Urethritis: structural features of the urinary tract, description of the pathology. Non-infectious urethritis: description of pathology, causes, symptoms, diagnosis, treatment methods Non-infectious urethritis symptoms

Urethritis - inflammation of the urethra , a very common urological disease. As a rule, urethritis in men is more severe than urethritis in women. The cause of urethritis is most often the presence of a sexually transmitted infection in one of the partners.

Symptoms of urethritis

The insidiousness of the disease lies in the fact that the usual general inflammatory manifestations (fever, weakness, malaise) are most often not observed with urethritis. The disease urethritis can generally occur without pronounced symptoms. In this case, one of the partners may suffer the disease much more severely. Urethritis can make itself felt even after a considerable time after infection - from several hours to several months with nonspecific infectious urethritis.

The main symptoms of urethritis may be as follows:

pain and burning when urinating (in women they are localized mainly at the end of the urethra (outside), in men - along the entire length of the urethra);
copious mucopurulent discharge from the urethra (mainly in the morning) with a sharp, specific odor;
frequent urge (with an interval of 15-20 minutes) to urinate;
incomplete emptying of the bladder;
urinary disorders;
cloudy urine, drops of blood may appear in it at the end of urination;
change in the external opening of the urethra in color and shape;
irritation of the glans penis and foreskin in men;
pain during erection in men;
high level of leukocytes in a general urine test.

Types of urethritis

Depending on the degree of intensity of the process and the duration of the disease, there are acute urethritis And chronic urethritis .

For acute urethritis characterized by a bright onset and severity of all symptoms, the duration of the disease is up to 2 months.

Chronic urethritis (disease lasting more than 2 months) is characterized by a duration of course, erased symptoms and the development of complications.

Based on the nature of occurrence, the following types of urethritis are distinguished:

primary (after sexual intercourse or therapeutic manipulations in the groin area) and secondary urethritis (the appearance of infection from other organs of the genitourinary system);
allergic urethritis (allergy to medications, shampoos, soaps, condoms);
chemical urethritis (reaction to drugs entering the urethra);
mechanical urethritis (occurs due to mechanical damage to the urethra);
infectious urethritis (caused by specific pathogens, such as chlamydia, mycoplasma, ureaplasma, gardnerella, gonococcus, and nonspecific pathogens (streptococcus, staphylococcus, E. coli);
non-infectious urethritis , occurs due to injuries to the urethra (due to the passage of a stone during urolithiasis, when using a bladder catheter), as well as due to narrowing of the urethra and congestion in the pelvis;
nonspecific urethritis - purulent inflammation, which is caused by streptococci, staphylococci and E. coli;
specific infectious urethritis - appears as a result of a sexually transmitted infection.

According to pathological signs, the following types of urethritis can be distinguished:

gonorrheal urethritis (the causative agent of the disease is gonococcus, infection through sexual intercourse with an infected person, through underwear, general hygiene and personal items - washcloths, towels, etc.);
bacterial urethritis (the causative agent is a nonspecific bacterial flora, the disease can appear as a result of endoscopic manipulations or long-term use of a catheter);
trichomonas urethritis (characterized by the presence of foamy, whitish discharge, itching, and in the absence of treatment quickly becomes chronic and trichomonas prostatitis);
candidal urethritis (the causative agent is a yeast fungus that affects the mucous surface of the urethra, appears after long-term use of antibacterial drugs, less often after contact with an infected partner);
chlamydial urethritis (viral urethritis, affects the urethra, conjunctiva, vagina and cervix).

Features of urethritis in men and women

Men (due to their anatomical structure - a longer and narrower urethra) feel the manifestations of urethritis earlier and more acutely, while a woman may not notice its symptoms at all. Men may experience redness and sticking of the sponges of the external opening of the urethra in the morning.

Urethritis in men

The cause of urethritis in representatives of the stronger sex can be the following factors:

infection through sexual intercourse;
hypothermia of the body;
presence of stress;
unbalanced diet with a lot of spicy, sour, salty foods;
inflammatory process in the body;
the presence of urolithiasis.

Chronic urethritis in men occurs rarely when the following conditions occur:

untreated acute urethritis;
expansion of the inflammatory process to the entire urethra and prostate gland;
weakening of the immune system.

Urethritis in women

Compared to urethritis in the stronger sex, female urethritis appears as a result of various infections. If the disease is not treated, then due to the female anatomical structure, urethritis can quickly develop into cystitis.

Various infections play a major role in the disease of urethritis in women. Among the infectious types of urethritis in women, the most common is gonorrheal. Within 12 hours of infection, a woman may experience symptoms of acute urethritis. If left untreated, after 20 days the disease becomes chronic.

Quite often, women become infected with the following types of urethritis: chlamydial , trichomonas or candida .

Candidal urethritis in women can occur with long-term use of antibacterial agents.

Typically, the first signs of the disease occur at the beginning of menstruation, the cessation of contraceptives, or the onset of menopause.

Diagnosis and treatment of urethritis

Treatment of urethritis requires careful diagnosis; you need to undergo special tests for urethritis. First of all, this is the collection and culture of secretions from the urethra (if they are absent, an analysis of the first portion of urine is collected). Laboratory diagnostics makes it possible to determine the causative agent of urethritis and its sensitivity to various groups of antibiotics. This allows you to make a correct diagnosis and prescribe adequate therapy.

An important diagnostic method is urethroscopy.

In addition, additional studies (ultrasound, MRI) may be required to exclude an inflammatory process in other organs (in women - in the bladder, in men - in the prostate gland and seminal vesicles).

Treatment of urethritis

The standard treatment program for urethritis consists of 3 stages:

establishing and clarifying the diagnosis;
drug therapy;
conducting a re-examination.

Drugs for the treatment of urethritis

A typical treatment program for urethritis includes the following treatments for urethritis:

antibiotics (for urethritis they vary depending on the type of disease);
medicines that restore intestinal microflora;
anti-inflammatory drugs;
antihistamines;
immunostimulants;
vitamin complexes.

Self-medication in this case can lead to serious complications. Only a urologist can select the correct medications for the treatment of urethritis based on the results of the examination.

