Chronic gonorrheal urethritis in men, symptoms and treatment. Urethritis

The most frequent patients of the urologist are men who seek treatment for urethritis. The disease manifests itself at any age, and passes with severe symptoms. Severe itching and pain during urination do not allow a man to wait out a relapse without going to the doctor. If the acute form of the disease is not treated, the inflammatory process will spread to the prostate gland and testicles, which will bring with it even more painful processes.

What is urethritis in men?

And men are different. If the disease in the female body is almost asymptomatic due to the anatomical features of the urinary tract, then men suffer from this disease more. Male urethritis is an inflammation of the urethra caused by a variety of reasons. The most common among them is any sexually transmitted disease that promotes inflammation.

After pathogenic microbes enter the urethra, after a few hours, fatigue and weakness appear, preceding the main symptoms of urethritis. Urethritis also has a non-infectious origin, but rarely. Factors in such cases are allergic reactions, trauma to the genitals, metabolic disorders or malnutrition.

Urethritis in men can adversely affect reproductive function and lead to a serious violation of the functionality of the genitourinary system. Therefore, the identification of signs that indicate the onset of an inflammatory process in the urethra is an indicator of contacting a doctor for advice for an examination and complex treatment.

Symptoms and signs of inflammation of the urethra

The first symptoms of urethritis in a man appear, depending on the incubation period of the pathogen, from several hours (allergic) to several years (tuberculous). The most typical among all types of urethritis are the following symptoms:

Burning, itching, pain when urinating.
Purulent discharge.
Frequent urination.

Hyperemia or high temperature with urethritis, as a rule, is not observed. Allocations depend on the pathogen and are of a different nature. Often this discharge is green or white with an unpleasant odor, which appear in the morning and form yellow crusts on the penis. With inflammation of the urethra, redness and gluing of the external opening, pain in the lower abdomen, cloudy urine can be observed.

Causes

Urethritis in a man can be triggered by several reasons. As already mentioned, the most common are venereal diseases. But inflammation of the urethra can occur if a man ignores the rules of personal hygiene, because dirt quickly collects on the genitals and pathogenic bacteria multiply.

E. coli, which remains on the surface of the intimate zone after bowel movement, very actively increases its population on the skin. When it gets deep into the urethra, signs of the development of urethritis immediately appear. Pathogenic microbes that affect the urethra include:

staphylococci;
streptococci;
coli.

Urolithiasis can also cause the development of urethritis. Stones that are in the kidneys, under certain conditions, can end up in the urethra of a man, causing inflammation. Medical interventions also often cause inflammation, since microscopic abrasions very quickly become infected with an infection in the body, and then become inflamed.

Diagnosis - what tests to take?

The presence of any of the above symptoms is a reason for a visit to the urologist, who should make a diagnosis based on laboratory and clinical data. During the initial examination, the doctor examines the discharge from the urethra by pressing, examines the swelling and redness of the lips of the urethra, feels how painful and compacted the urethra is and whether the inguinal lymph nodes are enlarged.

Each patient with suspected urethritis is examined for HIV infection and syphilis, and is also sent for the following tests:

Urogenital smear.
Urethral culture for sensitivity to antibiotics.
PCR studies to identify pathogens of urethritis.
General urine analysis.
Three glass urine sample.
Urethroscopy.
General blood analysis.
Biochemistry of blood.
Rheumatic tests, if urethritis appeared after a sore throat.

How to treat urethritis in men - drugs

Before starting treatment, the doctor warns that during the treatment of urethritis, sexual intercourse, oral sex, and masturbation are completely prohibited. If the disease is caused by a sexual infection, then the treatment of the sexual partner is mandatory. The diet should also be observed, excluding spicy, salty, pickled, fried, spicy foods. Drinking alcohol is strictly forbidden, and drinking water should be consumed daily at least 2 liters to improve metabolism and speedy recovery.

Antibiotics

It is impossible to cure urethritis without antibiotics. The type of medication, dosage and treatment regimen for urethritis is determined by the doctor, depending on the causative agent of the disease and based on the type of pathology. General antibiotics for urethritis are not prescribed, since each microorganism has its own sensitivity to drugs.

For the treatment of gonococcal urethritis, antibiotics such as Azithromycin, Cefipmaxone are prescribed.
For the treatment of Trichomonas urethritis, "Trinidazole", "Metronidazole" are more suitable.

Antiseptics

Effective antiseptic drugs include: "Miramistin", "Furacilin".

Ointments and suppositories

In the complex of antibacterial therapy, local preparations (ointments and suppositories) are used, which accelerate the healing process. For example, it will be effective in the treatment of viral urethritis caused by herpes. Rectal suppositories are equivalent in their effectiveness to injections, so urologists often prescribe them for the treatment of various types of urethritis in men: Metronidazole, Hexicon, Indomethacin, Cifran.

Immunomodulators

These are substances that affect the functioning of the human immune system. It is known that the higher the immunity, the faster the recovery will come. Immunomodulators are mandatory medicines for the treatment of urethritis in men. They are prescribed in addition to antibiotics so that they do not suppress the immune system.

Effective drugs of domestic production: Timalin, Mielopid.

vitamins

During the treatment of urethritis, the deficiency of vitamins in the body must be replenished, so doctors prescribe multivitamin complexes with vitamins A, E,

C, D and minerals. A proper diet can make up for the lack of some vitamins, but not to the full extent. For example, vitamin A is found in the form of esters in animal products, so with a strict diet, its reserves cannot be replenished in the required norms.

Popular vitamin complexes for urethritis: "Bio-max", "Pikovit forte".

Treatment of urethritis with folk remedies

It is impossible to cure urethritis by folk methods alone. But decoctions and tinctures of herbs will help alleviate the condition. We offer several folk recipes that will help with chronic urethritis and will be an excellent prevention of relapse:

Infusion of black currant leaves. An excellent replacement for the vitamin complex and antiseptic. Take 30 gr. dry leaves pour a glass of boiling water, leave for one hour, then strain. Drink three times a day before meals (for 15 minutes). If possible, eat fresh blackcurrant berries for food. The duration of admission is not limited.
Infusion of oak bark. It will help relieve burning sensation and pain when urinating. Brew with boiling water (1 cup) a tablespoon of oak bark, leave for three hours. The resulting remedy should be drunk 1 tbsp. l. 3 times / day before meals in a warm form. Also, the infusion is used for men in the form of baths or lotions.
Infusion of cornflower flowers. Pour boiling water over one teaspoon of dried cornflower flowers, leave for an hour, then consume 2 tbsp. l. before meals 3 times / day until the natural microflora is restored and the inflammatory process passes.

