eMedicine Specialties > Urology > Common Problems of the Urethra

Urethritis: Follow-up

Author: Martha K Terris, MD, FACS, Professor, Department of Surgery, Medical College of Georgia
Coauthor(s): Kamran P Sajadi, MD, Staff Physician, Division of Urology, Medical College of Georgia Health System
Contributor Information and Disclosures

Updated: Aug 10, 2009

Follow-up

Further Outpatient Care

  • Only patients who remain symptomatic require follow-up cultures to ensure eradication of infection.
  • If symptoms persist following adequate treatment, the disease is most likely nongonococcal urethritis (NGU). Prior to improved culture methods and increased awareness of the causes of NGU, symptom recurrences were thought to be psychological in nature. This is usually not the case, and most cases of recurrent NGU are related to persistent chlamydial, ureaplasmal, or mycoplasmal infection. These patients benefit from prolonged (14-28 d) therapy with erythromycin. Consider also quinolone resistance in gonococcal urethritis, based on local epidemiologic data.
  • Most infections after treatment are due to reinfection by the same or a new partner, stressing the need to educate patients and to treat partners.

Deterrence/Prevention

  • Educate at-risk patients on how to prevent disease recurrence.
  • Educate patients on risks of other sexually-transmitted infections, including HIV.
  • Try to find asymptomatic patients and symptomatic patients who are unlikely to seek treatment.
  • Early diagnosis and treatment of infected individuals is essential.
  • Evaluate and treat sexual partners of known infected persons.

Complications

  • Complications, such as stricture, stenosis, or abscess formation, are quite rare. Concomitant epididymitis or prostatitis is not uncommon.
  • PID and tubo-ovarian abscess are known complications of urethritis in females that may predispose to infertility. In addition, increasing evidence shows that genital chlamydial infection in males may predispose to infertility. In addition, both Chlamydia and U urealyticum can impair sperm and adversely affect semen parameters.2,3

Prognosis

  • All patients with uncomplicated urethritis spontaneously recover with or without treatment.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to detect or treat co-infections
  • Failure to identify and treat partners
  • Failure to screen for other STDs
 


More on Urethritis

Overview: Urethritis
Differential Diagnoses & Workup: Urethritis
Treatment & Medication: Urethritis
Follow-up: Urethritis
References
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References

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Further Reading

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Keywords

urethritis, gonococcal urethritis, nongonococcal urethritis, NGU, GU, urethral inflammation, urethra inflammation, infected urethra, STD, sexually transmitted disease, Neisseria gonorrhoeae, N gonorrhoeae, Chlamydia trachomatis, C trachomatis, Ureaplasma urealyticum, U urealyticum, Mycoplasma hominis, M hominis, Trichomonas vaginalis, T vaginalis, Mycobacterium, lymphogranuloma venereum, herpes genitalis, genital herpes, syphilis, mycobacteria, cystitis, urethral stricture, post-traumatic urethritis, posttraumatic urethritis, foreign body insertion, epididymitis, orchitis, prostatitis, proctitis, Reiter syndrome, iritis, pneumonia, otitis media, urinary tract infection, UTI, pelvic inflammatory disease, PID, disseminated gonococcal infection, DGI, infectious urethritis

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Contributor Information and Disclosures

Author

Martha K Terris, MD, FACS, Professor, Department of Surgery, Medical College of Georgia
Martha K Terris, MD, FACS is a member of the following medical societies: American Cancer Society, American College of Surgeons, American Institute of Ultrasound in Medicine, American Urological Association, New York Academy of Sciences, and Society of University Urologists
Disclosure: Nothing to disclose.

Coauthor(s)

Kamran P Sajadi, MD, Staff Physician, Division of Urology, Medical College of Georgia Health System
Kamran P Sajadi, MD is a member of the following medical societies: American Urological Association, Endourological Society, and National Association for Continence
Disclosure: Nothing to disclose.

Medical Editor

Leonard Gabriel Gomella, MD, FACS, The Bernard W Godwin Professor of Prostate Cancer Chairman, Department of Urology, Associate Director of Clinical Affairs, Kimmel Cancer Center, Thomas Jefferson University
Leonard Gabriel Gomella, MD, FACS is a member of the following medical societies: American Association for Cancer Research, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Urological Association, Sigma Xi, Society for Basic Urologic Research, Society of University Urologists, and Society of Urologic Oncology
Disclosure: GSK Consulting fee Consulting; Astra Zeneca Honoraria Speaking and teaching; Watson Pharmaceuticals Consulting fee Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Edward David Kim, MD, FACS, Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center
Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association
Disclosure: Lilly Consulting fee Consulting; Astellas Consulting fee Speaking and teaching; Indevus Consulting fee Speaking and teaching

 
 
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