Urethritis Follow-up

  • Author: Martha K Terris, MD, FACS; Chief Editor: Edward David Kim, MD, FACS   more...
 
Updated: Aug 10, 2009
 

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.
Next

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.
Previous
Next

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]
Previous
Next

Prognosis

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

Patient Education

Previous
 
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.

Specialty Editor Board

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

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

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

References

  1. Johnson LF, Lewis DA. The effect of genital tract infections on HIV-1 shedding in the genital tract: a systematic review and meta-analysis. Sex Transm Dis. Nov 2008;35(11):946-59. [Medline].

  2. Bradshaw CS, Chen MY, Fairley CK. Persistence of Mycoplasma genitalium following azithromycin therapy. PLoS ONE. 2008;3(11):e3618. [Medline].

  3. Gunn RA, O'Brien CJ, Lee MA, Gilchick RA. Gonorrhea screening among men who have sex with men: value of multiple anatomic site testing, San Diego, California, 1997-2003. Sex Transm Dis. Oct 2008;35(10):845-8. [Medline].

  4. Anagrius C, Lore B, Jensen JS. Mycoplasma genitalium: prevalence, clinical significance, and transmission. Sex Transm Infect. Dec 2005;81(6):458-62. [Medline].

  5. Frenkl T and Potts J. Sexually Transmitted Diseases. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders; 2006:371-85.

  6. Centers for Disease Control and Prevention. CDC Division of AIDS, STD, and TB. Gonococcal Isolation Surveillance Project (GISP) Annual Report - 2007. Atlanta, Ga: Centers for Disease Control and Prevention. [Full Text].

  7. [Guideline] Centers for Disease Control and Prevention, Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep. Aug 4 2006;55:1-94. [Medline].

  8. Chorba T, Tao G, Irwin K. Sexually Transmitted Diseases. In: Litwin MS, Saigal CS, eds. Urologic Diseases in America. 2004;233-79. [Full Text].

  9. Cunningham KA, Beagley KW. Male genital tract chlamydial infection: implications for pathology and infertility. Biol Reprod. Aug 2008;79(2):180-9. [Medline].

  10. Frenkl T, Potts J. Sexually Transmitted Infections: Part II - Associated Vaginitides and Urethritides. AUA Update Series. 2006;25:17-9.

  11. Isselbacher HK, Braunwald E, Wilson JD et al, eds. Harrison's Principles of Internal Medicine. 13th ed. New York, NY: McGraw-Hill; 1994.

  12. Jensen JS, Bradshaw CS, Tabrizi SN, Fairley CK, Hamasuna R. Azithromycin Treatment Failure in Mycoplasma genitalium-Positive Patients with Nongonococcal Urethritis Is Associated with Induced Macrolide Resistance. Clin Infect Dis. Dec 15 2008;47(12):1546-1553. [Medline].

  13. Kataria RK, Brent LH. Spondyloarthropathies. Am Fam Physician. Jun 15 2004;69(12):2853-60. [Medline].

  14. Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 5th ed. New York, NY: Churchill Livingstone; 1998.

  15. National Institute of Allergy and Infectious Diseases. Fact Sheet. STD Statistics. Bethesda, Md: National Institutes of Health; December 1998. [Full Text].

  16. Newman LM, Moran JS, Workowski KA. Update on the management of gonorrhea in adults in the United States. Clin Infect Dis. Apr 1 2007;44 Suppl 3:S84-101. [Medline].

  17. Ochsendorf FR. Sexually transmitted infections: impact on male fertility. Andrologia. Apr 2008;40(2):72-5. [Medline].

  18. [Guideline] Workowski KA, Levine WC. Selected topics from the Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines 2002. HIV Clin Trials. Sep-Oct 2002;3(5):421-33. [Medline]. [Full Text].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.