Complications

Treatment of the disease urethritis in men is mandatory, because ignoring the inflammatory process can lead to damage not only to the urethra, but also to the scrotum, testicles, and prostate gland. It is difficult to treat urethritis, but diseases of the reproductive system can lead to inability to bear children, and such processes are often irreversible.

In men, a complication of urethritis can lead to : prostatitis, funiculitis, seminal vesicles, formation of epidirmitis or orchitis.

Chronic desquamative urethritis can lead to keratinization of the epithelium, and staphylococcal pathology to a more complex consequence of urethritis - narrowing of the urethra, which occurs due to scarring of the mucosal tissue. Such a disease leads to a violation of the outflow of urine, throwing it into the kidneys with the formation of renal failure and pyelonephritis.

Types of male urethritis

Male urethritis is divided into several types and types. It can be infectious and non-infectious, primary and secondary, that is, it enters the urethra from already infected organs. The classification of urethritis in men is also carried out according to its characteristics (types of pathogen).

Painful urination is usually the first sign of urinary dysfunction. Doctors often diagnose urethritis in men. This pathology can develop in the stronger sex at any age. The causes of the onset of the disease can be very different. Only an experienced specialist can figure out what exactly caused the disease, but a man can suspect signs of the disease on his own.

Basic information

Urethritis in men, the symptoms of which are well known to urologists and venereologists, is a disease in which the urethra becomes inflamed. Unlike the female, the male urethra consists of three sections and has a significant length (its length is about 15-25 centimeters). Due to this physiological feature, men feel inflammation and pain localized in the urethra much more strongly than women.

Depending on what causes provoked the onset of the inflammatory process, two types of urethritis can be distinguished:

infectious (the disease develops due to the ingestion of pathogens into the body);
non-infectious (inflammation is not caused by an infection, but by some other factor, the disease is not sexually transmitted).

In turn, infectious urethritis is also of two types:

specific (the cause of the development of the disease is any infection that has entered the body from the outside during sexual contact);
non-specific (the causative agent of the disease becomes a conditionally pathogenic microflora, which is always present in the body, but with high immunity does not cause the development of inflammation).

Doctors divide specific urethritis into several types (according to the type of infection detected):

chlamydial;
gonorrheal;
gardnerella;
ureaplasmic;
mycoplasma;
trichomonas;
candidal;
herpetic;
tuberculosis, etc.

In some cases, in men, the examination reveals several infections at once, each of which is sexually transmitted. In such situations, doctors may diagnose mixed urethritis.

Nonspecific infectious urethritis most often occurs due to the penetration of E. coli, staphylococci or streptococci into the urethra. These microorganisms also negatively affect the urethra.

If the tests do not show the presence of any infection, the doctor may diagnose the man with non-infectious urethritis. This type of disease is much less common, but causes the representatives of the stronger sex no less suffering than inflammation caused by infection. Non-infectious urethritis has several varieties:

allergic (appears due to the impact of any allergen on the mucous membrane of the urethra);
traumatic (occurs after trauma, examinations of the urethra, surgical interventions, etc.);
radiation (develops after radiation therapy in the treatment of oncology);
toxic (this type of disease is provoked by toxins that have entered the urinary system);
congestive (occurs with congestion and circulatory disorders in the pelvis).

Like most diseases, urethritis is acute, subacute and chronic. The disease is classified as primary if it initially occurs in the urethra. In cases where inflammation appears in nearby organs, and then moves to the urethra, doctors speak of a secondary type of disease.

Risk factors

Having found out the causes of urethritis, it is necessary to understand what actions and phenomena can provoke this disease. Most often, inflammation of the urethra appears as a result of the influence of factors such as:

hypothermia;
unprotected sex;
rare sex life;
weakening of the immune system;
lack of vitamins in the body;
non-compliance with personal hygiene;
alcohol abuse;
irrational nutrition;
insufficient consumption of drinking water;
sedentary lifestyle;
chronic pathologies of internal organs.

Main symptoms

The first signs of an infectious disease may appear in the stronger sex within a couple of hours after infection. In some cases, the incubation period can last up to several months. A man without fail needs to see a doctor, having discovered such symptoms as:

the appearance of purulent discharge with an unpleasant odor from the urethra (acute trichomonas urethritis in men is most often accompanied by white discharge, gonococcal - yellow and greenish, gardnerella and chlamydial - foamy whitish-transparent, etc.);

cloudy urine;
blood in the urine;
pain, cramps, burning during emptying of the bladder;
frequent urge to urinate;
violation of the outflow of urine;
spasms in the pubic area;
redness and hyperedema of the opening of the urethra (can be seen in the photo);
adhesion of the urethra;
itching in the head of the penis.

Reviews of sick men say that inflammation of the urethra is never accompanied by high fever, fever or weakness. In chronic urethritis, signs of the disease may be completely absent.

Diagnostic methods

Symptoms of urethritis are often confused with manifestations of a disease such as cystitis, because. both diseases have similar symptoms. To understand what kind of ailment develops in the body of a man, and only a doctor can prescribe treatment. To do this, he needs to conduct a survey and examination of the patient. Diagnostics may include such laboratory and hardware studies as:

blood tests;
urine tests: general, according to Nechiporenko, three-glass test, etc.;
urine culture;
scraping from the urethra for bacteriological and microscopic examination, as well as PCR;
ureteroscopy (endoscopic diagnosis of the urethra);
ultrasound examination of the pelvic organs, etc.

Treatment Methods

The stronger sex should not independently treat inflammation of the urethra and take any pills (including antibiotics) or put candles without a doctor's prescription. Noticing the manifestations of the disease, the man should go to the specialists. Experienced doctors always know how to treat urethritis in men. They can prescribe medications to the patient that eliminate not only the existing symptoms, but also the causes of the disease.

