Male Urethritis in Emergency Medicine 

  • Author: Michael C Plewa, MD; Chief Editor: Erik D Schraga, MD   more...
 
Updated: Apr 15, 2010
 

Background

Urethral discharge, dysuria, and exposure to a sexually transmitted disease (STD) are frequent presentations of urethritis in the male population presenting to the ED. Recent research has focused on cost-effective antibiotic therapy with minimal adverse effects and dosing; the goal is to optimize compliance and prevent recurrence of this disease, which is predominantly sexually transmitted.

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Pathophysiology

Inflammation of the urethra is more frequently infectious than posttraumatic, with sexually transmitted diseases (STDs) the most common cause. Sexually transmitted urethritis is classified as either gonococcal urethritis (GCU) following infection with Neisseria gonorrhoeae, or nongonococcal urethritis (NGU) from organisms such as Chlamydia trachomatis, Ureaplasma parvum, Ureaplasma urealyticum, Mycoplasma hominis, Mycoplasma genitalium,Trichomonas vaginalis, and Gardnerella vaginalis.[1, 2, 3]

Idiopathic urethritis, defined as urethritis in the absence of nucleic acid amplification testing (NAAT) evidence for the most common infectious causes (N gonorrhoeae, C trachomatis, M genitalium, and T vaginalis), may be considered the largest category.[4]

Unusual infectious causes of urethritis include herpes genitalis, syphilis, mycobacterium, adenovirus, cytomegalovirus, as well as typical bacteria (usually gram-negative rods) associated with cystitis in the presence of urethral stricture or following insertive anal sex.

Urethritis following trauma is less common, but it can occur with intermittent catheterization or after urethral instrumentation or foreign body insertion. Fewer than 20% of patients practicing intermittent catheterization suffer urethritis; however, use of latex instead of silicone catheters significantly increases this risk. Symptoms of urethritis (urethral syndrome) can also be due to sensitivity to chemicals in spermicidal or contraceptive jellies or foams.

Idiopathic urethritis of childhood is of uncertain cause, perhaps related to dysfunctional elimination syndrome,[5] and presents as blood-stained urethral discharge, bleeding between micturition, or dysuria in the 5- to 15-year-old male.[6]

Urethritis involves local mucous membrane epithelial cell damage or invasion by an infectious agent (bacterial, viral, or fungal) followed by inflammatory changes including accumulation of leukocytes and chemical mediators (antibodies, cytokines, and interleukins) with resultant swelling, discharge, and pain.

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Epidemiology

Mortality/Morbidity

Urethritis usually resolves without complication, even if untreated, yet it can result in urethral stricture, stenosis, or abscess formation in rare cases. Urethritis can occur in a continuum with concomitant seminal vesiculitis and epididymitis.[7]

Recurrent urethritis may occur from reinfection, therapeutic failure or "venereophobia," an old term describing fear of recurrence where men can induce urethral inflammation and drainage (negative by white blood cell or Gram stain criteria) by repeatedly milking the urethra checking for infection.[8]

Sex

This article discusses male urethritis.

Age

Urethritis is predominantly a disease of adolescent and adult men. The prevalence is greatest in men younger than 25 years.

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Contributor Information and Disclosures
Author

Michael C Plewa, MD  Research Coordinator, Consulting Staff, Department of Emergency Medicine, Lucas County Emergency Physicians, Inc, and Mercy Saint Vincent Medical Center

Michael C Plewa, MD, is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Physicians for Social Responsibility, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

David S Howes, MD  Professor of Medicine and Pediatrics, Section Chief and Emergency Medicine Residency Program Director, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

David S Howes, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physicians-American Society of Internal Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: eMedicine Salary Employment

Richard H Sinert, DO  Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD  Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

References

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