The course of treatment can last from several days to several weeks and depends on the form of the disease. Treatment of urethritis is usually carried out on an outpatient basis, but severe purulent complications require hospitalization.

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Urethritis is a chronic or acute inflammation of the urethra (urethra). The disease can occur in an infectious or non-infectious form.

We will consider further what causes the development of urethritis, what are the signs in adults, and what is prescribed for diagnosis and treatment.

What is urethritis?

Urethritis is an inflammation of the wall of the urethra. Usually has an infectious nature. It extremely rarely develops without the presence of an infectious agent (radiation, toxic, allergic). Sometimes the cause of the disease is injury during a diagnostic or therapeutic procedure (catheterization of the bladder in men, administration of drugs, etc.).

In men, urethritis is slightly more common than in women, and always occurs in more severe forms. This is due to the anatomical features of the male and female urinary system.

Kinds

There are primary and secondary urethritis.

With primary inflammation of the urethra, the infection penetrates directly into the urethra, most often through sexual contact with a partner who has a sexually transmitted disease.
Secondary urethritis occurs when infection spreads from an inflammatory focus located in another organ (pelvic organs, seminal vesicles, bladder, prostate gland).

In accordance with the localization of the inflammatory process, urethritis is of the following types:

anterior - if the inflammation is localized in the area from the external opening to the external urethral sphincter;
posterior – with damage to the urethra located between the sphincter and the opening opening into the bladder cavity;
total.

Gonorrheal urethritis

The causative agent of the disease is gonococci that enter the body during sexual intercourse. In addition, infection can occur through shared objects, such as a towel.

Candidiasis urethritis

The causative agent is yeast-like fungi. Inflammation of the urethra of fungal etiology is rare and is usually a complication after long-term treatment with antibacterial drugs. Sometimes it develops after sexual contact with a woman who suffers from candidiasis vulvovaginitis.

The risk of infection increases if there is a history of inflammatory diseases or damage to the urethra.

Patients complain about:

slight burning sensation
slight itching,
whitish scanty discharge from the urethra.

Trichomonas

The causative agents of Trichomonas urethritis are considered to be single-celled microorganisms Trichomonas vaginalis, which enter the urethra during sexual contact with an infected partner. The waste products released by Trichomonas damage epithelial tissue in the area of infection, allowing toxins to freely penetrate into the intercellular space.

Symptoms do not appear immediately, but after approximately 5-15 days. This species is characterized by a whitish, foamy discharge from the urethra, as well as mild itching in the genital area.

Chlamydial form

The cause is infection with chlamydia. Discharge from the urethra may contain pus or mucus or may not appear at all. Unnoticed or not treated in time, chlamydial urethritis can lead to complications.

In men, symptoms of this type may not appear at all, which makes such patients the main source of infection with Trichomonas urethritis.

Causes

The causative agents of the disease are bacteria and viruses. Often the cause of inflammation of the urinary tract is E. coli, as well as infections that cause sexually transmitted diseases (,).

Viral causes include cytomegalovirus and virus.

Among the infectious agents that provoke the development of urethritis, the most common are the following:

herpes simplex virus;
coli;
gonococcus (diplococcus family Neisseriae);
Trichomonas;
staphylo-, entero-, pneumo-, streptococci;
fungi of the genus Candida;
chlamydia;
mycoplasma;
gardnerella.

Quite often it is not possible to isolate a single pathogen that causes urethritis; a combination of several pathogenic microorganisms is determined.

Non-infectious urethritis is provoked by hypothermia, the influence of allergens, and may result from injury to the mucous membrane of the urethra or exposure to aggressive chemical compounds.

The main risk factors for the development of urethritis include:

Reproductive age;
Promiscuous sex life;
Repeatedly recurring venereal diseases.

Symptoms of urethritis in adults

Symptoms to watch out for:

One of the first symptoms of urethritis is painful urination. It is advisable to contact a specialist at this stage, since there is a high probability of preventing further spread of inflammation.
If you continue to ignore the discomfort that occurs during urination, the next symptom is purulent discharge.
In some cases, inflammation of the external urethral opening can be observed.

With each subsequent exacerbation of the disease, inflammation affects an increasingly significant part of the mucous membrane of the urethra. Therefore, the symptoms of urethritis become more pronounced with each exacerbation. If the disease is not treated with adequate methods, complications may occur.

Acute urethritis

Signs of acute urethritis appear after a few days (the duration of the period depends on the type - from 2-3 days to 5-20 days). Appears:

discharge from the urethra,
bothered by pain during urination.

General signs:

itching and other unpleasant sensations during urination;
pain in the pubic area - periodic, aching;
in men – disturbance of urination, difficulty in the outflow of urine, up to acute retention;
purulent discharge from the urethra;
blood in the urine - hematuria;
the external opening of the urethra in the morning seems to be glued together.

Chronic form of urethritis

With chronic urethritis, which manifests itself as a result of an incorrect approach to treatment or the complete absence of it, neurotic phenomena are possible. Most often, with this form of urethritis there is: small discharge from the urethra.

They become more abundant subject to the presence of certain factors that provoke an exacerbation of the disease. This could be heavy drinking, agitation, or hypothermia.

The course of the disease can be long-term, which means not only months, but also years, which ultimately may lead to a visit to the doctor (if this was done earlier, before the disease progressed to this form).

A long course of this form of urethritis can provoke urethral stricture, in which the urethra in the lumen begins to narrow, which is why urination is accompanied by a change in the stream of urine (it becomes weak) and pain.

Complications

Complications of urethritis can be:

chronicity of the process;
prostatitis, cooperitis, epididymitis, vesiculitis, erectile dysfunction, balanitis, balanoposthitis, etc. in men;
periurethral abscess;
ascending infection (cystitis, nephritis);
paraurethritis;
deformation of the urethra (scarring).

Diagnostics

Diagnostics include:

Laboratory diagnosis of bacterial urethritis is carried out using microscopic and microbiological analysis of urine. The presence of red blood cells, mucus and bacteria in the samples proves the fact of a urinary tract infection.
It is recommended to carry out a bacterial culture of urine and a smear from the urethra, and determine the sensitivity of the pathogen to antibiotics. This allows treatment to be carried out more efficiently and accurately.
Sexually active people must be excluded from sexually transmitted diseases. The optimal method is polymerase chain reaction (PCR). The technology makes it possible to diagnose any infections quickly and accurately.