Most often, the treatment of urethritis takes place at home. It usually consists of drug therapy and physiotherapy. Doctors prescribe the following drugs to their patients:

Antibiotics (Azithromycin, Cefotaxime, Summamed, etc.). Such drugs help to cure purulent bacterial or desquamative chronic urethritis. Antibiotics stop growth and destroy disease-causing bacteria that provoke inflammation. The treatment regimen with antibacterial drugs should be drawn up by a doctor; uncontrolled intake of such drugs is unacceptable.
Antifungal (Flucanozol, Pimafucin, etc.). With such means it is necessary to treat candidal urethritis in men. Antimycotic drugs act on pathogenic fungi.
Antiviral (Acyclovir, Farmciclovir, etc.). Such funds block the activity of viruses and are prescribed in order to cure viral (herpetic) urethritis.
Antihistamines (Suprastin, Tavegil, etc.). Block allergens and help eliminate allergic urethritis.
Diuretic. For a speedy recovery, men will need to take diuretic and anti-inflammatory drugs such as Canephron, Fitolizin, Monural, etc. At home, you can also use folk remedies by brewing lingonberry leaves or parsley.
Immunomodulators and vitamins. Vitamin complexes are needed to strengthen the immune system.

Doctors who treat inflammation of the genitourinary system usually combine several drugs (for example, they can prescribe Azithromycin, Flucanosole, Miramistin and Monural to their patients at the same time). The treatment regimen prescribed by the doctor may include not only tablets, but also medicinal ointments, as well as suppositories (men need to inject them into the anus).

Acute gonorrheal urethritis under the influence of modern methods of treatment in the vast majority of cases ends in complete recovery. In a small part of cases, recovery does not occur and the disease can go into a chronic stage.

Symptoms of gonorrheal urethritis. In chronic gonorrheal urethritis, scanty discharge from the urethra is observed, especially in the morning, aggravated after drinking alcohol or after sexual intercourse. Subjective complaints of slight itching or burning during urination. The first portion of urine may be cloudy due to the admixture of a large amount of mucus and pus, or transparent with an admixture of mucopurulent and purulent threads.

pathological anatomy. There are the following four main forms of chronic gonorrheal urethritis.

1. Infiltrative urethritis- soft and hard. A soft infiltrate consists mainly of cellular elements, with a hard infiltrate, fibrous connective tissue predominates.

2. Urethral adenitis- closed and open. With gonorrheal urethritis, the glands of Littre and the sinuses are often involved in the process. Due to blockage of the excretory duct, the products of inflammation stretch the lobule of the gland, which leads to the formation of pseudoabscesses (closed littreitis). With undisturbed outflow, the products of inflammation of the urethral glands are freely released into the lumen of the urethra (open littreitis).

3. Granulation urethritis characterized by the occurrence of inflammatory growths in certain areas of the mucous membrane, which are more common in the back of the urethra.

4. Desquamative urethritis develops as a result of a chronic degenerative process leading to significant changes in the epithelial cover, sometimes ending in severe keratinization.

The listed forms of chronic urethritis rarely occur in isolation, their combination is usually observed. It should be noted that with modern methods of treatment, granulation and desquamative urethritis are rare.

Diagnosis of chronic gonorrheal urethritis is established on the basis of a detailed systematic examination of the patient according to the proposed scheme.

Examination scheme for chronic gonorrheal urethritis.

1. Anamnesis. Attention should be paid to the frequency, imperativeness and pain of urination (day and night).

2. Penis. Inspection, pay special attention to the condition of the paraurethral passages.

Z. Urethra. Pay attention to the size and condition of the outer hole; to palpate in order to identify compacted areas of infiltrates; in the presence of secretions, a microscopic examination is mandatory.

4. Urine. Urinalysis using two glass samples. With cloudy urine in both portions, disease of the prostate and seminal vesicles should be excluded, and the condition of the upper urinary tract should be identified.

5. Organs of the scrotum - infiltrates, adhesions, soreness.

6. Prostate gland - size, shape, consistency, boundaries, pain.

7. Seminal vesicles - soreness, infiltration.

8. Microscopic examination of the secretion of the prostate and seminal vesicles. In the presence of pyuria, massage of the gonads for diagnostic purposes is contraindicated. If pus is found in the secret obtained after simultaneous massage of the prostate and seminal vesicles, it is necessary to further separately investigate the secret of each of these organs.

9. An instrumental examination of the urethra can be performed only with a transparent second portion of urine: with a capitate bougie and on a straight bougie; ureteroscopy with palpation of the urethra on the tube.

The patient should be warned that he must appear for examination without urinating for 4-5 hours.

The absence of gonococci in the discharge from the urethra does not yet indicate their absence in the urethra or its accessory glands.

Macroscopic examination of urine still does not give grounds to judge the state of the gonads, prostate and seminal vesicles. Therefore, in all patients with chronic gonorrheal urethritis, it is necessary to palpate the prostate and seminal vesicles, followed by a microscopic examination of their secret obtained by massage. With the help of a capitate bougie, the presence of a soft or hard infiltrate can be determined.

With the help of a straight metal bougie with a closed littreite, infiltrates ranging in size from millet grain to a pea can be felt in the thickness of the urethra. Larger infiltrates can be detected in the same way.

With the help of ureteroscopy, it is possible to detect edema and hyperemia of the urethral mucosa, rough or smoothed folding and lack of radiarity with an irregular but closed central figure, which are characteristic of a mild infiltrate. Pale mucous membrane with smoothed folding, lack of radiarity and a gaping central figure is characteristic of a solid urethral infiltrate.

In unclear cases, to clarify the diagnosis, one should resort to a combined provocation of gonorrhea. The discharge from the urethra (or threads in the urine) that appeared after the provocation is again subjected to careful microscopic examination.

To establish the diagnosis of chronic gonorrhea, it is necessary to detect gonococci in the pathological discharge.

In the differential diagnosis of chronic urethritis, postgonorrheal, and then non-gonorrheal and Trichomonas urethritis should be excluded first.

