Urethritis, urethral infection annoying

Uretritis

Urethritis is an inflammation of the urethra which is the tube responsible for transporting urine from the bladder to the outside. From a medical standpoint, urethritis is defined as a syndrome characterized by a mucopurulent or purulent urethral discharge (pus) or dysuria (difficult expulsion, incomplete and painful urination), although it may not produce any symptoms. Usually (not always) is transmitted by sexual contact. Cervicitis is the equivalent of urethritis in women, and is characterized by inflammation and mucus secretion of the uterine cervix. Infectious urethritis is typically caused by germs sexually transmitted, so the majority of cases are seen in patients sexually active youth. Neisseria gonorrhoeae and Chlamydia trachomatis are the most common microorganisms that cause urethritis. Neisseria gonorrhoeae As is readily visualized in the Gram stain, which is the diagnostic method is initially used to assess urethral discharge, urethritis has traditionally classified gonococcal urethritis (GU) and nongonococcal urethritis (NGU) .

Causes of urethritis

The main causes of urethritis include:

• Infectious causes :
  • Neisseria gonorrhoeae (25%) call causes gonorrhea or gonococcal urethritis. Neisseria infection (gonococcal) infection is the second most common bacterial sexually transmitted in the Western world, being a very common cause of urethritis in both the United States and Europe. In other areas, especially in developing countries, the incidence of gonococcal urethritis could be even higher (up to 60% in some countries like South Africa). Often there coinfection with other sexually transmitted germs, so that up to 25-30% of patients with NGU Chlamydia have also simultaneously.
  • Chlamydia trachomatis is a sexually transmitted bacterial infection most common in the western world. It is the most common cause of NGU, producing between 15 and 30% of them.
  • Ureaplasma urealyticum, Mycoplasma hominis y M. genitalium.
  • Other germs causing urethritis include Trichomonas vaginalis , Herpes simplex , Haemophilus , fungi, adenovirus, enterobacteria (especially with the practice of anal sex) and seeds of oropharyngeal flora (oral sex).
• Non-infectious Causes : autoimmune, allergic, traumatic ...         
• Cause unknown : up to 25% of cases of urethritis is not a cause.

Symptoms of urethritis

The infection is asymptomatic in 5-10% of men with NGU and in up to 40-45% of non -gonococcal urethritis . Meanwhile up to 80% of women with chlamydia and 50% with gonorrhea may have no symptoms.
incubation period (time from infection is caused by the germ until symptoms appear) is variable, but generally ranges from 4-7 days with infections caused by Neisseria , and 7 to 21 days in those produced by Chlamydia .
Main symptoms that men with urethritis are:

• Dysuria or painful urination: is the main complaint of men who have urethritis. It affects most men with gonorrhea and more than half of patients with non-gonococcal urethritis.
• Urethral discharge: is a high percentage of patients with urethritis. It may be more or less abundant, and generally has a purulent or mucopurulent appearance. A very abundant and purulent urethral discharge suggests that urethritis is caused by Neisseria gonorrhoeae . Urethral discharge may be present throughout the day, or be limited and only observed with the first morning urine. At other times, it is only evident after urethral expression.
• Itching and burning of the urethral opening.
• Increased number of urination during the day, which also tend to be small numbers.
• Genital pain.
• Arthritis: a minority of patients with urethritis, especially if it is produced by Chlaymidia , can develop arthritis (in this case we speak of Reiter's syndrome).
• Anorectal symptoms or nonspecific symptoms pharyngeal practice anal or oral sex. However, over 90% of the pharyngeal conditions are asymptomatic.

As for the most common symptoms of cervicitis include:

• Increased vaginal discharge.
• Localized pain in the lower abdomen (5-25%).
• Bleeding between periods or after sex (the cervix is ​​very swollen, so it is more likely to bleed).
• Purulent or mucopurulent cervical discharge (50%).
• Pain with sexual intercourse (dyspareunia).
• Pain and burning with urination.
• Increased number of urination during the day, which is usually limited quantity.

Diagnosis of urethritis

In patients with suspected urethritis , making a good history and a detailed physical examination is essential, as is achieved with both practically make the diagnosis of this disease. In addition, a number of additional tests that help achieve a more accurate diagnosis. Sometimes if laboratory tests can not be performed, the existence of risk factors ( unsafe sex ) and about symptoms consistent enough to start treatment.
Anamnesis (interview with the doctor about the history and symptoms patient) is important to ask the patient about sexual risk, because as we said urethritis is caused primarily by sexually transmitted bacteria. The presence of symptoms such as burning with urination and urethral discharge are highly suggestive of urethritis. Physical examination has to be detailed, genital exploration being particularly relevant. . Also check whether there are other associated lesions, such as genital ulcers and swollen lymph glands in the genital area or around
laboratory tests are used more for diagnosis of gonococcal urethritis are:

