Urethritis

Descriptive text is not available for this image 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 2022, 648,056 cases of gonorrhea were reported, a 9.2% decrease in the overall rate from the previous year. This was the first decrease in the rate of gonorrhea observed since 2009.
  • Gonorrhea is the second most commonly reported STD.
  • 40% of gonorrhea cases occurred in men who have sex with men (MSM).
  • In 2022, there were 1,649,716 cases of chlamydia reported, making it the most common STD in the United States.
  • The rate of chlamydia in 2022 (459.0 per 100,000) was similar to the rate in 2021 (459.5 per 100,000), but the rate in men increased by 1.8%, and the rate in women decreased by 1.2%.
  • Highest incidences of gonorrhea and chlamydia among young men and women, ages 15 to 24 years (61% of all cases)
  • Chlamydial infections are 5 times more likely in young adult women than gonococcal infections.
  • In 2022, there were 207,255 reported cases of syphilis, the greatest number of cases reported since 1950; representing a 17.3% increase since 2021.
  • The number of primary and secondary syphilis cases—the most infectious stages of syphilis—increased to 59,016 cases.

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 or coexisting STI, sex partner with concurrent partner(s)
  • Inconsistent condom use outside a mutually monogamous relationship; exchanging sex for money or drugs
  • Members of the 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 aged <24 years and women aged >25 years with risk factors (B recommendation). There is insufficient evidence to recommend screening in men (1)[A]

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