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Urethritis

Urethritis is inflammation of the urethra. It is usually an ascending infection in men. In women, it is usually associated with cystitis or vaginitis.

Pathophysiology and Causes of  Urethritis

1. Nongonococcal urethritis—urethritis not caused by gonococcus; may be sexually transmitted:

   a. Chlamydia trachomatis—most clinically significant of the pathogens, three cases of chlamydia diagnosed for every one case of gonorrhoea. Usually asymptomatic.

   b. Ureaplasma urealyticum and Mycoplasma genitalium responsible for up to one-third of cases.

   c. Trichomonas vaginalis and herpes simplex virus are other sexually transmitted organisms causing urethritis in men and women.

   d. Incubation period of 1 to 5 weeks depending on the organism; in some cases, infection may be subclinical for a period of time, particularly in men.

2. Gonococcal urethritis—caused by Neisseria gonorrhoeae, sexually transmitted; usually most virulent and destructive.

   a. Incubation period usually 3 to 10 days.

   b. Urethritis in homosexual men is more commonly gonococcal than nongonococcal.

3. Gonococcal and nongonococcal urethritis can both be present.

4. Nonsexually transmitted.

   a. Bacterial urethritis—may be associated with UTI.

   b. From trauma—secondary to passage of urethral sounds, repeated cystoscopy, indwelling catheter.

Signs and Symptoms of  Urethritis

1. Can be asymptomatic.

2. Itching and burning around area of urethra.

3. Urethral discharge: may be scant or profuse; thin, clear, or mucoid; or thick and purulent (gonococcal).

4. Dysuria and frequency.

5. Penile discomfort

Temporary Cardiac Pacing: Indication, Type of Pacing, Procedure, Complication

Diagnostic Evaluation of  Urethritis

1. Gram stain—N. gonorrhoea is detected as Gram-positive diplococci on microscopic examination of urethral discharge or urine.

2. Culture of urethral discharge on selective medium.

3. Deoxyribonucleic acid (DNA) amplification tests on urethral voided specimen or other DNA/antibody tests of urethral discharge (currently, primary test)—to detect C. trachomatis and N. gonorrhoea.

4. Wet mount microscopic examination of fresh urethral discharge—trichomonads may be visible and motile.

5. First voided urine for screening either positive leukocyte esterase test by dipstick or greater than 10 WBC per high power field by microscopy indicates urethritis.

6. In rare cases, urethroscopy may be necessary to isolate a lesion such as warts caused by human papillomavirus (HPV).

Management of  Urethritis

 1. Gonococcal urethritis: one dose oral antibiotic of cefixime 400 mg; or one-dose I.M. treatment with ceftriaxone 125 mg

2. Chlamydial urethritis: single dose of oral antibiotic azithromycin 1 g or doxycycline 100 mg orally twice per day for 7 days.

 3. Unless proven otherwise by negative testing, treatment for chlamydia is given along with treatment for gonorrhoea.

 4. Recurrent urethritis despite appropriate treatment for nongonococcal urethritis or confirmed presence of Trichomonas vaginalis one dose oral metronidazole 2 gm.

Complications of  Urethritis

Depends on cause, but may include:

 1. Prostatitis, epididymitis, urethral stricture, sterility due to vas epididymal duct obstruction.

 2. Rectal infection, pharyngitis, conjunctivitis, skin lesions, arthritis with gonococcal infection.

 3. Long-term complications of these infections in women include pelvic inflammatory disease and infertility.

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Nursing Assessment of  Urethritis

 1. Obtain history of unprotected sexual contact and assess patient’s understanding of risk.

 2. Assess for signs and symptoms involving urinary and reproductive tracts.

 3. Perform genital and abdominal examination to assess for extent of infection.

Nursing Diagnoses of  Urethritis

 1. Risk for Infection related to ascending or systemic spread of pathogens.

 2. Risk for Infection related to high-risk sexual activity.

Nursing Interventions of  Urethritis

Resolving Infection and Preventing Complications

1. Collect urethral swab of discharge, urine, and blood, as ordered, for laboratory examination.

2. Use standard precautions when handling specimens.

3. Administer antibiotics, as prescribed.

   a. Usually ordered based on presumptive diagnosis before test results are obtained.

   b. Monitor for and advise patient of adverse effects or allergic reactions.

Preventing the Spread of Infection

1. Encourage compliance with an antimicrobial regimen for the prescribed time period.

2. Advise abstinence from sexual activity until treatment is complete and cure is established (usually 7 to 10 days).

3. Instruct the patient to avoid sexual activity with previous sexual partner until that person has been tested and treated for infection as well.

4. The use of condoms may prevent transmission, but depends on technique.

Patient Education and Health Maintenance

1. Advise safer sex practices, such as abstinence, mutual monogamy, and use of male or female condoms to prevent transmission of sexually transmitted organisms as well as unintended pregnancy.

2. Emphasize the need for follow-up care if symptoms persist or return.

3. Advise patient that reporting of gonorrhoea to the public health department is required by law in all of the United States and Canada.

4. Tell patient that he or she will be called on to name all sexual partners within the past 60 days and that the process will be confidential.

5. Provide written information about all STDs and ensure that patient understands the dangers of high-risk sexual behaviour.

Evaluation: Expected Outcomes

1 Signs of infection resolved.

2 Reports of sexual contacts have been treated.