Disease urethritis symptoms and treatment. Urethritis in men and women

Often, with the appearance of burning and pain during urination, women do not go to the doctor. They diagnose themselves, believing that inflammation of the bladder is to blame. However, the treatment that works for some is completely useless for others. A protracted disease is even more difficult to treat. The causes of discomfort can be different. Similar manifestations occur, for example, with urethritis. Moreover, in women there are many varieties of this disease. Only a doctor can clarify the diagnosis and choose an effective remedy to prevent the development of consequences.

Causes of the disease

The main factors that can provoke the occurrence or exacerbation of the inflammatory process in the urethra in women are:

• sexual contacts;
• hypothermia of the lower body;
• gynecological diseases and related diagnostic and therapeutic procedures;
• abuse of salty and spicy foods, the components of which, getting into the urine, have an irritating effect on the mucous membrane;
• weak immunity;
• exposure to radioactive radiation.

Note: Inflammation of the urethra can occur in women due to too infrequent emptying of the bladder, holding back urination. Stagnation of urine promotes the multiplication of pathogenic microbes.

Depending on the causes of urethritis in women, infectious and non-infectious types of the disease are distinguished.

Symptoms of infectious urethritis

Inflammation of the mucosa occurs due to its defeat by pathogens. There are 2 types of urethritis: specific and nonspecific.

Specific urethritis occurs if pathogens of infections that are predominantly sexually transmitted, such as gonococci, chlamydia, mycoplasmas, Trichomonas, tubercle bacilli, and some viruses penetrate the urethra. When a woman is infected, they penetrate not only into the genitals, but also into the organs of urination adjacent to them. The spread of infection is facilitated by their anatomical proximity and the presence of a common circulatory system, as well as the fact that the urethra is wide and short.

The risk of contracting sexually transmitted infections increases during sex without a condom, especially in women who often change sexual partners or who have sex with unfamiliar men.

Nonspecific urethritis is a disease associated with the reproduction in the mucous membrane of opportunistic microorganisms, such as, for example, staphylococci, streptococci, Escherichia coli, gardnerella, fungi of the genus Candida. They are always present in the body, and have a pathogenic effect in conditions of a sharp decrease in resistance to infections.

Factors contributing to the occurrence of urethritis, in this case are:

1. Failure to comply with the rules of hygiene of the genitourinary organs.
2. Violation of the composition of their natural microflora. The cause of urethritis may be frequent douching or the use of antibiotics that kill beneficial bacteria that block the reproduction of pathogens.
3. The presence of infectious diseases in a woman, the pathogens of which can penetrate into the urethra through the blood vessels.
4. A sharp decrease in immunity after an illness, surgery, with various stresses. The cause of the pathological weakening of the body's defenses is often the presence of autoimmune pathologies, metabolic disorders, hormonal failure. In some cases, a decrease in immunity is the norm (for example, during pregnancy or during menopause).

Addition: Sometimes urethritis occurs in a woman after the first sexual contact or when changing sexual partners. The cause of the disease in this case is the entry of foreign microflora into the vagina, leading to an imbalance of beneficial and harmful microbes.

Often, opportunistic microbes begin to develop in the body after infection by contact and household contact (for example, when using common bath accessories, linen).

Non-infectious urethritis

Urethritis in women occurs in this case under the influence of factors not associated with infection with infections. Inflammatory changes occur in the mucosa of the urethra due to trauma. It is possible to damage it with calculi during urolithiasis, as well as when installing a catheter or performing cystoscopy. Allergy can be the cause of non-infectious inflammation.

Video: Urethritis and its types. Causes and symptoms of the disease

How is urethritis

The inflammatory process in the urethra can be acute, subacute and chronic (recurrent). Urethritis develops in stages, turning into an increasingly complex form.

At stage 1, discomfort during urination is weak, occurs only occasionally, which does not cause much concern for a woman, because after a short time they disappear on their own.

Stage 2 is characterized by an increase in such episodes. Unpleasant symptoms appear only when urinating, not appearing at other times. However, most often the sensations are so painful that you have to see a doctor.

At stage 3, pain in the urethra is felt constantly, inflammation spreads to the bladder and above. If you do not start treatment of urethritis, then various complications appear. How long the individual stages are depends on the individual characteristics of the organism.

