Overview
Urethritis caused by pathogens other than gonococcus.
manifested by frequent urination, urgency, painful urination and urethral discharge
Caused by the invasion of pathogenic bacteria, Chlamydia trachomatis and Mycoplasma mycoplasma are more common.
Anti-infective treatment is the mainstay, with antibiotics chosen according to the pathogen.
Definition
Urethritis caused by pathogens other than gonococcus is called non-specific urethritis. It is also called non-gonococcal urethritis.
The pathogens are mainly Chlamydia trachomatis and Mycoplasma, but also Trichomonas vaginalis, herpes viruses, Candida albicans, and Bacillus circumcision.
Mainly transmitted through sexual contact or homosexuality.
It has a higher incidence than gonorrheal urethritis and ranks first among sexually transmitted diseases.
Manifestations include urethral tingling, painful urination and secretion of a small amount of thin white fluid.
Morbidity
Most common in young adults during the period of high sexual activity.
Takes the 1st place among sexually transmitted diseases.
There is a significant increasing trend in the incidence of non-specific urethritis.
75% of women with non-specific urethritis are asymptomatic and become carriers and sources of transmission, and 40% of these untreated patients develop pelvic inflammatory disease.
Causes
Causes
Source of transmission
Patients with UTIs or asymptomatic infections are the source of the disease, which can be caused by a variety of pathogens.
Chlamydia trachomatis
accounts for 40% to 50% of non-specific urethritis and is an important cause of genitourinary infections.
The biological characteristics of Chlamydia are between bacteria and viruses.
Sensitive to heat, 56 ~ 60 ℃ only 5 ~ 10 minutes of survival, -70 ℃ can be stored for several years.
Mycoplasma
Mycoplasma accounts for 20% to 30% of non-specific urethritis.
Mycoplasma is the smallest microorganism known to be able to grow and reproduce outside the cell.
Heat sensitive, 55 ℃, 5 ~ 15 minutes can be killed, low temperature or freeze drying can be long-term survival.
Others
A variety of other pathogens are associated with 10% to 20% of cases.
For example, Trichomonas vaginalis, Neisseria catarrhalis, Bacillus circumcision, Candida albicans, herpes viruses, or other microorganisms cause it.
Route of transmission
Non-specific urethritis is mainly transmitted through sexual intercourse.
Sexual contact
Adults are mainly infected through sexual contact.
Transmission occurs through sexual contact with a person with non-specific urethritis or a carrier of the pathogen.
In adults, the urethra is the main site of infection in men and the cervix in women.
Birth canal transmission
Newborns can be infected by the mother’s birth canal during labor and delivery.
It can cause neonatal urethritis, pneumonia, conjunctivitis and vaginitis in female infants.
Indirect infection
Indirect infection is relatively rare.
It is transmitted through indirect contact with the clothing and utensils (such as clothes, pants, towels, bathtubs, toilets) of patients or carriers of the pathogen, or obstetric and gynecological examination instruments that have not been strictly sterilized.
Susceptible people
Unhealthy sex life: unclean sex, multiple sexual partners, high-risk sex (such as anal sex).
Young adults: Young adults are sexually active and prone to UTI.
Women: Women have a short and straight urethra, which makes it easier for germs to invade and cause urethritis.
Predisposing factors
The following conditions are associated with a higher risk of non-specific urethritis.
Urethral obstruction: penile, urethral stricture, urethral stone, etc., which hinders the discharge of urine.
Genitourinary infections: prostatitis, vaginitis, cervicitis, etc.
Mechanical irritation in the urethra: indwelling catheter, application of intraurethral instruments, etc.
Others: congenital malformations, chemical irritation, tumors and certain allergic factors can also lead to urethritis.
Symptoms
The onset of the disease usually occurs after 1 to 3 weeks (average 2 weeks) of infection.
Main symptoms
Symptoms of non-specific urethritis vary significantly among different groups of people. 30% to 40% of men and 80% to 90% of women are asymptomatic or have very mild symptoms.