Treatment for chronic gonorrheal urethritis. In all cases, a topical diagnosis should be established before starting treatment. One of the antibiotics is usually prescribed. Ecmonovocillin or penicillin in these cases is administered in a total dose of 1,500,000 to 3,500,000 units per course, depending on the nature of the process. In case of unsuccessful use of them, it is recommended to prescribe streptomycin in an amount of 5 to 4 g per course of treatment. The daily dose of streptomycin should be 0.5 g, it is administered at intervals of 10-12 hours. You can also use other antibiotics, but in much larger total doses.

Along with antibiotics, local methods of treatment should also be used, depending on the nature of the inflammatory process and its localization.

With abundant discharge from the urethra or the presence of turbidity in the urine, the method of large lavages should be used, periodically adding a solution of oxycyanic mercury (1:6000) to the potassium permanganate solution in order to influence the secondary flora of the urethra. For washing, use Esmarch's mug, suspended at a height of 1 - 1.5 m from the patient's genitals. A rubber tip is put on the glass tip extending from the rubber tube.

With a mild infiltrative process in the urethra and granulation urethritis, instillation with an elastic catheter of 0.25% silver solution is recommended, which acts bactericidal and promotes the resorption of the inflammatory infiltrate.

For resorption of individual seals (littreit), baths for the penis from hot water (45 °) are used for 15-20 minutes 2-3 times a day. Diathermy is also recommended every other day on a direct bougie, as well as massage of infiltrates on the bougie and washing the urethra; massage should be from back to front towards the external opening of the urethra.

The described method of treatment of littreitis can also be applied to the treatment of solid infiltrates in the anterior part of the urethra. Bougienage should begin with bougie No. 18-20, leaving the bougie in the urethra for 5-10 minutes. The caliber of the bougie is increased by 1-2 numbers with each session and adjusted to No. 23-25 according to Charrière, depending on the width of the external opening of the urethra. Bougienage can be carried out no more often than in 1-2 days. After bougienage, the urethra should be washed with a solution of potassium permanganate.

With chronic gonorrheal urethritis, a cure is achieved, but a complete cure in the anatomical sense may not occur; often persistent changes remain in the urethra.

Criterion of cure. The criterion of cure for chronic gonorrheal urethritis is: 1) the absence of gonococci in the discharge: the urethra or in the threads from the urine during the last 2 weeks; 2) the absence of inflammatory changes in the urethra during its urethroscopic examination; 3) the absence of changes in the prostate and seminal vesicles, as well as leukocytes in their secret, in the presence of a significant amount of lecithin grains in it. A month after the end of treatment, an examination is again performed, using, if necessary, the method of combined provocation.

It is believed that this is an exclusively female deviation, although this is not so. Pathology is equally observed in both sexes. When the disease occurs, inflammation of the urethra. The causes of inflammation of the urethra in men are different, but most often they become infected after sexual intercourse. Depending on the foci of exposure, infectious and non-infectious urethritis are distinguished. The problem is manifested by pain during the excretion of urine, discharge, redness of the urethra and other unpleasant symptoms are observed. Urethritis needs prompt diagnosis and treatment to avoid possible complications. If the pathology is not treated, then in the future it will affect the reproductive function and there will be a violation in the genitourinary system.

Features of the structure of the male urethra

Paying attention to the fact that the male urethra is different from the female, the stronger sex more clearly feels the symptoms and more difficult to tolerate inflammation of the urethra. This organ in men consists of a narrow hollow tube, which is 16–24 centimeters in length, while the female urethra is no more than 4 centimeters long. Therefore, the weaker sex often suffers pathology without symptoms.

Due to the special structure of the urethra, men often experience signs of pathology from the first days of infection.

The urethra in men consists of three sections: prostatic, membranous and spongy. The first section (posterior) is located in the prostate and is about 4 centimeters long. The length of the membranous or membranous section is 2 cm and is located between the prostate and the base of the penis. This part of the urinary canal in men is the narrowest. The longest is the spongy or spongy section, which is located in the trunk of the male genital organ. The disease in this part is called anterior urethritis and needs special treatment.

Classification of urethritis

Depending on the pathogen that caused urethritis, various factors and other diseases occurring in the body, special symptoms appear. In frequent cases, bacterial urethritis is observed, the development of which was caused by various harmful bacteria. In medicine, there are many classifications of urethritis.

Given the type of pathogen, there are specific and nonspecific urethritis. The sources of specific urethritis lie in bacteria that are transmitted through sexual contact: trichomonas, chlamydia and others. Symptoms of acute nonspecific urethritis are detected when the pathogens are fungi, Staphylococcus aureus and other microorganisms.

Pathology of a non-infectious nature is classified into congestive, traumatic and allergic urethritis. In turn, an infectious lesion has its own varieties, which depend on the specific pathogen. So, doctors talk about gonorrheal, viral, trichomonas, bacterial, chlamydial and tuberculous lesions. There is also a species such as ureaplasma urethritis. Mixed urethritis occurs when infections of different types attack the body.

Depending on the course of the disease, acute and chronic urethritis in men are distinguished. Pathology can enter the body directly through the genitourinary system, externally, then it is called primary. Secondary urethritis occurs due to infection of other organs. Urethritis is also distinguished, depending on the degree to which it is expressed: a weakly active disease, a pathology of moderate activity and a disease with a high degree of activity.

Main reasons

The causes of inflammation in the urethra are varied. Most often, infection occurs in the case of sexually transmitted diseases that are transmitted through sexual contact. But it also happens that a fungal pathogen enters the body due to non-compliance with intimate hygiene.

Often, E. coli enters the genitals, and then into the urethra after the act of defecation and actively spreads.

Staphylococcal urethritis is often diagnosed, and microorganisms such as streptococcus, E. coli and others cause pathology. Urolithiasis can affect urethritis, since stones located in the kidneys injure the urethra at the exit. Pathology in men occurs for the following reasons:

physical fatigue;
stressful situations;
alcohol abuse;
disturbed nutrition;
lack of vitamins;
various inflammations.

In some cases, urethritis in males is observed after surgery. In this case, the urethra is injured, which leads to inflammation. In the resulting abrasions, an infection is formed that spreads rapidly.

Symptoms of urethritis

After the penetration of the infection, the pathology begins to appear after a few days, and sometimes even after a few weeks. Viral urethritis may not make itself felt for several months, and tuberculosis is not detected for many years. The patient in most cases complains of pain with urethritis, and the following symptoms are also present:

irritation around the urethra;
burning sensation when going to the toilet;
the presence of unpleasant discharge;
congestion of the urethra.

