Urethritis
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 common autoimmune disorders [Reiter syndrome], trauma, or chemical irritation)
Epidemiology
Incidence
- In 2021, there were 1,644,416 reported cases of chlamydia, the most commonly reported bacterial STI, which is a 4.1% increase from 2020.
- Young people aged 14 to 25 years comprise 2/3 of newly diagnosed chlamydial infections.
- About 1 in 20 young women between 14 and 24 years of age have chlamydia.
- In 2021, there were 710,151 reported cases of gonorrhea, the second most commonly reported bacterial STI; rates of gonorrhea have increased by 118% since 2009.
- For both chlamydia and gonorrhea, rates have increased among men and women, among most age groups, as well as among most racial/ethnic groups.
- In 2021, there were a total of 176,713 reported cases of syphilis.
- The number of primary and secondary syphilis cases—the most infectious stages of syphilis—increased 28.6% to 53,767 cases from 2020 to 2021.
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 that interacts with nonciliated epithelial cells → cellular invasion → inflammation, neutrophil production, and 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 coexisting STI
- Sex partner with concurrent partner(s)
- Inconsistent condom use outside 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
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Citation
Domino, Frank J., et al., editors. "Urethritis." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116630/2.0/Urethritis.
Urethritis. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116630/2.0/Urethritis. Accessed September 7, 2024.
Urethritis. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116630/2.0/Urethritis
Urethritis [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2024 September 07]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116630/2.0/Urethritis.
* Article titles in AMA citation format should be in sentence-case
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ED - Baldor,Robert A,
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