How to treat urethritis?

Identification of any symptoms indicating the development of urethritis is the basis for seeking advice from a urologist. The diagnosis is clarified based on the patient’s complaints, the results of an examination of his genitals and a number of laboratory tests (CBC, FAM, urethral smear, culture for sensitivity to antibacterial drugs).

Treatment of urethritis begins with antibiotics. The medicine is selected depending on the causative agent and the severity of the inflammation. In case of an acute process, broad-spectrum antibiotics are immediately prescribed, then they switch to drugs to which the sensitivity of the microflora in a particular case has been identified.

The main treatment measures are rinsing with antiseptic drugs, aimed directly at the area of the urethra; antibiotics can also be used. Efficacy in the treatment of urethritis is determined by the use of erythromycin and tetracyclines.

Additional effect is achieved through:

physiotherapy procedures (warming applications, electrophoresis, etc.),
local treatment (for example, sitz baths based on herbal decoction),
taking immunostimulants and immunomodulators.

Directions for treatment of chronic urethritis:

use of antibacterial drugs- the same as for acute urethritis, taking into account the sensitivity of microorganisms to antibiotics (monitoring is carried out periodically - smears are taken from the urethra for bacteriological examination and determination of the sensitivity of microorganisms to antibacterial agents);
instillation (rinsing) urethra with solutions of antiseptics, for example, furacillin;
immunocorrectors– medications that increase the body’s defenses;
vitamin and mineral complexes– are necessary to maintain protective forces and restore the mucous membrane of the urethra.

Folk remedies only complement the main treatment. Chamomile tea, parsley roots and greens, carrots and celery, lingonberries and cranberries, beets - these products are introduced into the daily diet. Herbal infusions are prepared separately and taken for at least a month (St. John's wort, sage, horsetail).

After a course of treatment for urethritis, an examination is carried out to determine whether the patient is healthy. The criteria for cure are:

No foreign discharge from the urethra within two weeks after the course of treatment.
No inflammation of the urethra.
Disappearance of itching and burning during urination.

Prevention

The likelihood of the disease occurring can be minimized by following some simple rules:

First of all, casual relationships should be avoided.
Maintaining good personal hygiene also reduces the likelihood of infection.
Quitting bad habits: smoking and excessive consumption of strong alcoholic beverages.
Regular preventive monitoring by a urologist.
Diet: do not abuse spicy, pickled, salty foods.
Timely treatment of infectious diseases of the genitourinary system.
Avoid hypothermia.

Urethritis, like any other urological disease, requires timely treatment. If you experience unpleasant symptoms when urinating, be sure to visit a urologist for an accurate diagnosis.

Urethritis essentially an inflammatory process that develops in the tissues that form the urethra (urethra). Any inflammation is characterized by swelling and local stagnation of blood, leading to pain and subsequently to disruption of the normal functioning of the affected organ. With urethritis, the wall of the urethra swells, preventing the passage of urine, and the integrity of the epithelium is disrupted, which manifests itself in pain or pain.

Common signs of urethritis are pain of varying intensity when urinating, mucous or purulent discharge from the urethral canal and redness of the tissues that surround the urethral outlet. The severity of symptoms depends on the clinical form of the disease - acute, subacute or chronic. Symptoms of urethritis vary depending on the type of pathogen and the anatomical features in the structure of the male or female urethra.

Anatomical features of the urethra

In men, the length of the urethra is on average 20-23 cm. Conventionally, it is divided into the posterior part, which unites the membranous and prostatic parts of the canal, and the cavernous part, which is called anterior urethra. Topography is important for choosing medical tactics: for inflammation of the anterior or posterior urethra, different approaches to the treatment of urethritis are used. Anterior urethritis is complicated in 90-95% of cases, posterior – inflammation of the bladder with ascending infection, frequent urge to urinate.

The male urethra is distinguished by physiological local expansions and narrowings of its lumen. The wide part (scaphoid fossa) extends up to several centimeters and ends with an external opening, the narrow part falls on the posterior urethra. Several depressions in the mucosa are formed by the exits of the urethral glands. The walls of the urethra are always closed outside of urination, the external opening is covered by folds of the skin of the head of the penis.

structure of the female (left) and male (right) urethra

In women, the urethra is short, only 1.5-3 cm, and is about one and a half times wider than the male one. The external opening is covered by the labia minora, inflammation from the urethra easily spreads to the vagina and then to the cervix. Urethritis is very often combined with inflammation of the bladder - cystitis, is complicated by ascending infection of the ureters and renal pelvis. In the chronic form of urethritis, urinary incontinence may develop.

Video: urethritis and its consequences in medical animation

Clinical forms of urethritis

Acute urethritis is characterized by intense inflammation, during the day – multiple times, which may not stop even after urination. For subacute urethritis, the main symptom is the appearance of discharge only after active pressure on the urethra.

Chronic urethritis is more difficult to notice: discharge occurs mainly after provocations, which can occur in men - alcohol, spicy food, in women - the beginning of menstruation, withdrawal of contraceptives, menopause. The diagnosis of chronic urethritis is made in cases where the duration of the disease is more than two months or the patient is not exactly sure about the time of onset of the first symptoms.

Urethritis, nonspecific and specific

According to the type of causative agent of the disease, urethritis can be bacterial, viral and fungal, that is, infectious. Non-infectious urethritis develops with inflammation of the urethra due to allergic reactions, after injuries to the urethra with catheters or bougies, and with strictures.

Urethritis caused by a sexually transmitted infection is called specific, all others are called nonspecific.

Nonspecific urethritis is caused by bacteria for which sexual transmission is not the main route. Bacterial nonspecific urethritis can be obtained through household contact (through linen or a towel, toilet paper, “public” solid soap), failure to comply with normal hygiene rules, or the spread of infection from a source of inflammation inside the body. The main pathogens are streptococci and staphylococci, Escherichia coli, Klebsiella, and Haemophilus influenzae.