Blood impurities in urine, pus and mucus are also observed. Symptoms vary and are expressed with different intensity depending on the pathogen and the degree of the course. Infectious urethritis has more pronounced symptoms than non-infectious. And in some men, signs of pathology may be completely absent.

Non-infectious urethritis is characterized by itching, redness of the penis. Back to index

Non-infectious pathology

Pathology of a non-infectious type has a special symptomatology and other manifestations join the main signs. With a non-infectious lesion, there is a violation in sexual function, and the main symptoms are mild. With allergic pathology, itching is present and a red urethra is observed due to the inflammatory process. It is important to seek help in a timely manner so that the symptoms of urethritis in men do not provoke a dangerous complication.

Infectious lesion

Infectious type urethritis is the most common and more pronounced. Chronic desquamative urethritis is characterized by common symptoms, but changes in the epithelial cover occur. Along with viral pathology, conjunctivitis occurs and the joints become inflamed. The most dangerous is candidal urethritis, because it tends to quickly become chronic and proceed in a latent form. This deviation is difficult to treat and leads to strictures in the urethra.

Pathology poses a danger to internal organs and health in general. Acute urethritis in men leads to a decrease in sexual function and libido. In this case, the prostate and gonads are most injured. Pathology entails a decrease in the quantity and quality of spermatozoa. It is worth getting rid of urethritis with the help of medicines that will be prescribed by a qualified specialist after diagnosis.

Diagnosis of urethritis in men

In case of discomfort, pain and suspicion of inflammation in the urethra, a set of examinations is prescribed, which is aimed at a complete examination of the disease. First of all, it is worth contacting a urologist who will conduct an examination. If an infectious pathology is detected, then the patient is referred for a consultation with a venereologist. The patient is assigned the following studies:

a urine and blood test;
take a smear of discharge from the urethra;
collect urine samples for bacterial culture and nutrient medium;
ultrasound examination of the kidneys and organs of the genitourinary system;
ureteroscopy.

In the presence of pathology, the results of the tests will indicate a significant excess of the norm of leukocytes and bacteria. If fungi are found, then a candidal urethritis is diagnosed. During the diagnosis, studies are carried out that determine which antibiotics will affect the pathology. A complete study allows doctors to understand how to treat urethritis and what drugs to use so that the therapy brings the maximum effect.

Infection treatment

Treatment of urethritis in men occurs with the use of antibiotic therapy, which is selected individually, taking into account the results of diagnostic studies. Doctors usually recommend an antibiotic such as Lincomycin Hydrochloride or Metronidazole. If the pathology is not in a critical form, then two tablets are prescribed per day, and the duration of the therapeutic course is no more than 10 days.

If there is a permanent sexual partner, then individual antibiotics are mandatory for both partners.

Often, with pathology in men, dysbacteriosis is observed, which can be eliminated with the help of drugs aimed at restoring the intestinal microflora. The composition of the drug complex includes agents that have an anti-inflammatory effect and support the immune system in a normal way. For the treatment of urethritis in men, the urethra is washed. "Hydrocortisone" is injected into the urethra, which produces a disinfecting effect. Also, the patient is prescribed an ointment against viruses, which is most effective for herpes lesions.

Therapy with folk remedies

It is possible to cure this pathology at an early stage at home, using medical medicines along with folk remedies. It is important to remember that male pathology is quite dangerous and before using any drugs, you should first consult a doctor. Medicinal herbs can only remove painful symptoms, but not eliminate the source of pathology.

In folk medicine, there are many recipes that can cure urethritis in the stronger sex. An infusion made from blackcurrant is very popular. For cooking use 30 grams of leaves, which are poured with boiled water. The medicine is left to infuse for an hour, then filtered and drunk three times a day.

Folk remedies manage to relieve itching and pain during urination. To do this, use preparations for treatment, which are made from oak bark. To prepare the infusion, you should use 20-25 grams of oak bark, filled with boiling water (200 ml). From this tool, you can make baths and lotions in the urethra. But it should be understood that self-medication, there is a high probability of harming health, so you should not use any means without the approval of a specialist.

Is a diet necessary?

Proper nutrition will help to avoid pathology and speed up the healing process. A special diet for urethritis is not provided, doctors recommend only eating healthy foods rich in vitamins. It is not recommended to eat salty foods, canned and pickled foods, it is worth reducing the intake of fatty and spicy foods. It is extremely important to lead a healthy lifestyle, do not drink alcohol and stop smoking.

Prevention

Preventive measures are simple, first of all, in the use of protection during sexual intercourse and maintaining intimate hygiene. Men should take care of the genitals and not overcool, so that inflammation does not occur. It is recommended not to take antibiotics for a long time. In order to detect the problem in time, you should regularly undergo an examination by a urologist. Early detection of pathology gives more chances for a speedy recovery. And improper or untimely treatment leads to the fact that complications appear.

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How to treat urethritis in men

What is urethritis in men?

Urethritis in women and men proceeds differently. If the disease in the female body is almost asymptomatic due to the anatomical features of the urinary tract, then men suffer from this disease more. Male urethritis is an inflammation of the urethra caused by a variety of reasons. The most common among them is any sexually transmitted disease that promotes inflammation.

Symptoms and signs of inflammation of the urethra

Burning, itching, pain when urinating.
Purulent discharge.
Frequent urination.

Causes

Diagnosis - what tests to take?

Each patient with suspected urethritis is examined for HIV infection and syphilis, and is also sent for the following tests:

Urogenital smear.
Urethral culture for sensitivity to antibiotics.
PCR studies to identify pathogens of urethritis.
General urine analysis.
Three glass urine sample.
Urethroscopy.
General blood analysis.
Biochemistry of blood.
Rheumatic tests, if urethritis appeared after a sore throat.

How to treat urethritis in men - drugs

Antibiotics

For the treatment of gonococcal urethritis, antibiotics such as Azithromycin, Cefipmaxone are prescribed.
For the treatment of Trichomonas urethritis, "Trinidazole", "Metronidazole" are more suitable.

Antiseptics

Effective antiseptic drugs include: "Miramistin", "Furacilin".