Possible consequences

One of the first consequences of the progression of urethritis in women is the development of cystitis (inflammation of the bladder). In this case, the nature of the symptoms changes somewhat. If, with urethritis, pains appear precisely in the process of urine output, then with cystitis, a painful burning sensation appears at the end of urination.

Inflammation of the urethra can lead to a narrowing of the channel (stricture), a violation of the outflow of urine. The opposite phenomenon is also possible - urinary incontinence, which often occurs, for example, in chronic chlamydial or ureaplasma disease.

The process can affect all organs of the urinary tract, lead to severe damage to the kidneys. The spread of infection to the genital area in an ascending way leads to inflammation of the mucous membranes of the cervix, endometrium, and appendages. Such processes are extremely dangerous, as they lead to the formation of adhesions, fusion of the fallopian tubes and, as a result, to infertility or ectopic pregnancy, damage to other organs of the small pelvis, and chronic abdominal pain.

The consequence of inflammation is erosion, dysplasia of the cervix, provoking malignant degeneration of tissues over time.

Symptoms of urethritis

As a rule, in women, the symptoms of urethritis are not as pronounced as in men. However, in acute inflammation, such unpleasant manifestations as burning in the urethra during emptying of the bladder, itching in the vulva, redness and swelling of the mucous membranes in the region of the mouth of the urethra, irritation of the skin around the genitals can occur. Perhaps the appearance of blood and purulent discharge from the urethra, fever. More often than usual, there is a urge to urinate.

If the doctor is not consulted and the necessary treatment is not carried out, then after 3 weeks the urethritis becomes chronic. At the same time, obvious symptoms, such as discharge, fever, burning sensation, weaken or disappear altogether. Chronic urethritis is manifested mainly by aching pain in the lower abdomen. Pain and itching in the genitourinary organs are aggravated during menstruation, as well as during intercourse. Exacerbation of symptoms can be caused by the use of not only hot spices and pickles, but also alcohol, carbonated drinks, tomatoes, sour fruits. The reason for the exacerbation is often the wearing of synthetic underwear, a violation of heat transfer in the body.

Features of symptoms in various types of urethritis

With infectious urethritis in women, the nature of the symptoms differs depending on the type of pathogens and the degree of involvement of nearby organs in the process.

Bacterial urethritis, which arose when exposed to the mucosa of staphylococci, streptococci, Escherichia coli, is manifested by abundant yellowish-greenish discharge with an unpleasant odor, as well as pain in the genitourinary organs, high fever.

Candida urethritis resembles a thrush. Allocations are not as plentiful as with vaginal candidiasis. They have a white color, viscous texture, sour smell.

Trichomonas urethritis. This kind of disease manifests itself approximately 2 weeks after infection with Trichomonas. Initially, itching appears in the perineum and in the inguinal region, then foamy discharge of moderate intensity, whitish in appearance. Pathogens simultaneously affect the genitals, resulting in trichomonas colpitis. At the same time, the volume of secretions gradually increases.

Gonococcal urethritis occurs when infected with gonorrhea. Already 2-7 days after unprotected sexual contact with the carrier of the infection, abundant grayish-green discharge of pus appears. In them, one can notice impurities of blood and particles of mucus - the desquamated epithelium of the urethra. The temperature rises to 39-40°. During the examination, the doctor observes the narrowing of the urethral opening due to edema, the gluing of the walls with pus.

Viral urethritis. It is provoked by herpes viruses, human papillomaviruses (HPV) and other similar sexually transmitted microorganisms. Usually in women, this type of urethritis is observed in a sluggish form. In addition to the typical symptoms, redness of the eyes, photophobia, and lacrimation are noticeable. They arise due to the penetration of viruses into the mucous membrane of the eyes by the hematogenous route. Joint damage is possible. There are rashes in the genitals.

Urethritis during pregnancy

During pregnancy, additional factors appear that provoke the development of inflammation of the urinary organs. These include:

1. Natural weakening of the immune system, due to which rejection of the fetus is prevented. At the same time, the body's susceptibility to any infections, including venereal ones, is significantly increased.
2. A sharp change in the hormonal background, leading to a change in the structure of the mucous membranes.
3. Constriction of the urethra by a growing fetus. Urination becomes more frequent, there is stagnation of urine in the urethra, which contributes to the growth of bacteria.