Manifestations of gonorrheal (gonococcal) urethritis

Wu mu In women, acute urethritis is the most common manifestation. After infection, on average, 2 to 7 days pass quietly, gonococci multiply in the urethra asymptomatically. When a certain critical number of pathogens is reached, symptoms of urethritis appear. The time elapsed from the moment of infection to the pronounced onset of the disease is called the incubation period. For gonorrheal urethritis it varies from 2 days to 2 weeks.

The main symptoms are discharge from the urethra and acute pain when urinating. At first, the urethral discharge is quite scanty and mucous, but quickly turns into copious and purulent. It is these signs that distinguish gonococcal urethritis from non-gonococcal urethritis. Men with “erased” forms of gonorrheal urethritis, the development of which is possible when the disease becomes chronic or due to improper treatment, are especially dangerous as spreaders of the infection. In addition, this group is more likely to suffer from complications that can lead to male infertility.

Among women diagnosed with gonococcal urethritis, more than 70% do not experience any discomfort from the urethra. There may be nagging pain in the lower abdomen, mild irritation and hyperemia (redness) of the labia minora. Discharge from the urethral canal is scanty, often women do not notice it at all. Sometimes the disease is detected quite late, when inflammation affects the internal genital organs - the vagina, uterus and fallopian tubes.

In this case, the pain intensifies, there is more discharge, and heavy bleeding (menorrhagia) begins during menstruation. Gonococci can also spread through the bloodstream, causing inflammation of the kidneys and liver, brain and heart, muscles and joints.

Chlamydial urethritis

The incubation period lasts on average from 4 days to 4 weeks, then There is a tingling and burning sensation in the urethra when urinating. Men have mucous discharge, can be completely transparent or slightly cloudy, turning into purulent . In women, the symptoms of urethritis are an increased urge to urinate, during sexual intercourse - pain in the lower abdomen, yellowish mucous or purulent discharge from the urethra and.

Without adequate treatment, nongonorrheal urethritis becomes chronic, with inflammation continuing for many months and years. As a result, women develop scars in the fallopian tubes, leading to ectopic pregnancy or infertility. In men, chronic urethritis is complicated by inflammation of the testicular appendages (), which is manifested by unilateral or bilateral swelling of the scrotum and prostatitis.

Complications: inflammation can result in the formation of persistent narrowing or partial fusion of the walls of the urethra, leading to female and male infertility, and impaired sexual function.

Candidiasis and viral urethritis

These types of urethritis are characterized by a burning sensation in the urethra, severe pain and frequent painful urination and periodic relapses.

Candidal urethritis manifests itself through direct (sexual or household) infection with yeast fungi of the genus Candida, as well as as a complication after treatment with antibiotics or when the body’s immune defense is reduced. Often combined with vaginal candidiasis, commonly known as. Characterized by copious liquid discharge and a grayish coating in the area of the external opening of the urethra.

Viral urethritis is caused by a simple human. The reproduction cycle of this virus is only 14 hours, and it is transmitted primarily through sexual contact. So patients’ suspicions that urethritis appeared after sex are completely justified. Symptoms can develop quickly, within 24 hours, especially due to stress or hypothermia. In men, discharge from the urethra is mucous, mainly noticeable in the morning in the form of a drop. During urination, a tingling sensation is felt, then the pain intensifies. The inguinal lymph nodes may become enlarged and the body temperature may rise.

The distinctive visible signs of viral urethritis are the appearance of small blisters, erosions and ulcers grouped around the external opening of the urethra. Elements of the rash can merge, ultimately forming lesions covered with a yellowish crust and having jagged edges. The duration of viral urethritis is up to 2 weeks, relapses are possible at intervals from a month to several years.

Trichomonas urethritis

The asymptomatic presence of Trichomonas, called carriage, is found in 20-37% of infected people.

The inflammation is moderate, but the waste products of Trichomonas are toxic to the human body: they loosen the surrounding tissues, facilitating the spread of the process. A distinctive feature of Trichomonas urethritis is constant itching. At the onset of the disease, men may experience a sensation of “pins and needles” in the area of the head of the penis., on the first day - small watery grayish-white discharge, semen mixed with blood. Within a month, these manifestations subside, then torpid urethritis develops, which is aggravated by drinking alcohol, after sexual intercourse, and with general and local hypothermia.

Local complications of Trichomonas urethritis - erosions and ulcers on the genitals, reminiscent of. Ulcers often have a clean, bright red bottom, less often with a purulent coating, and soft, rolled edges of irregular shape.

Trichomonas urethritis is especially dangerous for the female body., since in most cases it occurs without specific treatment and leads to complications during pregnancy or to infertility. In men, inflammation spreads from the anterior part of the urethra to the posterior part, causing prostatitis, epididymitis and subsequently also infertility. Trichomonas have been nicknamed “silent killers” for the contrast between the insignificance of symptoms and the severity of general complications.

Urethritis in pregnant women

Urethritis during pregnancy often occurs due to pharyngitis(inflammation of the pharynx) caused by chlamydia, mycoplasma or ureaplasma infection, gonorrhea. Infection can occur before or during pregnancy. Exacerbation of asymptomatic chronic infection occurs due to increased internal pressure on the urethra and expansion of its external opening; infection in early pregnancy is caused by increased libido.

Symptoms of urethritis are the same as in non-pregnant women. Worry about frequent urge to urinate, burning and pain in the urethra, itching in the perineum, discharge from the vagina and urethra.

The main danger of urethritis during pregnancy is the negative impact on the child and the development of complications during pregnancy and childbirth. The risk for the newborn is sepsis, infection of the membranes, intrauterine death. The infection can be transmitted to the child during childbirth: a common form of gonorrhea is specific conjunctivitis or gonoblenorea, which doctors should suspect first of all if they notice discharge from the eyes of a newborn before 2-3 days of life.

Chlamydia can cause pneumonia, inflammation of the conjunctiva, and nasopharyngitis in a child. Mycoplasmas and ureaplasmas easily penetrate the amniotic fluid and the fetus, but appear only in premature babies.

The risk for the mother is premature birth, spontaneous abortion and bleeding.