Ointments and suppositories

In the complex of antibacterial therapy, local preparations (ointments and suppositories) are used, which accelerate the healing process. For example, the antiviral ointment "Acyclovir" will be effective in the treatment of viral urethritis caused by herpes. Rectal suppositories are equivalent in their effectiveness to injections, so urologists often prescribe them for the treatment of various types of urethritis in men: Metronidazole, Hexicon, Indomethacin, Cifran.

Immunomodulators

Effective drugs of domestic production: Timalin, Mielopid.

vitamins

During the treatment of urethritis, the deficiency of vitamins in the body must be replenished, so doctors prescribe multivitamin complexes with vitamins A, E,

Popular vitamin complexes for urethritis: "Bio-max", "Pikovit forte".

Treatment of urethritis with folk remedies

Infusion of black currant leaves. An excellent replacement for the vitamin complex and antiseptic. Take 30 gr. dry leaves pour a glass of boiling water, leave for one hour, then strain. Drink three times a day before meals (for 15 minutes). If possible, eat fresh blackcurrant berries for food. The duration of admission is not limited.
Infusion of oak bark. It will help relieve burning sensation and pain when urinating. Brew with boiling water (1 cup) a tablespoon of oak bark, leave for three hours. The resulting remedy should be drunk 1 tbsp. l. 3 times / day before meals in a warm form. Also, the infusion is used for men in the form of baths or lotions.
Infusion of cornflower flowers. Pour boiling water over one teaspoon of dried cornflower flowers, leave for an hour, then consume 2 tbsp. l. before meals 3 times / day until the natural microflora is restored and the inflammatory process passes.

Complications

In men, a complication of urethritis can lead to: prostatitis, funiculitis, seminal vesicles, formation of epidirmitis or orchitis.

Types of male urethritis

Urethritis in women and men symptoms

Urethritis is the inflammation of the urethra, the thin duct that carries urine out of the bladder. Often caused by a bacterial infection, urethritis can cause different symptoms in men and women. Infectious agents (including vectors for chlamydia, gonorrhea, and herpes) are transmitted through sexual contact and can cause urethritis in both men and women, and the woman may not develop any symptoms. If symptoms do occur, urethritis may be difficult to distinguish from a bladder infection; however, the treatment for both diseases is similar. Urethritis can also be caused by sexually transmitted diseases; such infectious diseases are most common among women. How to use folk remedies for this ailment, see here.

The reasons

In women, urethritis often results from an infection caused by bacteria that normally inhabit the anal area and do not cause an effect. illness. If these bacteria enter the urinary tract, urethritis may develop.
Urethritis can result from sexual transmission of the herpes virus or the bacteria that cause chlamydia or gonorrhea.
Prolonged use of a urinary catheter increases the risk of urethritis.
Sexual activity can damage the urethra in women and contribute to inflammation.
Some soaps, bath oils, and vaginal douches can irritate the urethra.

Symptoms

Burning when urinating.
Frequent urination with a small amount of urine passed.
Urgent need to urinate.
Blood in the urine.
Yellowish discharge from the urethra.
Pain in the lower abdomen.
Painful sexual intercourse in women.

Diagnostics

Medical history and physical examination.
Microscopic examination and culture of urethral and urine secretions.

General clinical examination of discharge from the urethra

Discharge from the urethra is examined mainly for the diagnosis of the inflammatory process in non-gonococcal urethritis, gonorrhea, trichomoniasis, chlamydia, syphilis, etc. In addition, the study allows us to differentiate a number of pathological and physiological conditions characterized by discharge from the urethra (prostorrhea, spermatorrhea, urethrorrhea).

In the study of discharge from the urethra, the number and composition of cellular elements depend mainly on the severity and duration of the inflammatory process. According to the European guidelines for urethritis (2001), the diagnosis of urethritis must be confirmed by the detection of polynuclear neutrophils in the anterior urethra, since discharge in men does not always indicate pathology. Informative material for the study are smears from the urethra and / or the first portion of urine. Conducting two types of studies allows you to identify cases that can be missed using only one of them. The inflammatory condition of the mucous membrane of the urethra (urethritis) is expressed by the presence of at least 5 polynuclear neutrophils in the field of view with immersion magnification of the microscope. The predominance of cylindrical and parabasal epithelial cells in smears-imprints testifies to the depth of the pathological process in the urethra. During the initial review of preparations, the following practical conclusions can be drawn.

Leukocytes predominate (neutrophils and lymphocytes) - acute urethritis or exacerbation of chronic urethritis; with a high content of eosinophils (over 5-10%) - allergic urethritis.
Epithelial cells predominate with a small number of leukocytes - chronic urethritis with epithelial metaplasia (desquamative urethritis) or urethral leukoplakia.
A significant number of erythrocytes along with leukocytes and epithelial cells - traumatic urethritis, tumor of the urethra, crystalluria, ulceration of the mucous membrane, etc.
Leukocytes are absent or only single in the field of view at a high magnification of the microscope - prostorrhea (lipoid grains are present); spermatorrhea (many spermatozoa); urethrorrhea (mucus without shaped elements predominates - the secret of the urethral glands).
With a low content of polynuclear neutrophils, massive accumulations of small pleomorphic rods on epithelial cells (key cells) are urethritis caused by Corynebacterium vaginale.
There are key cells, a large number of various bacteria, single polynuclear neutrophils, there is no phagocytic reaction - bacteriorrhoea.

In a more detailed examination of smears, the criteria for the diagnosis of urethritis according to the European Guidelines for Urethritis (2001) are as follows.

Gram-stained urethral swab containing at least 5 polynuclear neutrophils per high magnification (x1000) microscope field (mean of 5 or more fields with the highest concentration of polynuclear neutrophils), and/or:
detection of at least 10 polynuclear neutrophils in the field of view at high magnification (x1000) of the microscope (the average of 5 or more fields with the highest concentration of polynuclear neutrophils) in a Gram-stained preparation from a sample of the first portion of urine.

The sensitivity of the above tests depends on how long the patient has not urinated before sampling. Usually a 4 hour interval is recommended.

