Urethritis

Urethritis
inflammation of the urethra
Infectious causes (typically
sexually transmitted)
Gonococcal urethritis
(GCU) - Neisseria
gonorrhea
Nongonococcal urethritis
(NGU) - Chlamydia
trachomatis,
Ureaplasma
urealyticum,
Mycoplasma genitalium,
or Trichomonas
vaginalis.
 Urethritis
Presentation & Findings:
Urethral discharge, dysuria
and urethral pruritus
40% GCU and 25% NGU=
asymptomatic
Complications
Men: epididymitis and
Reiters syndrome
Women (female sex
partners): pelvic
inflammatory disease, ectopic
pregnancy and infertility
Children: neonatal
pneumonia and ophthalmia
neonatorum
 Diagnosis
Traditional diagnostic
algorithm
Microscopy exam of
Grams stained urethral
smear
Nucleic acid
amplification testing
using first void urine
 Management
1. Antibiotic Regimen
Gonococcal Infections
Cefixime, 400 mg as a single dose; or ceftriaxone, 125 mg as a single
IM dose; or ciprofloxacin, 500 mg as a single oral dose or ofloxacin,
400 mg as a single oral dose, plus azithromycin, 1 g as asingle oral
dose; or doxycyline, 100 mg orally twice a day for 7 days.
Non-gonococcal Urethritis
Azithromycin, 1 g as a single oral dose; or doxycycline, 100 mg orally
twice a day for 7 days
Recurrent and persistent urethritis
Metronidazole, 2 g as a single oral dose, plus erythromycin base, 500
mg orally 4 times a day for 7 days; or eryhtromycin ethylsuccinate, 800
mg orally 4 times a day for 7 days
2. Sex partners should be referred for appropriate evaluation and
treatment.
 Follow-up
Presence of any of the following clinical signs:
Mucopurulent urethral discharge on PE
> 5 leukocytes per oil immersion field of the
Grams stained urethral secretion
(+) leukocyte esterase test on first-void urine
> 10 leukocytes per high-power microscopic field
of the first void urine
Epididymitis
 Epididymitis
inflammation of the epididymis
Bacterial infection results in the infiltration of white
blood cells into the epididymal connective tissue, with
resultant congestion and edema.
Men <35 y/o STDs
Homosexual men (anal intercourse) E. coli
Children & older men urinary pathogens (E. coli)
 Epididymitis
Presentation & Findings
Severe scrotal pain that
may radiate to the groin
or flank
Scrotal enlargement
 Epididymitis
Physical Examination
Edematous tender
epididymis
Erythematous
edematous scrotum
Prehn sign: distinguish
epididymitis from
testicular torsion.
Urethral discharge (10%)
Fever or other
constitutional symptoms
with progression of
disease
Epididymitis
Presentation and Findings
Urinalysis: WBCs and bacteria in
the urine or urethral discharge
Serum blood analysis:
leukocytosis
Radiologic Imaging
Scrotal Doppler UTZ or
radionuclide scanning
Epididymitis: enlarged
epididymal head
Diagnosis:
Urine gram stain and culture
Syphilis serologic and HIV tests
 Epididymitis
Management
Antimicrobial regimen:
Gonococcal or chlamydial infection
Ceftriaxone, 250 mg in a single IM dose, plus doxycycline, 100mg orally
twice a day for 10 days
Enteric infection
Ofloxacin, 300 mg orally twice a day for 10 days
Bed rest, scrotal elevation & NSAIDS until fever and local
inflammation subside
Sepsis or severe infection hospitalization & parenteral
antibiotic therapy
Abscess open drainage
Chronic, relapsing epididymitis & scrotal pain
epididymectomy
CANDIDIASIS
Etiology
Candida albicans
- yeastlike fungus that
is a normal inhabitant
of the vagina,
respiratory and
gastrointestinal tracts
CANDIDIASIS
Pathogenesis
Intensive use of potent and modern
antibiotics disturbs the normal balance
between the pathogenic and non-pathogenic
forms of the organism
Fungi overwhelms an otherwise healthy organ
Usually involves the urinary bladder and the
kidney
CANDIDIASIS
Signs & Symptoms

Vesical irritability
Symptoms of
pyelonephritis
Spontaneous
passage of fungus
balls
CANDIDIASIS
Diagnosis
Microscope
-mycelial or yeast forms
in a urine specimen
Culture
Excretory Urograms
-caliceal defects
-ureteral obstruction
(fungus masses)
CANDIDIASIS
Treatment
Vesical Candidiasis
Alkalinization of the urine with Sodium
Bicarbonate (pH 7.5)
Amphotericin B via catheterization 3x a day

Renal Involvement
Irrigation of the renal pelvis with
Amphotericin B
CANDIDIASIS
Treatment
Systemic involvement/Candidemia
Flucytosine (Ancobon): DOC
dosage: 100 mg/kg/d orally in divided doses
given for 1 week
in cases of serious involvement:
dosage: 600 mg IV (1st day)
shift to oral form
CANDIDIASIS
Treatment
Systemic involvement/Candidemia
Nifuratel (nitrofuran antibiotic)
dosage: 400 mg 3x daily for 1 week
Ketoconazole 200-400 mg/d for 2-3 weeks or
more depending on the effect
Amphotericin B (Fungizone) 1-5 mg/d IV in
divided doses dissolved in 5% dextrose