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 commonly autoimmune disorders [Reiter syndrome], trauma, or chemical irritation)

Epidemiology

• In 2018, increased 5% to >580,000 cases—the highest number reported since 1991
• In 2018, increased 3% to >1.7 million cases—the most ever reported to CDC
• Chlamydia is the most commonly reported STD (1).
• Rate of chlamydial infection in U.S. women was more than twice that of men, reflecting higher rates of screening (1).
• Highest incidences of gonorrhea and chlamydia among young men and women, ages 15 to 24 years (>50% of all cases) (1)
• Chlamydial infections are 5 times more likely in young adult women than gonococcal infections (1).
• In 2018, there were 115,000 reported cases of syphilis; the number of primary and secondary syphilis cases—the most infectious stages of syphilis—increased 14% to >35,000 cases, the highest number reported since 1991

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 which interacts with nonciliated epithelial cells → cellular invasion → inflammation, neutrophil production, bacterial cell phagocytosis (2).
• 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 or coexisting STI
• Sex partner with concurrent partner(s)
• Inconsistent condom use outside of 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

ALERT
Annual chlamydia and gonorrhea screening is recommended for all sexually active women <25 years, women >25 years with risk factors, and all men who have sex with men. There is insufficient evidence to recommend testing all men <25 year (3)[A].