When an inflammatory process in the urethra is detected, its etiology must be established. Urethritis is either gonococcal (when Neisseria gonorrhoeae is found) or non-gonococcal (gonococci are not detected). A significant proportion of non-gonococcal urethritis is due to chlamydia. Cases in which neither chlamydia nor gonococci can be detected are classified as non-gonococcal non-chlamydial urethritis (nonspecific urethritis).

For research on gonococci, discharge from the urethra, prostate gland, urine in men and discharge from the vagina, cervix, paraurethral ducts, rectal lavage in women are taken at the same time. For diagnosis, a bacterioscopic method is used (Gram smear stain), which in acute gonorrhea in men has high sensitivity and specificity (95 and 98%, respectively). In chronic and treated cases of the disease in men, a positive result is observed only in 8-20% of cases. In men, in acute cases, the urethra is affected, in chronic cases, the prostate gland, seminal vesicles; in women, the Bartholin glands, vagina and urethra are primarily affected, later - the mucous membrane of the cervix, fallopian tubes, rectum, in girls - the vagina, urethra, rectum, conjunctiva of the eyes. A single negative result is not conclusive, so repeated studies are needed.

In the study of smears in patients with gonorrhea, a bacterioscopic picture of three types is mainly observed:

leukocytes cover the entire field of view, gonococci are often located intracellularly, some of them are localized extracellularly; other microorganisms are absent;
the cellular picture is the same, but there are no gonococci and extraneous microflora (this picture is typical for chronic gonorrhea);
a small number of degenerated leukocytes and abundant extraneous microflora, the appearance of which indicates an improvement in the course of the process (during treatment).

Trichomoniasis is widespread among women aged 2-40 years, it is less common in men and extremely rare in children. The causative agent of the disease is Trichomonas vaginalis. The disease in women is characterized by liquid, foamy or purulent discharge, irritation of the vaginal mucosa. In most men, the disease proceeds imperceptibly, in some cases, the so-called "morning expiration" (excretion of a drop of pus from the urethra) is noted, and only in a small part the infection takes an acute form with symptoms of urethritis and prostatitis. In women, trichomonas are found mainly in the vulva and vagina, less often in the urethra, cervix. In men, the urethra, prostate, seminal vesicles are affected.

Chlamydia. Chlamydia is rarely diagnosed by bacterioscopic methods, mainly serological methods or PCR are used.

Candidiasis. Candida is the most common causative agent of mycotic urethritis, sexually transmitted. Much less commonly, candidal urethritis develops as a result of dysbacteriosis after antibiotic treatment. In smears from the urethra, mycelium and spores are found, which confirms the diagnosis.

Any inflammatory processes in the organs of the urinary tract, as a rule, are accompanied by extremely unpleasant symptoms, which makes the patient consult a doctor rather early. However, if the disease is latent or subacute (subfebrile), then there is a threat of its transition to a chronic form, requiring a very long and sometimes ineffective treatment.

Urethritis is a pathological process of an inflammatory nature, localized in the mucous layer of the urethra (urethra), which has an infectious or non-infectious nature of its origin.

Before talking about the causes of urethritis, variants of its clinical course and principles of treatment, it is worth mentioning that the disease is a very urgent problem among doctors of various specialties. Gynecologists, venereologists, urologists and others deal with the treatment of the disease.

Most often, the disease is registered among population groups with a low socio-cultural level of development, this fact is explained by the peculiarities of their sexual life and the lack of adherence to timely diagnosis.

Most often, the disease occurs against the background of sexually transmitted infections, in the absence of barrier contraceptive measures.

Classification

First of all, the disease is usually divided into two large groups (the classification is based on the belonging of infectious agents to the occurrence of a pathological process).

Infectious urethritis:

specific variant of the disease: trichomonas; tuberculosis; gonorrheal.
non-specific variant of the disease: associated with bacterial agents (mycoplasmic, ureaplasmic, gardnerella, etc.); associated with viral agents (herpes, candidiasis, etc.); chlamydial; fungal; mixed.

Non-infectious urethritis:

traumatic;
allergic;
exchange;
congestive urethritis.

The inflammatory process in the urethra of any etiology is extremely unpleasant

There is a separate classification of the disease, according to which the process is divided into gonococcal and non-gonococcal urethritis. However, such a division of the disease is considered not entirely correct and is rarely used among doctors.

It is also worth highlighting the inflammatory processes in the urethra that occur against the background of impaired psychosomatics in the patient (psychogenic, that is, due to mental disorders, prolonged depression, nervous strain). There are also urethritis, which are associated with incorrect medical tactics (iatrogenic).

Morphological characteristics of urethritis

The chronic form of the disease can occur in several morphological variants:

Follicular urethritis. It is characterized by blockage of the excretory ducts of the Littre glands (located around the urethra), and the accumulation of inflammatory exudate in them, which can form cysts.
Infiltrative urethritis. It develops with the introduction of a pathogenic pathogen under the mucous layer of the organ. There is a pathological restructuring of the epithelial layer (its metaplasia).
Granulation urethritis. If the process does not respond to adequate therapy for a long time, then there is a gradual multiplication of infectious agents in the thickness of the epithelial layer, ulcers and growths of the granulation type form in places.
Desquamative urethritis. This form of the disease is characterized by the involvement of the entire urethra in the pathological process, the mucous layer of which undergoes keratinization (observed with gonorrheal urethritis).

Causes

infectious factors

A greater percentage of cases of urethritis, one way or another, is associated with the reproduction of infectious agents and their impact on the patient's body.

In women, the disease can begin when pathogenic properties are activated in microorganisms that are representatives of the “natural” microflora of the vagina and rectal lumen. We are talking about such pathogens as Klebsiella, Esherichia coli, Enterobacter, Proteus and others.

Most often, the process occurs against the background of enterococcus fecalis (in case of non-compliance with the rules of intimate hygiene)

Males are characterized by the association of the disease with Chlamydia trachomatis and Neisseria gonorrhoeae. If none of these microorganisms is detected in the test materials, then a diagnosis of non-chlamydial non-gonococcal urethritis is made.

It occupies one of the leading places among all causes of the disease. In about 1/3 of patients, the process is asymptomatic, while they are active carriers.

Among non-specific pathogens, it is worth highlighting mycoplasma and ureaplasma, which can become a trigger for the development of rather serious diseases not only of the urethra, but also of the bladder and kidneys. In about 1/4 of men, non-gonococcal urethritis is associated with the active reproduction of these particular microorganisms.