During this period, the signs of urethritis in women are much more pronounced. In addition, the risk of dangerous complications increases. Possible ascending damage to the uterus and birth canal, as well as infection of the fetus. Diagnostic procedures and treatment are difficult. The sooner you manage to cope with the disease, the less likely it is to have serious consequences.

Urethritis with menopause

The occurrence of the inflammatory process is facilitated by the fact that after a decrease in estrogen production in a woman, the condition of the mucous membranes worsens, they become thinner and become drier. Microcracks may appear in the membrane of the urethra.

In older women, prolapse of the urogenital organs often occurs, which leads to squeezing of the urethra. Age-related decline in immunity increases the likelihood of infection.

In addition, at this age, the formation of tumors in the pelvic organs is more often observed, and the risk of damage to the urethra increases. As a rule, chronic inflammatory processes are exacerbated. Manifestations of urethritis further exacerbate the ailments associated with menopausal restructuring of the body.

Diagnostics

To establish the nature of the inflammatory process in the organs of urination, urine tests are performed. A general analysis allows you to identify a change in color, transparency, acidity, specific gravity, to detect the appearance in the composition of elements indicating the localization of the inflammatory process, the presence of infectious pathogens. In order to control the process of treatment, the analysis is given repeatedly.

Urine analysis according to Nechiporenko is carried out to accurately determine the number of leukocytes, erythrocytes and other components in 1 mg of urine. This makes it possible to find out how the kidneys function, to detect the degree of development of the inflammatory process in the urinary tract.

To clarify the sensitivity of bacteria to certain antibiotics, a urine culture is done.

Microscopic analysis of smears from the urethra is carried out, as well as PCR analysis to detect "hidden" pathogens, the nature of which can be determined by their DNA. Methods of hardware diagnostics are also used: ureteroscopy (examination of the inner surface of the bladder and urethra), to detect various pathologies in them.

Video: Causes, symptoms and treatment of urethritis

Treatment of urethritis

First of all, in the treatment of urethritis in women, drugs are prescribed to destroy pathogenic microorganisms. If the tests showed that the cause of inflammation was a bacterial lesion, then antibiotics of various groups are used: sulfonamides (Urosulfan, Sulfazol), macrolides (Azithromycin), quinolones (Clinafloxacin), cephalosporins (Ceftriaxone, Cefazolin).

With fungal urethritis, Natamycin, Levorin and other antifungal agents are prescribed. If viruses have become the cause of the disease, antiviral drugs (Acyclovir, Lamivudine and others) are used. Trichomonas urethritis is treated with Metronidazole or Trichopolum.

Medicines are used in the form of tablets for oral administration, as well as in the form of vaginal suppositories. When infected with sexually transmitted infections, the woman's sexual partner must also undergo treatment.

During treatment, antihistamines, as well as painkillers and anti-inflammatory drugs, may be prescribed. In addition to antimicrobial therapy, treatment with immunostimulating drugs is carried out.

The patient must follow a diet, exclude foods and drinks that are harmful to her from the diet. With the help of proper nutrition, it is necessary to regulate the work of the intestines, since constipation and diarrhea aggravate the process of inflammation, the symptoms are exacerbated.

During treatment, it is necessary to drink plenty of fluids to stimulate urination and excretion of microbes in the urine. For this purpose, diuretics are prescribed.

The use of folk remedies

Most often in the treatment of urethritis in women, plant-based home remedies are used. Doctors advise to supplement the main therapy with them, for example, take inside an infusion of bearberry or decoctions of chamomile, yarrow, coltsfoot, calendula, eucalyptus as anti-inflammatory drugs. They can also be used for washing, preparing medicinal baths and tampons.

As diuretics and sources of vitamins, it is recommended to use rosehip decoction, teas from birch leaves, lingonberries, cranberries, as well as infusions of horsetail, St. John's wort or lemon balm.

Traditional medicine helps to relieve the main symptoms: inflammation, painful manifestations.

Lime blossom decoction

Helps with pain and pain in urethritis. 2 tbsp. l. plants are poured with 0.5 liters of boiling water, kept on low heat for 10 minutes. Strain and chill. Drink 1 glass before bed.

parsley medicine

Pour a small amount of milk 3 tbsp. l. fresh parsley. Place the mass in the oven for about 0.5 hours. The resulting slurry is taken every hour for 1 tsp.

