0521779407-21 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:59
Urethritis 1489■Patients could have painful urination throughout the stream or dis-
comfort only with the initiation of stream.
■In women, it is often a prelude to a full-blown urinary tract infection.
■In elderly men with difficulty with urinary stream, symptoms could
indicate urinary tract infection or prostatitis.
Signs & Symptoms
■The urethral meatus may have signs of dried crust, erythema, or
moist discharge.
■Occasionally, discharge can be collected following gentle pressure
along the dorsum of the penis.tests
■A Gram stain smear of urethral exudate or an intraurethral swab
specimen that reveals >5 PMN’s/oil immersion field is presumptive
for a diagnosis but insensitive.
■A first voided urine (first 5 ml) can be examined for leukocytes.
■A swab of urethral exudate or intraurethral swab specimen should
be submitted for nucleic acid amplification test (NAAT, Gen-probe)
forChlamydiaandN. gonorrhoeae.
■Either an LCR (ligase chain reaction) or PCR done on first voided
urine specimen is a more sensitive and specific but more expensive
test.Other Tests
■Syphilis serology and HIV counseling and testing are indicated.
■Examine a wet mount of urethral material for Trichomonas.differential diagnosis
■The principle causative agents of urethritis with polymorphonuclear
leukocytes areChlamydia trachomatis(25–40%) andNeisseria gon-
orrhoeae(approximately 20% of cases).
■Less frequent causative agents include Mycoplasma, Ureaplasma,
Trichomonas, HSV, and genital candidiasis in diabetics.
■Urethritis can be a feature of systemic diseases, including Reiter’s,
Behcet’s, Stevens-Johnson syndrome or Wegener’s granulomatosis.
management
What to Do First
■It is imperative to examine urethral specimen and provide care at
the time of examination.
■If Gram stain evidence of gonococcal infection is not established,
then treatment for both gonococcal and non-gonococcal causes of
urethritis is to be administered.