Males
Abnormal urination
Symptoms of urinary tract irritation, manifested as symptoms of urinary frequency, urgency and pain.
Some patients are accompanied by difficulty in urination.
Burning and itching in the urethra, always feel the urge to urinate in the urethra or always have the feeling of incomplete urination after urination.
Cloudy urine color and flocculent sediment in the urine.
Urethral discharge
A little mucous discharge is visible from the urethra in the morning.
The secretion is characterized by thinness, small amount, plasma or thin purulent.
It is rarely self-exuded and often has to be overflowed by squeezing the urethra with the hand.
Sometimes it only appears as a scab sealing the urethral opening or crotch soiling.
Stinging pain in the urethra
Slightly red urethral opening in men.
Accompanied by tingling, stinging or burning sensation in the urethra.
Persistent painful sensation in the urethra.
Females
Most women have no obvious clinical symptoms, and most often discovered by going to the hospital after the sexual partner is diagnosed.
Frequent urination and difficulty in urination, but mostly without urinary pain.
There may be a burning sensation in the urethra, and the urethral opening is congested and red.
Leukorrhea is increased and vaginal discharge is increased.
Some patients may also experience pain in the lower abdomen.
Other symptoms
Fever, chills
Non-specific urethritis, when further progressed, can lead to bacteremia and fever and chills.
This is characterized by chills followed by fever.
Low back pain
When the infection spreads to the upper urinary tract, the symptoms of low back pain may appear.
It manifests as unilateral or bilateral low back pain, which is often dull and aching.
Other systemic symptoms
Systemic symptoms may occur in severe cases of non-specific urethritis.
It manifests as nausea, vomiting, fatigue, and headache.
Complications
Male
Urethral stricture
After migrating to chronic urethritis, repeated episodes can cause fibrosis of the urethral connective tissue and progress to urethral stricture.
Epididymitis
Mostly unilateral, presenting as an enlarged, hard, tender epididymis.
Prostatitis
It is characterized by perineal swelling and discomfort, dysuria and symptoms such as urinary frequency, urgency and pain.
Vesiculitis
Often occurs together with prostatitis, manifested by ejaculatory pain, hematospermia (reddish, coffee-colored semen) and so on.
Infertility
Can be caused by epididymitis, chronic prostatitis, and seminal vesiculitis leading to male infertility.
Female
Pelvic inflammatory disease
In acute pelvic inflammatory disease, systemic symptoms are obvious, such as fever, lack of appetite, nausea, vomiting and other gastrointestinal symptoms, and severe lower abdominal pain.
In chronic pelvic inflammatory disease, most of the systemic symptoms are not obvious, and the main manifestations are increased leucorrhea, lower abdominal distension, lower back pain and menstrual irregularities.
Endometritis
Caused by upward spread of pathogen infection.
It manifests as increased menstrual flow, prolonged or shortened menstrual period and lower abdominal pain.
Tubulitis
Mild clinical symptoms, mainly manifested as lower abdominal pain.
If recurrent and prolonged, it may cause tubal obstruction, infertility, ectopic pregnancy, miscarriage and stillbirth.
Affecting fertility and fetal development
Endometritis and salpingitis can lead to ectopic pregnancy, infertility and secondary miscarriage.
Some patients may also suffer from fetal growth retardation.
Newborn babies
Nearly 50% of newborns born to mothers with chlamydial infections may develop eye infections as they pass through the birth canal.
The main symptom is a mucopurulent discharge from the eye.
Medical care
Department of Medicine
Urology
If symptoms such as frequent urination, urgency, painful urination and urethral discharge occur, consult the Department of Urology.
Gynecology
If women experience symptoms such as increased vaginal discharge, lower abdominal cramps, frequent urination, urgency, and painful urination, they can visit the Gynecology Department.
Preparation for medical treatment
Preparation for consultation: registration, preparation of information, common problems
Tips for the doctor
Drink plenty of water, urinate promptly, and keep the vulva clean to facilitate the taking of a qualified urine sample.