• Gram stain: is the initial test performed in all patients with suspected urethritis. This is an example of urethral discharge is obtained and sent to a lab to be stained and analyzed. The method of obtaining the sample in males involves inserting a swab into the urethra about two inches and rotate 360 º several times, until it is considered that the sample has been properly collected. Subsequently, the swab was removed and the sample on the desired location, in this case on a clean slide staining to perform standing. The microscopic observation of germs with rounded, grouped in pairs and do not stain with Gram stain (medically speaking of Gram-negative diplococci) provides a presumptive diagnosis of urethritis. The presence of five or more polymorphonuclear cells (a type of white blood cell with a characteristic shape) in the smear of urethral discharge, or ten or more in the first urine sample (after a period without urinating four hour minimum), suggests urethritis also diagnostic. Finally, some authors give the same value to positive for white blood cells in the urine test strips.
• Growing urethral discharge: is the test of choice to confirm the diagnosis. The culture is positive when the growth of germs causing urethritis, is observed in this case Neisseria gonorrhoeae . You can also make culture samples obtained from the rectum or pharynx if appropriate, based on the type of sex that has kept the patient.
• Other tests: EIA (enzyme immunoassay) of urine samples, or DNA detection methods such as PCR (polymerase chain reaction). These tests are not available in all hospitals, and are more complex and difficult to perform; however, they may be useful in some cases.

Tests used to diagnose chlamydial urethritis produced are:

• Cropping is necessary that the sample includes epithelial cells, as Chlamydia is a parasite that is located inside the cells, and not contain sufficient germs pus.
• DNA detection methods: have a high sensitivity, close to 98-100%. Can be performed on a urine sample. It is expensive techniques that can not afford all laboratories.
• Antigen detection methods, such as direct immunofluorescence or enzyme immunoassay.

Finally, in all patients suffering from urethritis is recommended that a complete blood analysis, in which a study to rule out other diseases such as HIV or syphilis is included.

Treatment of urethritis

Most of the time the treatment of urethritis is empirical, ie, antibiotic treatment is initiated because there is a high suspicion of infection exists, but there really is not a definite confirmation. Up to 40-50% of cases have a mixed cause urethritis ( Chlamydia-Neisseria gonorrhoeae ), so it is recommended that empirical treatment covers both germs. In fact, in any situation where you can not access the minimum diagnostic resources, when a patient has signs and symptoms of urethritis syndromic treatment is recommended by ceftriaxone (a single intramuscular dose) and azithromycin (a single dose orally administered simultaneously). It is important to start as soon as possible after the samples have been collected.
isolated detection of some germs as Mycobacterium hominis or Ureaplasma urealyticum in asymptomatic patients is not an indication for starting antibiotic treatment, because often these germs are colonizing the genital tract ; ie, found naturally in the urethra without causing disease. administration Without treatment, symptoms can submit over a period of weeks or months, but the affected patient will probably remain contagious. In untreated Chlamydia infections have been found that the seed persists for at least 15 months. Given a case of urethritis is important to treat the affected couples , because as we have said it is a sexually transmitted infection. Managing partners are as follows:

• Chlamydia : all the people you have had sexual contact the patient for the past two months should be evaluated by a physician in consultation. Also, the last couple with whom the patient has had sex, but have been more than 60 days, and should be valued.
• Neisseria : all partners of patients diagnosed with gonorrhea who have had sex in the past two months should be evaluated in consultation. For patients diagnosed with NGU, having a very short incubation period, simply contact the test 2-3 weeks before the onset of signs and symptoms. In all cases must be studied also the last couple with whom the patient has had sex even if they last more than 60 days.

Sometimes urethritis is without a resolution of it. The presence of symptoms, no clinical signs or laboratory findings of urethral inflammation, is not enough time to start a new treatment base. For recurrent processes likely urethritis, should assess the following:

• Therapeutic noncompliance; ie, the patient does not meet the treatment he has indicated correctly.
• Treatment of sexual partner, if not done at first.
• You have been a new exhibition with a sexual partner who has not been treated or new. The most frequent cause of recurrence of symptoms after proper treatment is reinfection rather than treatment failure.
• In patients with persistent symptoms, the infection could be due to other pathogens, or a noninfectious cause (allergic, autoimmune).
• If the patient has met the initially prescribed treatment, and a new exhibition also discarded, uncommon causes of urethritis is suspected.

No need to keep track of properly treated patients whose symptoms have disappeared and have not had any relationship with an untreated contact. Yes is recommended in pregnant control and in patients who have undergone treatment with certain antibiotics. most important
complications may appear during a urethritis include epididymitis, or prostatitis in men orquioepididimitis (inflammation of the epididymis, testis and epididymis and prostate, respectively) and pelvic inflammatory disease (endometritis, salpingitis) in women. Other more serious complications such as disseminated gonococcal infection (appears in 1-2% of gonococcal infections untreated, manifesting through symptoms such as fever, dermatitis, arthritis, endocarditis, meningitis ...).

Article contributed for educational purposes