Parsley infusion

1 st. l. parsley insist in 0.5 l of water for 12 hours, filter the infusion. Use 4-5 times a day for 1/3 cup.

It is pointless to hope for a complete cure for urethritis with the help of folk remedies alone, since their action is aimed only at alleviating the symptoms, but they do not help to eliminate the causes of the disease. It is necessary to contact a urologist who will prescribe drugs for treatment, and, if necessary, refer you to a gynecologist or venereologist.

Urethritis is an inflammatory process that occurs in the urethra. The disease is widespread, equally common in patients of both sexes.

The main signs of the disease are pain, cramps, burning at the time of urination, discharge from the urethra of a pathological nature, depending on the pathogen.

In particularly difficult situations, inflammation can affect other organs located nearby - the urea, prostate, scrotum. Another consequence of the disease is the narrowing of the urethra, reaching its complete adhesion.

Causes of the disease

The treatment process must begin by understanding the cause of the disease. Only in this case, the doctor will be able to prescribe adequate therapy.

Female urethritis, like male, can occur in a complicated form. In addition, pyelonephritis can become the main problem. and the absence of a treatment course causes deformation of the urethra, narrows it. Deformation causes complications in the process of urination.

Diagnostic measures

At the initial stage, the doctor has to identify the cause of the formation of this disease. To do this, you need to find pathogens. But if there is no purulent discharge from the urethra, it will be quite difficult to determine the cause of the disease. In order to extract pus, you will have to apply provocative tests.

The chemical method is considered easier - the patient needs to take a medicine that provokes copious pus. Thermal and mechanical options are quite complex and are accompanied by pain. To obtain pus, the urethral mucosa is irritated with the thinnest metal probe or a temperature effect is created.

Subsequent to these actions, the diagnosis of urethritis can be performed in two ways - bacterioscopic or bacteriological. The first option involves examining smears with a microscope.

If the pathogen is not installed, use the second method. The secretions obtained from the urethra are placed on a special nutrient medium. With a positive result, whole bacterial colonies form very soon on this medium.

More advanced methods for detecting pathogenic bacteria are also known. Most medical centers use a polymerase chain reaction. This method of examination is based on the isolation of the DNA of the urethritis pathogen from the biological fluids of the patient.

Patients with trauma to the organs in the pelvic area are prescribed an X-ray examination of the urethra. With the help of contrast radiography, defective areas on the walls of the urethra are revealed. In the study, it is often used - the introduction of a special optical apparatus into the urethra.

Treatment of pathology

Most often, antibiotics are used in the treatment of urethritis. In order to achieve the best results, the information of the antibiogram should be taken into account. Simply put, before prescribing medications to a patient, a specialist determines the degree of sensitivity of the patient to a particular type of drug.

This type of examination is performed a couple of days after a person is diagnosed. But even at this time, the patient should be provided with medical assistance.

Temporarily prescribed drugs from the penicillin group, which have a wide spectrum of action. Today, semi-synthetic penicillin preparations are very popular.

This group has a strong effect on pathogens, perfectly resists human biology.

If such drugs do not give the desired effect, the doctor may replace them with more effective drugs. In addition, some antiseptic drug is prescribed, which is used to wash the urethra. In carrying out such a procedure, Dekasan or Furacilin, which is considered more effective, is used. The procedure must be performed by an experienced specialist.

In order not to disturb the signs of the disease, the patient should not engage in self-treatment and use medicines before the doctor determines the diagnosis.

You can use it during treatment, but you should first consult with a specialist. There are remedies that can speed up the healing process.

Undergoing a treatment course, the patient must adhere to a strict diet, refusing products that can increase the secretion of the urethral mucosa. Such products should include all hot spices and seasonings.

It must be remembered that the rehabilitation period following urethritis is required not only for the patient, but also for his partner. Quite often, after the discovery of the disease, people begin to accuse each other of sexual infidelity. As soon as the diagnosis is revealed, you can come to an appointment with a specialist together. The causes of the disease will be explained to you in detail.

Possible complications after the disease

In the case when a patient with urethritis does not consider it necessary to pay attention to such a problem, tries to “endure” not too pleasant sensations during urination and not disturb the specialist “on trifles”, then after a certain time all signs of the disease will disappear. It turns out that there is no need to waste time on doctors and money on treatment.