Choose loose-fitting clothes and pants that are easy to put on and take off to facilitate the examination.
Preparation Checklist
Symptom list
Pay particular attention to the time of onset of symptoms, special manifestations, etc.
Is there any frequency, urgency or pain of urination?
Is there any cloudy urine?
Is there any urethral discharge? Is there any dirty discharge from the crotch of the pants?
Is there any redness, swelling, itching, burning pain in the urethra?
Is there any increase in vaginal discharge or irregular menstruation?
Has there been any fever and what was the highest temperature?
List of medical history
Is there any history of infection by pathogens such as Chlamydia trachomatis, Mycoplasma, Trichomonas vaginalis, etc.?
Are there any urologic diseases such as urinary stones, urinary tuberculosis, urinary tumors, prostatic hyperplasia, etc.?
Have you ever shared towels and intimate clothing with others recently?
Is there any history of unclean sexual intercourse recently? Do you have multiple sexual partners?
Are you allergic to drugs or food?
Checklist
Test results for the past 6 months, which can be brought to the doctor’s office.
Laboratory tests: blood routine, urine routine, urine bacterial culture, urethral secretion smear, kidney function, etc.
Imaging tests: Ultrasound of the urinary system, plain film of the urinary tract, CT of the urinary system, etc.
Medication list
Medication used in the last 3 months, if available, bring the box or package to the doctor’s appointment
Antibiotics: e.g. amoxicillin, azithromycin, levofloxacin
Painkillers: ibuprofen
Diagnosis
Diagnosis is based on
Medical history
The onset of the disease is usually preceded by a history of impure sexual intercourse.
The incubation period ranges from 1 to 3 weeks, with an average of 2 weeks, i.e., onset occurs 2 weeks after a history of unclean sexual intercourse.
Clinical manifestations
Male patients often have mucous or plasma urethral discharge, accompanied by frequent and painful urination.
Female patients may have frequent urination, difficulty in urination, increased secretions, and itching of the vulva and urethra.
The urethral opening is congested and red.
Squeezing the urethra there is thin secretion.
The crotch of the pants may be stained with soiled secretions.
Laboratory Tests
Chlamydia test
A positive test result confirms the diagnosis.
Smear staining: very low sensitivity, not advocated for urethral secretions.
Cell culture: complicated, time-consuming and costly, generally not used as a routine examination method.
Direct immunofluorescence (DFA) method: fast and easy, simple operation, high sensitivity and specificity.
Rapid diagnostic test: easy to operate, no need for complex equipment, results can be obtained within 30 minutes.
Mycoplasma test
Positive test results can establish the diagnosis.
Culture method: Culture method is highly specific and sensitive, and is the only method recommended by the World Health Organization.
Serologic diagnostic tests: low specificity and sensitivity, only used as auxiliary diagnosis and epidemiological investigation.
Molecular biology methods: the sensitivity and specificity are high, but due to the radioactive hazards and cumbersome, it is difficult to promote, and there are some false positives and false negatives.
Microscopic examination of urethral secretion smear
A large number of leukocytes can be seen, and no gonococcus can be found inside or outside the cells.
The number of polymorphic leukocytes is >5 in the 1000x microscopic field.
Pathogen testing should be performed in hospitals where available.
Polymerase Chain Reaction (PCR) and Ligase Chain Reaction (LCR) Tests
The detection of chlamydia is highly sensitive and specific.
Especially for asymptomatic patients, the detection of chlamydia in urine sediment by PCR or LCR is of great significance for their screening diagnosis.
Blood test
It can assist in determining the presence and severity of infection.
If the white blood cell count and neutrophils are elevated, it suggests the presence of bacterial infection.
Imaging
Examination items: urological ultrasound, urological CT, urological magnetic resonance and so on.
Purpose of examination: to clarify the presence of urinary stones, tumors, malformations and other diseases, and to distinguish them from other diseases.