Pregnant women with chlamydial and mycoplasma infections belong to the risk group and are treated before birth and, if necessary, after. Chlamydial urethritis is treated in both sexual partners with the use of antibiotics, prescribing them to pregnant women only after 12-16 weeks; use josamycin, amoxicycline. For gonorrheal urethritis, specinomycin, ceftriaxone, and cefixime are prescribed. Ureaplasma and mycoplasma urethritis: treatment is carried out with josamycin, starting from the second trimester of pregnancy.

Diagnosis of urethritis

Survey, analysis of information received. The doctor is interested in what exactly worries the patient and when the first manifestations of urethritis appeared, and finds out the time connection between the symptoms of the disease and sexual intercourse.
Urological examination performed by a urologist or gynecologist. The external opening of the urethra is visually assessed, the presence and nature of the discharge - serous or purulent, liquid or viscous, abundant or scanty. Examination of the perineal area and external genitalia: detection of hyperemia, plaque, rash, erosions and ulcers, external scar changes.
from the urethra for inoculation on a nutrient medium and microscopic examination of the cellular composition of the material. With trichomonas urethritis, in fresh secretions under a microscope you can see actively moving flagellates: the phenomenon is called “Trichomonas dancing”.
Urethroscopy, instrumental examination method. A thin probe with fiber light guides is inserted into the urethra, thanks to which you can examine the condition of the walls of the canal and assess the degree of its narrowing. A contraindication for urethroscopy is urethritis in the acute phase.
Urethrography, X-ray examination of the urethra with the introduction of an X-ray contrast agent into it.
Traditional tests:
1. A general blood test for urethritis will indicate signs of acute or chronic inflammation - leukocytosis; for purulent inflammation - an increase in the number of neutrophils;
2. biochemical analysis - increased inflammation marker, c-reactive protein;
3. urine test, first portion - the presence of epithelial cells, leukocytes, traces of blood.
(polymerase chain reaction), a fast and reliable option for diagnosing specific urethritis infections. Suitable materials include epithelial scrapings, urethral discharge, blood and serum.
Ultrasound of the pelvic organs: in women – monitoring the condition of the ovaries, uterus and bladder; in men - the bladder, seminal vesicles and prostate gland.

The diagnosis is made after evaluating the data obtained from examinations. A correctly completed diagnosis must be entered into the medical history (or outpatient card) in Latin and contain an indication of the location of the process - urethritis, the clinical form - acute, subacute or chronic, and the causative agent. In the Russian version, the diagnosis looks somewhat different, in the first place is the form, then the pathogen, and finally urethritis. For example, acute gonococcal urethritis.

Principles of treatment of urethritis

Nonspecific urethritis: cephalosporins (cefataxime, ceftriaxone), macrolides (clarithromycin), a group of fluoroquinolones (clinafloxacin).
Gonorrheal urethritis: cefacor, spectinomycin, ceftriaxone. Antibiotics are selected to which both gonococci and chlamydia are sensitive.
Trichomonas urethritis: imorazole, trichopolum (metronidazole), iodovidone suppositories.
Candidal urethritis: clotrimazole (vaginal tablets or cream, capsules), fluconazole.
Mycoplasma and chlamydial urethritis: group of tetracyclines (doxycycline), macrolides (clarithromycin).
Viral urethritis: ganciclovir, ribavirin - antiviral drugs.

To reduce inflammatory and reactive edema it is used non-steroidal anti-inflammatory drugs(aspirin), antihistamines (suprastin), antispasmodics (no-spa, papaverine) and diuretics.

Immunostimulants and probiotics prescribed to activate the body's natural defenses: injections of cycloferon, ribomunil, vitamins (B-group, PP, A, E, C), Linex or yogurt.

Biostimulants– aloe, homeopathic preparations – used for targeted exacerbation of chronic urethritis. As a result, susceptibility to treatment increases and the susceptibility of pathogens to antibiotics increases.

Enzyme therapy: Enzymes that break down proteins are prescribed. Action – anti-inflammatory, immunomodulatory.

Local treatment: instillation - the introduction of liquid medications into the urethra. Silver preparations (collargol) are used, the procedure is performed only in honey. institution using a sterile catheter.

Bougienage– instrumental dilatation of the urethra with the development of strictures of the urethra.

Physiotherapy: locally - medicinal baths, UHF exposure, electrophoresis with antibiotics.

Folk remedies only complement the main treatment. Chamomile tea, parsley roots and greens, carrots and celery, lingonberries and cranberries, beets - these products are introduced into the daily diet. Herbal infusions are prepared separately and taken for at least a month (St. John's wort, sage, horsetail).

Diet: It is recommended to exclude spicy and salty foods and alcohol. Drink more clean water, focus on fresh vegetables and fruits. When using diuretics, potassium is removed, so the diet is supplemented with dried apricots, prunes, and raisins.

Urethritis can be treated at home; only patients with an acute form of the disease are hospitalized. Treatment at home allows you to take medications, use vaginal suppositories, use medicinal baths, adhere to a regimen and a therapeutic diet. All manipulations (injections, instillations, bougienage) are carried out in a hospital.

Video: folk remedies useful for urethritis

Prevention of urethritis

Use a condom.
Follow the rules of personal hygiene. If sexual intercourse took place without a condom: urinate, wash the external genitalia with plenty of warm water and liquid soap. Use antiseptic solutions (Miramistin, Gibitan) for a maximum of 2 hours after sexual intercourse.
Avoid hypothermia, promptly treat diseases of the genitourinary system.
Periodically (1-2 times a year) undergo a medical examination.
Refrain from casual sex.

Video: urethritis in the program “Live Healthy!”

Urethritis is one of the most common diseases, which manifests itself in the fact that the urethra (urethra) becomes inflamed.

Urethritis affects both men and women. The percentage of people suffering from this disease among men and women is approximately the same.

The causes of urethritis in men and women are as follows:

Getting urethritis from a sexual partner. Most often, urethritis occurs as a result of unprotected sexual intercourse, as well as frequent changes of sexual partners.
Hypothermia.
Infectious and inflammatory diseases already occurring in the genitourinary system (for example, cystitis, prostatitis, etc.).
Failure to comply with personal hygiene rules.
Excessive consumption of spicy foods, alcohol and carbonated drinks.
Urethritis in women is not as severe as in men, due to the structural features of the female genitourinary system.

