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- 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)
- In 2016, there were 468,514 reported cases of gonorrhea, with a rate of 146 cases per 100,000 per population (18.5% rate increase since 2015) (1).
- In 2016, there were 1,598,354 reported cases of Chlamydia trachomatis infection or 497 cases per 100,000 per population (17.6% rate increase since 2015) (1).
- 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).
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 C. 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
- 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
- Use of male condoms, female condoms, or cervical diaphragms
- Abstinence or reduction in the number of sex partners
- Behavioral counseling
Commonly Associated Conditions
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].