Urethritis is inflammation of the urethra. The main symptom is dysuria, which is painful or difficult urination.

Diagnosis

A cotton swab is inserted 1–4 cm into the urethra and rotated once. The swab is then smeared onto a glass slide and examined under a microscope. A commonly used cut-off for the diagnosis of urethritis is 5 or more polymorphs per high power field, but this definition has recently been called into doubt.^[1]

Tests of gonorrhoea and chlamydia are sent on the swab.

Causes

In the diagnostic approach to urethritis, physicians classify the disease as gonococcal urethritis or non-gonococcal urethritis (NGU), based on its causation. Non-gonococcal urethritis, sometimes called non-specific urethritis (NSU), has both infectious and non-infectious causes. In men, purulent discharge usually indicates a urethritis of gonococcal nature, while clear discharge indicates urethritis of non-gonococcal nature. Urethritis is difficult to diagnose in women because discharge may not be present, however, the symptoms of dysuria and frequency may be present.

Causes include:

• Adenovirus
• Chlamydia trachomatis
• Escherichia coli
• Herpes simplex
• Mycoplasma genitalium
• Neisseria gonorrhoeae
• Reiter's syndrome
• Trichomonas spp.

Symptoms

Discharge (milky or pus-like) from the penis, stinging or burning during urination, itching, tingling, burning or irritation inside the penis.

Treatment

A variety of drugs may be prescribed based on the cause of the patient's urethritis. Some examples of medications based on causes include:

• Clotrimazole (Mycelex) - Trichomonas
• Doxycycline (Vibramycin) - Chlamydia
• Fluconazole (Diflucan) - Monilial
• Metronidazole (Flagyl) - Trichomonas
• Nitrofurantoin - Bacterial Infection
• Nystatin (Mycostatin) - Monilial
• Co-trimoxazole, which is a combination of Sulfamethoxazole and Trimethoprim in a ratio of 5 to 1 (Septrin, Bactrim) - Bacterial Infection

Proper perineal hygiene should be stressed. This includes avoiding use of vaginal deodorant sprays and proper wiping after urination and bowel movements. Intercourse should be avoided until symptoms subside.

References

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