Examination significance: Usually the imaging examination of non-specific urethritis does not show abnormal manifestations and is not used as a routine examination.
Precautions: Urine holding is required before the examination.
Differential Diagnosis
Gonorrhea urethritis
Similarity: both have symptoms such as urethral urethral erythema, painful urination, and urethral discharge.
Differences: non-specific urethritis secretion smear can find chlamydia or mycoplasma containers, secretion smear can not detect gonococcus. Gonococcal urethritis secretion smear can see gram-negative N. gonorrhoeae in leukocytes.
Urethral syndrome
Similarity: both have the manifestation of urinary frequency, urgency, and urinary pain.
Difference: Urethral syndrome has no bacteriuria in several examinations, and clean mid-stream urine culture is helpful for differentiation.
Bladder cancer
Similarity: both can present with symptoms of frequent and urgent urination.
Difference: bladder cancer mainly manifests as painless hematuria, while hematuria of non-specific urethritis is not obvious, and the two can be differentiated by urological CT and cystoscopy.
Treatment
Aim of treatment: control symptoms, remove pathogenic bacteria, prevent complications and block further transmission.
Treatment principle: choose the appropriate antibiotic according to the pathogen, sexual partners need to be treated at the same time.
General treatment
Drink plenty of water and urinate regularly.
Take sufficient rest. During the period of high fever, bed rest should be provided.
Keep the vulva clean and dry, avoid scratching.
Change underwear frequently and do not mix with other clothes.
Avoid spicy and stimulating food, keep a light diet.
Medication
Recommended program
Commonly used drugs: Azithromycin, Doxycycline.
Drug effects
Azithromycin is indicated for urethritis and cervicitis caused by Chlamydia trachomatis.
Doxycycline is suitable for non-Neisseria gonorrhea urethritis, and simple urethritis and cervicitis caused by Chlamydia trachomatis.
Precautions.
Common adverse reactions to azithromycin are gastrointestinal reactions (abdominal pain, nausea, vomiting, diarrhea) and rash.
Doxycycline adverse reactions include gastrointestinal reactions such as nausea, vomiting, abdominal pain, and diarrhea. Occasionally, esophagitis and esophageal ulcers are observed.
Alternatives
Erythromycin: a macrolide antibiotic, adverse reactions include gastrointestinal symptoms such as diarrhea, nausea, vomiting, upper and middle abdominal pain, and loss of appetite.
Erythromycin Succinate: a macrolide antibiotic indicated for use in nongonorrheal urethritis, with adverse reactions such as gastrointestinal reactions (nausea, vomiting, and loss of appetite), skin rashes, and medicinal fever.
Levofloxacin: a quinolone antibiotic, allergic to quinolones, pregnant and lactating women, patients under 18 years of age are prohibited.
Medication for women during pregnancy
Doxycycline, erythromycin, and ofloxacin are contraindicated.
Alternative options are azithromycin, amoxicillin.
Medication for infants and children
Tetracyclines are contraindicated; erythromycin and azithromycin can be used.
Medication for breastfeeding women
If quinolones must be used, breastfeeding needs to be stopped.
Surgical treatment
Generally, surgery is not required for non-specific UTIs. Surgery may be considered for the following conditions
For urethral stricture due to UTI, urethral dilatation may be performed periodically.
In severe cases of urethral stricture, surgical treatment is feasible with incision of the narrowed portion of the urethra or urethroplasty and reanastomosis.
Treatment precautions
The patient’s sexual partner should be examined and treated at the same time to avoid repeated infection.
Both partners should avoid sexual contact during treatment.
Strictly follow the doctor’s instructions for treatment, can not adjust the dosage or stop the medication.
Those who are allergic to drugs should inform the doctor so that the doctor can choose the appropriate antibiotics.
Alcohol consumption is prohibited during the treatment period.
Criteria for cure
Clinical symptoms have disappeared for more than 1 week, urine is clarified and there is no secretion from the urethra.
Negative microscopic examination of urine sediment.