The main signs of female urethritis:

Burning sensation and pain when urinating.
Itching during menstruation.
Purulent discharge from the urethra. The color of the pus may vary depending on the type of urethritis pathogen.
Redness in the genital area.
Compared to women, men experience symptoms earlier and more acutely.

The main signs of male urethritis:

Bloody discharge in urine or semen.
Increased sensitivity of the penis, the appearance of pain during sexual intercourse.
Itching in the genital area.
Frequent urge to urinate.

Features of the disease

Causes of urethritis of various types and their symptoms

There are several causes of urethritis, as a result of which several types of this disease are distinguished. Let's look at the main types of urethritis.

Gonorrheal. The cause of this type of urethritis is the causative agent gonococcus. The easiest way to become infected with gonorrheal urethritis is through sexual intercourse with a carrier of the pathogen, or by using personal hygiene items of an infected person - towels, sponges, etc.

Trichomonas. Symptoms do not appear immediately, but after approximately 5-15 days. This species is characterized by a whitish, foamy discharge from the urethra, as well as mild itching in the genital area. In men, symptoms of this type of urethritis may not appear at all, which makes such patients the main source of infection with Trichomonas urethritis. The cause of Trichomonas urethritis is sexual contact with a patient.

Symptoms

Bacterial. Most often, this type of urethritis occurs due to bacteria entering the urethra. The main cause of infection is sexual contact with a carrier of urethritis. Bacterial urethritis occurs:

Primary. Characteristic symptoms are itching and burning in the urethra, pain when urinating. Discharge from the urethra contains pus. Bacterial urethritis can become chronic - this form is difficult to treat.
Secondary. Occurs as a result of an infectious disease (for example, sore throat, pneumonia) or in the presence of inflammatory processes present in the body (for example, in the prostate gland). The main symptoms include pain during urination, as well as discharge with pus, which is especially intense in the morning.

Viral. This type of urethritis occurs due to perigenital chlamydia. This viral pathogen can provoke inflammation of the genital organs, because when it enters the cellular epithelium of the urethra it begins to multiply there.

Candidamicotic. This type of urethritis occurs as a result of infection of the urinary system by yeast fungi. Symptoms of such urethritis are mild itching and burning, whitish discharge or without it. Most often, this type of urethritis is infected due to complications from antibacterial therapy, less often - from a woman suffering from candidiasis vulvovaginitis.

Chlamydial. The cause of chlamydial urethritis is infection with chlamydia. Discharge from the urethra may contain pus or mucus or may not appear at all. Unnoticed or not treated in time, chlamydial urethritis can lead to complications.

Types of urethritis

Signs of urethritis: diagnosis and cure criteria

The signs of urethritis of various types are similar to each other. The difference is manifested in the intensity of inflammation of the urethra.

Symptoms of urethritis, which occurs without complications, consist of the following signs: itching and burning in the urethra, inflammation of the urethral mucosa, changes in the color and consistency of discharge from the urethra, pathological impurities in the urine. There are acute and chronic clinical courses of urethritis.

Signs of acute urethritis appear after a few days (the duration of the period depends on the type of urethritis - from 2-3 days to 5-20 days). Discharge appears from the urethra and pain occurs during urination.
Signs of chronic urethritis occur due to incorrect treatment of the disease or failure to comply with doctor’s instructions. Chronic urethritis manifests itself through scanty discharge, itching in the urethra, as well as moderate pain in the urethra. Chronic urethritis can lead to complications.

Clinical course of urethritis

After a course of treatment for urethritis, an examination is carried out to determine whether the patient is healthy. The criteria for cure are:

No foreign discharge from the urethra within two weeks after the course of treatment.
No inflammation of the urethra.
Disappearance of itching and burning during urination.

With proper (timely and appropriate means) treatment of urethritis, the prognosis is positive. In cases where the disease progresses with complications, the prognosis is less optimistic: the treatment process will either slow down or the disease will develop into a chronic form.

If urethritis is completely cured, a person remains at risk of getting sick again, so maximum care must be taken: avoid promiscuous sexual intercourse, and observe the rules of personal hygiene.

Diagnosis of urethritis consists of several stages:

Initially, an analysis of the patient’s complaints and the history of the disease itself is carried out (when and what signs of urethritis were first discovered).
Analysis of the patient’s daily life history (presence of chronic or prolonged inflammatory processes, what operations were performed previously, how many sexual partners there were in the last few months, etc.).
Examination by a doctor (urologist for men and gynecologist for women).
Microscopy of a smear of contents that is taken from the urethra to determine the presence of urethritis and its type.
Urethroscopy using a special medical microscope (not performed for acute urethritis).
(not performed for acute urethritis).
A general urine test to identify the presence of foreign impurities that are possible with urethritis of one type or another.
Bacteriological culture of a smear, which is carried out to determine the sensitivity of the causative agent of urethritis to the antibiotics proposed for treatment.
Ultrasound to detect any changes in the structure of the genitourinary system.
PCR diagnostics to identify pathogens or infections that can be sexually transmitted.

Prevention and treatment of urethritis

The following methods of treating urethritis can be distinguished:

Taking antibiotics. The type of antibiotic is determined by diagnosing the type of pathogen and its sensitivity to the drug.
Immunotherapy.
The use of liquid medications through their introduction into the urethra (local treatment).
Avoid junk food and drinks as much as possible (exclude alcohol, hot and spicy foods from the diet).
Sexual abstinence during the treatment of urethritis.
Drink plenty of non-carbonated and non-alcoholic liquids.

Prevention of urethritis lies primarily in a proper diet. It is necessary to exclude spicy foods from the diet and drink a lot of non-alcoholic and non-carbonated liquids.

Drinking linden tea (diuretic effect), lingonberry or cranberry juice (anti-inflammatory effect) will be especially useful. Parsley juice is doubly useful - it has both a diuretic and anti-inflammatory effect.

Treatment of urethritis

Exercise moderately: prolonged heavy physical activity will negatively affect the general condition of the body and can provoke urethritis. Monitor and promptly treat infectious and inflammatory diseases: an infection can easily get into the urethra and cause urethritis, so you should carefully monitor your health.

