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