If viral agents are introduced into the organs of the genital tract, which is observed during intimate relationships, a pathological process of the corresponding etiology is launched. Among the main pathogens, it is worth highlighting the herpes simplex virus type 2 (herpetic urethritis) and condylomatosis. Most often, the clinical picture is observed only during the primary infection, and then the disease passes into a latent form, accompanied by periods of remission and exacerbation.

Not so long ago, scientists have established involvement in the occurrence of the disease Gardnerella vaginalis, which is transmitted exclusively through sexual contact and is sown from the secretions of the urethra in both men and women.

Against the background of immunodeficiency states, fungal urethritis is most often diagnosed, and long-term antibiotic therapy or the use of hormones and cytostatics can also contribute to its occurrence.

Non-infectious factors

As mentioned above, the disease can be caused not only by infectious agents, but also by a number of other reasons:

traumatic effect on the epithelium of the urethra, as a result of which the protective ability of the mucous membrane is impaired (against the background of urethroscopy, catheterization or cystoscopy of the bladder, after the introduction of foreign bodies into the lumen of the urethra, after a difficult birth, etc.);
violation of the patency of the urethra against the background of strictures or its pathological bends (this leads to stagnation of urine, which is a provoking factor for the development of the inflammatory process);
allergic urethritis occurs when severe allergies to various chemicals, food, cosmetics, drugs, etc.;
congestion in the pelvic organs in women (against the background of varicose veins), in the penis or scrotum in men (congestive urethritis);
pronounced metabolic disorders leading to a change in the acidity of urine, the formation of sand and stones in the urinary tract (uraturia, oxalatria and others);
oncological processes in the urethra of a benign or malignant nature.

Urolithiasis often causes inflammation in the urethra

Predisposing factors

Among the predisposing causes, one way or another, affecting the development of the pathological process, it is necessary to highlight:

concomitant inflammatory processes in the bladder and kidneys (cystitis, pyelonephritis and others), prostate gland (prostatitis) and others;
low immune status of the patient;
prolonged and frequent alcohol intake, tobacco use;
low level of social development and uncontrolled sexual relations;
the use of antibiotics, glucocorticoid hormones or cytostatics;
sedentary lifestyle, low level of daily physical activity;
non-compliance with the rules of intimate hygiene, the use of personal products (for example, infecting girls with infected mothers using a common washcloth or towel).

Complications

If the disease is not diagnosed in time, or the treatment is inadequate, then there is a risk of complicating the process.

Among the most common adverse outcomes of the disease are the following:

inflammatory processes in the prostate (prostatitis), epididymitis, vesiculitis;
strictures in the lumen of the urethra;
inflammatory processes in the organs of the reproductive system in women, which very often causes female infertility, obstruction of the fallopian tubes, as well as ectopic pregnancy (endometritis, cervicitis and others).

Diagnostics

The basis for the diagnosis of urethritis is represented by several research methods:

The bacterioscopic method is the fastest. The essence of the procedure is a microscopic examination of the discharge from the lumen of the urethra (native and pre-stained preparation). Using this method, microbes (primarily gonococcus), protozoa, as well as all cellular elements and their increase (leukocytes, epithelial cells, and others) can be detected in a patient.
The bacteriological method is necessary to accurately determine the nature of the infectious agent. For this, the substrate is sown on nutrient media. In addition to growing a pure culture of the pathogen, its antibacterial sensitivity is assessed, which is necessary for adequate treatment.
Serological methods make it possible to detect in the patient's body antibodies developed to the antigens of the pathogen, as well as the DNA of the microorganism (ELISA, PCR, RSK, and others).

Material collection requirements are as follows:

In female representatives, discharge from the urethra is taken no earlier than one hour after the last act of urination. For sampling, only a sterile cotton swab (“urethral”) is used, which is inserted into the lumen of the urethra (to a depth of 2-4 cm). After several rotational movements, the doctor must take out the swab and place it in a special container for transportation.
In men, the discharge is taken 2 hours after the last emptying of the bladder. The further material sampling algorithm is similar to the previous one.

When the discharge is extremely judgmental or absent at all, therefore, the biological substrate for research is obtained by scraping the anterior wall of the urethra.

Principles of treatment

It is based on etiological and pathogenetic orientation. This is necessary in order to completely destroy the pathogenic microorganism, and not just stop the symptoms of the disease.

Etiological therapy includes the appointment of the following groups of drugs:

antibacterial agents (preference is given to penicillins and cephalosporins of the latest generation);
antiviral drugs;
antifungal agents.

If we are talking about urethritis that has arisen against the background of metabolic disorders in the body, then to correct the condition, it is necessary to fight against oxaluria, uraturia, etc.

Pathogenetic therapy involves the fight against anatomical defects (for example, strictures of the urethra) or other causes that contribute to the progression of the disease (inflammatory processes around the urethra and others).

In the chronic form of urethritis, special attention is paid to immunostimulating therapy, due to which the patient's own protective properties are activated.

Also, all patients are advised to adhere to a special diet. It is necessary to refuse or reduce as much as possible in the consumption of extractive substances that can cause an exacerbation of the disease (spicy, salty and fried foods, garlic, seasonings, semi-finished products, etc.).

In chronic urethritis, local treatment is mandatory. Various antiseptics are introduced into the lumen of the urethra (Furacilin, Chlorhexidine and others). To eliminate unpleasant symptoms with balanoposthitis (inflammation of the foreskin in men), Levomekol ointment is used, which can significantly reduce itching and burning sensation.

Do not neglect the methods of physiotherapy (UHF, electrophoresis with antibacterial agents, etc.), as well as homeopathy (the use of decoctions and infusions based on natural ingredients).

In combination therapy, traditional medicine methods have proven their effectiveness, as they contribute to the speedy recovery of the patient.

Conclusion

Urethritis is an extremely unpleasant disease, because it can worsen not only the physical well-being of the patient, but also his emotional state. Often, against the background of the disease, libido decreases, and family life collapses.

If urethritis “tormented” you, you should not delay your visit to the doctor and try to treat the disease yourself, because this can only aggravate the process and lead to a number of serious complications.