It is worth noting

To prevent urethritis, it is extremely important not to overcool: dress warmly, do not swim in very cold water without first hardening yourself. Even short-term hypothermia can immediately provoke urethritis. Non-infectious urethritis is easy to get if you have urolithiasis: the urethra can be injured by stones and sand. Be sure to check for sexually transmitted diseases once every six months!

If you notice any symptoms similar to those of urethritis, immediately contact a specialist, do not treat yourself and do not ignore the disease. Signs of urethritis may disappear for some time, but there is no need to rejoice: in fact, urethritis will not disappear, but will appear again one day, and in a more severe form and with complications.

Urethritis is an inflammatory disease in which the urethra (or urethra) is affected. Urethritis, the symptoms of which appear against the background of exposure to viruses or bacteria that provoked this inflammation, in its course may correspond to the nature of an infectious process or a non-infectious process.

general description

The urethra itself is the channel through which urine is discharged outward from the bladder. Urethritis is predominantly diagnosed in young patients who are sexually active, and it is the sexual route of transmission that determines the largest number of patients seeking appropriate medical help.

Symptoms of urethritis in women, by the way, are sometimes extremely difficult to distinguish from the symptoms that appear with cystitis. Actually, cystitis in women, which, as the reader probably knows, is a disease accompanied by inflammation of the bladder, is often a companion to urethritis, due to which the identification of both actual variants of the disease is somewhat complicated. The reason for this is the similar nature and symptoms. The difference is the actual localization of the inflammatory process and the symptoms that appear in both cases - the main symptoms of cystitis are based on increased urination, while with urethritis, urination is only combined with certain unpleasant sensations. However, one cannot deny the possible relationship between both of these diseases, because urethritis can develop against the background of cystitis, or, conversely, serve as the basis for its future development. These variants are caused by the ascending or descending route of infection.

The disease is not life-threatening, but its appearance, as one might assume, causes a certain kind of adjustment in life during the period of manifestation.

It should immediately be noted that due to the location of the urethra, which is somewhat shorter in women, urethritis in men develops almost unhindered. The urethra in men has several physiological narrowings and bends, which determines their greater predisposition to urethritis. Returning to the characteristics of the urethra in women, it remains to be noted that, as is already clear from the comparison, it is straight and short enough, which ensures practical washing away of the actual infection when urinating.

So to speak, in a “pure” form, urethritis is detected in patients extremely rarely. The “pure” form, in particular, means such a course of this disease in which the inflammation typical for it does not occur in the genitals. The first symptoms of urethritis require consultation with a doctor. The reason for this is the possible worsening of the course of this disease in the future, which, in turn, may manifest itself in a slightly different form. Thus, exposure to viruses or pathogenic bacteria against the background of urethritis, with such aggravation, can provoke infection of the prostate gland or epididymis in men.

Basically, urethritis develops as a result of infection with one or another sexually transmitted disease, which, as already noted, is facilitated by the main method of infection - sexual contact. Also, a violation of the rules provided for personal hygiene acts as a provoking factor for urethritis. In addition to the above reasons, which, however, happens somewhat less frequently, the introduction of microbes into the urethra is also considered possible, which occurs as a result of several other reasons. In particular, in this case it means inflammation of organs located above, or the introduction of microbes through lymphatic and blood vessels from foci of inflammation that are relevant to the body. Examples of such foci of inflammation include inflammatory processes in dental diseases, inflammation of the tonsils (which occurs with tonsillitis), etc.

Urethritis can be gonococcal (specific urethritis) or, accordingly, non-gonococcal (nonspecific urethritis); there is also a more expanded version of its classification.

Structure of female organs: urethra (urethra)

Causes of urethritis

In general terms, we have identified the causes of urethritis somewhat higher. Upon closer examination, the reasons are determined based on the classification compliance.

First of all, urethritis can be specific or nonspecific.

Specific urethritis diagnosed in cases where it is provoked by infections that are transmitted through sexual contact. Such infections include herpes virus, gonococcus, ureaplasma, and trichomonas. Somewhat less commonly, these are mycoplasma, chlamydia, gardnerella, etc. Specific urethritis is similarly defined as gonococcal urethritis (based on the nature of one's own emergence, as can be understood from the definition of this form).

As for the next form, which is nonspecific urethritis, then opportunistic microflora is considered here as an influencing factor. Examples include staphylococci and streptococci, E. coli, and various varieties of fungi.

Specific urethritis also defines a separate group within them, this non-gonococcal urethritis. This group is characterized by the fact that urethritis in it is provoked by various types of viruses and infections, but with the exception of gonococci. In turn, this group defines two other forms of urethritis, and this infectious urethritis or non-infectious urethritis. And if with infectious urethritis, in principle, no questions arise regarding the specifics of its occurrence, and it is determined on the basis of the name itself, then non-infectious urethritis, of course, can provoke the corresponding interest of the reader.

The basis for the development of non-infectious urethritis can be physical damage to the urethra. For example, this could be a blow or a diagnostic procedure that led to such a lesion, thermal or chemical exposure. In accordance with the traumatic nature of non-infectious urethritis, it is also defined as traumatic urethritis. Non-infectious urethritis, among other things, can also be allergic. Allergic urethritis, according to the specifics of allergies, it can act as a reaction of the body that occurs in response to food, drugs or other allergens. In some cases, urethritis is diagnosed in patients with diabetes mellitus and other types of metabolic disorders.

But these options do not complete our classification. In addition to the options already listed, urethritis can be primary or secondary. Primary urethritis is an independent disease that develops directly in the urethra, while secondary urethritis is the result of a complication of a particular disease. Infection in secondary urethritis occurs mainly from the bladder, vagina or prostate gland, etc.

Based on the considered classification options, urethritis, in accordance with the reasons that provoked it, can also be divided into two groups, and this venereal urethritis And non-venereal urethritis. As has already been highlighted, urethritis can be gonorrheal or non-gonorrheal, and both of these options can be classified as venereal urethritis, provided that the route of infection was sexual.

Urolithiasis can provoke urethritis, which is caused by the movement of sand or stone along the urethra, as a result of which its walls are damaged. As reasons that provoke urethritis, one can also note significant physical activity and characteristics of sexual life (excessively active sex life, or, conversely, inconsistent sex life). Certain foods also contribute to the development of urethritis, and these are salty foods, sour, spicy or pickled foods. In reality, there can be many factors, and those that we have listed are only the basis.