Negative urethral or cervical smear and negative chlamydia and mycoplasma examination.
Prognosis
Cure
Timely treatment of non-specific urethritis usually has a favorable prognosis and can lead to cure.
In some patients, symptoms persist or recur after treatment, mainly due to the following reasons
Sexual partners are not treated at the same time.
Poor adherence to treatment and failure to take medication as required.
Pathogen resistance and not choosing the right antibiotic.
Reinfection after cure.
Harmful
Transmitted to sexual partners through sexual contact, and to family members through indirect contact, affecting the health of family members.
Untreated urethritis can migrate to chronic urethritis and then progress to urethral stricture, which seriously affects the quality of life.
Secondary prostatitis, seminal vesiculitis or epididymitis not only affects the quality of life, but may also affect fertility.
Female urethritis can exist in combination with reproductive system infections, which can be secondary to endometritis, salpingitis, etc., and may affect fertility.
Severe symptoms such as urinary urgency, urinary frequency and urinary pain affect normal work and life.
Daily
Daily Management
Dietary management
A light diet with plenty of fresh fruits and vegetables is recommended.
Avoid intake of spicy and irritating foods, such as chili peppers, onions, ginger and garlic.
Balance nutrition and eat more food rich in protein and vitamins.
Quit smoking and drinking.
Exercise management
Appropriate exercise to enhance body resistance, choose jogging, yoga, tai chi and so on.
Avoid strenuous exercise in the acute stage and pay attention to rest.
Ensure sufficient sleep and rest, develop healthy work and rest habits, and avoid staying up late.
Life management
Pay attention to personal hygiene and keep the perineum clean.
Drink more water, urinate more often, do not have the habit of holding urine.
Change underwear and panties regularly, and try to choose cotton and breathable underwear and panties.
Prohibit coitus during treatment.
Pay attention to cleanliness before and after sex even after cure.
Psychological support
Seek medical treatment in time, do not avoid medical treatment, and do not have the psychology of procrastination.
Correctly recognize the disease, relax and maintain a positive attitude towards life.
Disease monitoring
Pay attention to urination during treatment and observe whether the discomfort symptoms such as frequent urination, urgency and pain of urination have improved.
Pay attention to whether the urethral secretion is reduced.
Follow-up
During the treatment, make sure to follow the doctor’s instructions to take the medication on time and according to the dosage, do not stop or change the dosage without authorization.
Regular checkups will allow the doctor to evaluate your condition and adjust the treatment plan.
Follow-up examinations usually include routine blood tests, routine urine tests, urine bacterial culture, and secretion smears.
Prevention
Adopt good living habits
Wash underwear separately and not with other clothes.
Pay attention to the hygiene of public places, such as when staying in hotels, pay attention to the protection of personal hygiene.
Drink plenty of water, urinate regularly and do not hold urine.
Actively engage in physical exercise to improve their own resistance.
Pay attention to the combination of work and rest, avoid sedentary, tired, late night, excessive fatigue.
Eat a light diet and avoid drinking alcohol, smoking and other bad habits.
Eliminate risk factors
Actively treat urinary stones, urinary tumors, phimosis, prepuce and other urinary system diseases.
If there is diabetes mellitus should actively monitor and control blood sugar.
If there are vaginitis, cervicitis and other gynecological diseases should be actively diagnosed and treated.
Maintain a good and healthy sex life
Be clean and avoid multiple sexual partners.
Women should not wash their private parts too frequently because the vagina has a self-cleaning function, and excessive washing may lead to an imbalance of flora and affect the self-cleaning function of the vagina.
Pay attention to personal hygiene before and after sex.
Avoid unclean sex and high-risk sex, and use condoms correctly.
Others
Avoid misuse of antibiotics, if you need to use antibiotics should consult a professional physician or pharmacist.
When suffering from non-specific urethritis, sexual partners need to be treated at the same time so as to have the expected curative effect.
Regular medical checkups for timely detection of urinary tract diseases and timely treatment.