But frankly, the body simply muffled the problem, not getting rid of it completely. Pathogenic bacteria will hide and wait until any hypothermia, excessive consumption of alcohol, active sexual life. All this will again cause inflammation in the urethra. This is urethritis, and it is quite possible that he has passed into the chronic stage.

In addition, without treatment of the disease, numerous problems can arise in the form of diseases of the kidneys, prostate and urinary tract. And getting rid of them is much more difficult than getting rid of urethritis.

Preventive measures

The likelihood of this disease can be minimized by following a number of not very complicated rules. It is strongly recommended to avoid casual sexual partners. Compliance with the requirements of hygiene rules will significantly reduce the likelihood of illness. You will have to stop smoking and drinking alcohol, regularly undergo preventive examinations with a specialist.

To these requirements, it is necessary to add the observance of proper nutrition, excluding spicy and salty foods, the prevention of hypothermia, and the timely treatment of infectious diseases.

Urethritis is an inflammation of the mucous membrane of the urethra (urethra), which is used to remove urine from the body. In men, the urethra is also a conduit for sperm.

In most cases, urethritis is caused by urogenital infections and opportunistic microorganisms (subject to a decrease in the immune status or a violation of the barrier function of local immunity factors).

Much less commonly, urethritis is caused by exposure to chemicals or trauma.

Inflammation that began in the urethra, with inadequate treatment, can spread and affect the bladder and other organs of the small pelvis. This disease affects both men and women, regardless of age.

Particularly at risk are young men aged 20-35 who are sexually active and neglect condom protection, as well as men who have anal sex.

Classification of urethritis

The following is a classification of urethritis based on the etiology of urethritis and their origin.

Urethritis of sexual origin

Venereal (due to naturally transmitted sexually transmitted microorganisms and not found in healthy people):

Chlamydial;
- Trichomonas;
- ureaplasma;
- herpetic (primary infection with herpes simplex virus type 2).

Conditionally venereal:

Caused by pathogenic pathogens of non-venereal infections (candidiasis, bacterial, entameba, etc.) that accidentally enter the urethra;
- Caused by opportunistic pathogens that usually live as saprophytes on the mucous membrane of the oropharynx (Neisseria non gonorrhoeae, gen. Mimeae, etc.);
- Gardnerella (caused by Gardnerella vaginalis?) and caused by group B streptococci.

Non-sexual urethritis

Infectious - urethritis that arose secondarily with general infections or local infectious and inflammatory diseases (chronic prostatitis, etc.), as well as dysbacterial urethritis (candidiasis and bacterial).

Non-infectious:

Traumatic (from exposure to mechanical, chemical and thermal stimuli);
- due to metabolic disorders (phosphaturia, oxaluria, uraturia);
- allergic;
- congestive;
- due to a tumor in the urethra;
- dermatous (symptomatic).

Causes of urethritis

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

Viral causes include cytomegalovirus and herpes simplex virus.

Chronic urethritis - a pathological condition that develops in the urinary tract as a result of improper treatment, or in its absence. In this case, periodic outbreaks are replaced by remissions. The long course of the disease leads to undesirable consequences: adhesions develop in the urethra, its lumen narrows, and concomitant complications occur.

G onococcal urethritis. This is inflammation that occurs as a result of sexual contact with a partner who has gonorrhea.
The causative agents of gonococcal urethritis (in 80% of cases) are gram-negative intracellular diplococci.
Patients with gonococcal urethritis have a shorter incubation period than those with non-gonococcal urethritis and experience symptoms such as dysuria and purulent discharge earlier.

Non-gonococcal urethritis (NGU). The disease usually begins with dysuria or, more rarely, with mucopurulent discharge. Sometimes NGU is asymptomatic, unlike patients with gonococcal urethritis.
causative agents are not G onococcal urethritis (15-55% of cases) are ureplasma, fungi of the genus Candida, chlamydia, Trichomonas, etc. Often pathogens cannot be identified in most patients with NGU.
Rare cases of NGU are associated with venereal lymphogranulomas, herpes simplex, syphilis, mycobacteria. Other less common causes include anaerobes, adenovirus, cytomegalovirus, and streptococcus.
Intermittent catheter use in 2-20% of patients can also cause NGU. As practice shows, latex-based catheters are 10 times more likely to cause infection than silicone ones.