The duration of the incubation period of the disease (which is the time interval between infection and the appearance of the first symptoms) is determined based on the specific pathogen that provoked urethritis. On average, the incubation period for gonococcal urethritis is about 3-10 days after infection occurs (contact itself), although a shortened version is not excluded. Thus, certain strains provoke the development of urethritis already 12 hours after contact. However, the manifestation of this disease even 3 months after this cannot be ruled out - here, of course, we are talking about a different type of strain that determines such a scenario.

Urethritis: symptoms

The main manifestation characterizing the course of urethritis is purulent discharge appearing from the urethra. Such discharge may be either yellow-green or pale yellow.

Symptoms of acute urethritis are characterized by itching, burning and pain; all these manifestations are noted at the very beginning of urination, again, by the appearance of purulent discharge. The edges on the side of the external opening of the urethra begin to become inflamed and, as the process progresses, stick together. At the same time, it is possible to develop urethritis without the concomitant appearance of purulent discharge, but with the listed symptoms that directly accompany the act of urination.

Urethritis, the symptoms of which appear in a rather severe form in men, manifests differently in women. Thus, the symptoms of urethritis in women are characterized by less severity, and in some cases they may not be detected at all.

Types of urethritis are characterized by their own characteristics of the course, despite the characteristics already indicated, depending on the stage of the course, several typical forms are determined, we will dwell on them in more detail.

Acute urethritis: symptoms

This variant of urethritis is accompanied by characteristic painful urination and burning sensation. These symptoms are also combined with copious discharge, which, as already noted, appears from the urethra. The lips of the external opening of the urethra turn red, swelling is noted, and the inflammatory process is concentrated in the area of the wall of the urethra. Slight pressure leads to the expiration of purulent discharge. After a night's sleep, purulent spots can be found on your underwear. Feeling the urethra allows you to identify some of its density.

In general, the sensations that a patient experiences with urethritis are characterized by the scale of the inflammatory process within the urethra (this is posterior urethritis, anterior urethritis, or complete urethritis), and the relevance of complications is also taken into account. Thus, some patients may experience burning or itching in the area of the urethra, while others especially experience pain during urination.

If an acute variant of torpid urethritis (a low-symptomatic form of this disease) is considered, then the urge to urinate is frequent, pain is noted in the urethral area, and body temperature rises. In this case, the completion of the act of urination is the appearance of a minimal amount of bloody discharge, which is defined as terminal hematuria. There is also swelling of the urethra. In general, the course of torpid urethritis, if we are not talking about its acute form, is characterized by its own monotony, such a course does not have sharp boundaries, as a result, it transitions into the chronic form of gonorrhea.

Subacute urethritis: symptoms

This form is characterized by a gradual reduction in swelling and pain in the urethra. Purulent discharge is either scanty or disappears altogether. In some cases, the presence of discharge in the morning is allowed (it looks like a crust, due to which the external opening in the urethra sticks together). The urine also changes: it becomes more transparent, and minor purulent threads are noted in its composition.

Chronic urethritis: symptoms

The transition to a chronic form occurs when therapy for the disease is ineffective or in the absence of proper treatment as such. The appearance of complaints (exacerbation of urethritis) in this case is preceded by the influence of provoking factors, against the background of which a certain amount of purulent discharge appears. Such factors include hypothermia, the patient’s consumption of alcohol, etc. Basically, the symptoms of chronic urethritis coincide with the manifestations characteristic of the torpid form of urethritis, which we previously identified. The course of the disease can be long-term, which means not only months, but also years, which ultimately may lead to a visit to the doctor (if this was done earlier, before the disease progressed to this form). A long course of this form of urethritis can provoke urethral stricture, in which the urethra in the lumen begins to narrow, which is why urination is accompanied by a change in the stream of urine (it becomes weak) and pain.

Total urethritis: symptoms

The peculiarity of this form of urethritis is that the urethra is completely exposed to inflammatory damage. The symptoms of total urethritis are characterized by similarities with the symptoms of prostatitis. In acute total urethritis, the urge to urinate is uncontrollable, and completion of urination is accompanied by pain. There are bloody and purulent components in the urine.

Diagnosis

Diagnosis is based on a physical examination of the patient if he has symptoms indicating possible urethritis. The examination is carried out 1-3 hours after the last act of urination. The diagnosis of acute urethritis or chronic urethritis is established on the basis of swelling and redness of the urethra, as well as on the basis of purulent discharge.

In the future, a Gram smear is done if there is a suspicion of the relevance of gonorrheal urethritis. Diagnosis of the disease is also supported by the results of a urine test by detecting leukocytes in the sediment, analysis of scrapings of the urethra and vagina (the presence of chlamydia is determined). If necessary, a scraping from the rectal area can be done.

Treatment of urethritis

The determination of drug therapy measures is based on the characteristics of the nature of the disease. The main treatment measures are rinsing with antiseptic drugs, aimed directly at the area of the urethra; antibiotics can also be used. Efficacy in the treatment of urethritis is determined by the use of erythromycin and tetracyclines. An additional effect is achieved through physiotherapy procedures (warming applications, electrophoresis, etc.), local treatment (for example, sitz baths based on herbal decoction), taking immunostimulants and immunomodulators.

Diet during treatment is mandatory. It specifically excludes salty, smoked and spicy foods and alcohol. In the acute stage of the disease, the diet is based on products of lactic acid origin, and drinking plenty of fluids is also recommended. The influence of negative provoking factors (physical overload, hypothermia) is excluded; restrictions also apply to sexual activity during this period.

If urethritis is not treated, there is a risk of developing already noted prostatitis (in chronic form), and in some cases, epididymitis, and this disease subsequently becomes the cause of infertility (obstructive form). Vesiculitis may also develop.

The main method of preventing urethritis is the implementation of the barrier method, which consists of contraception using condoms, which is especially important during sexual intercourse with non-regular partners. Also important in the prevention of gonorrhea is proper hygiene measures.

If you suspect the relevance of urethritis, you should visit a venereologist; in case of nonspecific urethritis, the patient is referred to a urologist.