomic levels and with less sexual promiscuity.

Symptoms of urethritis

In men, 3 or 4 days after infection with the gonococcus, intense dysuria (difficulties when urinating) appears and a purulent urethral exudate, more visible before the first urination in the morning; There may also be cloudiness in the first half of urination and pain on erection. 15% of the cases are asymptomatic or have few symptoms, and can go unnoticed and spread the disease. Inflammation of the anterior urethra can have local complications such as:

• Chronic anterior urethritis, less symptomatic, with a viscous, non-purulent exudate.
• Inflammation of the corpora cavernosa of the penis.
• Inflammation of local glands.
• Balanitis .

And retrograde complications such as:

• Posterior urethritis.
• Seminal vesiculitis.
• Epididymitis and prostatitis .

The prognosis can be aggravated in these cases by the possibility of dissemination of the disease or sterility. Gonococcus in women causes mucopurulent cervicitis, with more nonspecific symptoms than those in men -dysuria, frequency , exudate, or bleeding- and usually leads to associated urethral colonization.

Non-gonococcal urethritis (NGU) is asymptomatic with less symptoms than gonococcal urethritis (UG) (dysuria, mucous exudate). The incubation period is longer, 2 or 3 weeks. In women it also gives cervicitis.

How is it diagnosed?

The diagnosis of UG is based on symptoms, Gram stain (presence of gram-negative diplococci within neutrophils in urethral exudate) and culture. Serological antibody detection today is not of much value.

The diagnosis of UNG is made by exclusion; some authors make the clinical diagnosis based on the presence of urethral exudate and dysuria. Others do so due to the presence of polynuclear cells in the urethral smear as an absolute condition. Gram staining allows to verify the presence of four polynuclear cells per field in at least five fields (10 x 100). Urethral discharge is a very important sign, even if it is discrete. In the exploration of the genital tract, it is necessary to rule out ulcers in the foreskin, balanitis, epididymitis, prostatitis, rectitis, etc., also looking for inguinal and cervical adenopathies, etc.

Treatment of urethritis

UG is treated with the association of ceftriaxone and doxycycline since ceftriaxone is the cephalasporin of choice for gonococcus and doxycycline is the antibiotic of choice for Chlamydia and Ureoplasma.

UNG will be treated based on the cause:

• Chlamydia Trachomatis: they require antibiotics with good cellular penetration. Tetracyclines and macrolides are recommended.
• Ureoplasma urealyticum and mycoplasmas: sensitive to macrolides.
• Trichomonas vaginalis: preferentially sensitive to mitronidazole.
• Herpes virus: can be treated with acyclovir orally with subjective and objective improvements, but without effect on the virus, which remains quiescent within the lymph nodes.
• Candida albicans: sensitive to nystatin and amphotericin B, advising at the same time an alkalinization of urine.