Urethritis of mixed etiology usually caused by gonococcal infection and other organisms combined. The cause may be inadequate treatment and some other factors, such as:

Sexually transmitted diseases (gonorrhea, syphilis, chlamydia, herpes simplex virus or AIDS. Mycoplasma genital;
- Bacteria and other microorganisms located at the entrance to the urethra;
- Herpes simplex;
- Adenovirus;
- Injuries in women during sexual intercourse;
- Reiter's syndrome;
- Escherichia coli;
- Sensitivity to spermicides or contraceptive jellies, creams, foams, etc.

If the patient had medical manipulations using foreign objects (for example, a catheter) in the urethra, then the cause of inflammation is most likely trauma.

Causes of urethritis in men

Chemical irritation from exposure to soap, lotion, or cologne can cause temporary pain in the urethra. Spermicide in condoms, birth control gels, birth control creams, or foams can also cause irritation.
- Mechanical manipulation of the penis or minor trauma can lead to urethritis. Medical procedures, uncomfortable clothing, vigorous sexual activity, or masturbation can temporarily irritate the urethra.
- Sometimes ejaculation causes a feeling similar to urethritis. As a rule, it goes away in a short period without any special treatment.

Risk factors for urethritis

The main risk factors for developing urethritis include:

reproductive age;
- Chaotic sex life;
- Anal sex;
- Repeatedly recurring sexually transmitted diseases.

Symptoms urethritis

Urethritis, regardless of the etiological factor, manifests itself with the same clinical symptoms with varying degrees of severity, depending on the type of process. Although certain urethritis have their own clinical features, for example, with trichomonas urethritis, the discharge has a characteristic "smell of fresh fish." According to the type of the course of the process, the following are possible: acute form, subacute, torpid form (malosymptomatic).

The symptomatology of uncomplicated urethritis is summarized from the presence of discharge from the urethra (purulent, mucous, mucopurulent nature), inflammatory changes in the external opening of the urethra, leukocyturia in the first portion of urine, pain, burning, cramps of varying severity during urination.

As a rule, signs of the disease begin to appear within 4 days to 2 weeks after contact with an infected partner or may be asymptomatic. Here are the most common symptoms of the disease:

- Discharge from the urethra. The discharge may be yellow, green, brown, or tinged with blood.

- Urination disorder (dysuria). Difficulty in the process of urination is usually observed in the morning, may be aggravated by the use of alcohol. Urination frequency and urgency are usually absent and are more likely to be associated with signs of prostatitis or cystitis.

- Pain. Men sometimes complain of a feeling of heaviness in the genitals. Pain in the testicular region may indicate the presence of epididymitis, orchitis, or both.

- Menstrual cycle. Women sometimes experience a worsening of symptoms during menstruation.

Simple urethritis usually does not cause an increase in body temperature or a significant deterioration in physical condition. If complications occur, when the disease spreads to other organs of the urogenital area or the infection enters the bloodstream, the following symptoms may appear:

Backache;
- Abdominal pain;
- Heat;
- Nausea;
- Vomit;
- Swelling of the joints.

Typical symptoms of urethritis in men:

blood in urine or semen;
- Sometimes fever;
- Frequent urination;
- Acute pain when urinating (dysuria);
- Feeling of soreness, itching or swelling in the groin area;
- Discharge from the penis.

Typical symptoms of urethritis in women:

Pain in the lower abdomen;
- Burning pain when urinating;
- Sometimes fever and chills;
- Vaginal discharge;
- Frequent urination;

Diagnosis of urethritis

The study involves passing the following tests:

Complete blood count (CBC);
- C-reactive protein test;
- Urinalysis and culture for pathogenic cultures;
- For women - a pregnancy test and ultrasound of the pelvic organs;
- Tests for the detection of sexually transmitted diseases - chlamydia, gonorrhea, etc.

The doctor will examine the skin, the nature of the lesion of which may indicate other sexually transmitted diseases.
In women, an abdominal and pelvic examination is performed, including a complete gynecological examination, including the cervix.

The medical examination of a man includes:

Inspection of linen for the presence of secretions;

Examination of the penis: The doctor examines the skin for lesions that may indicate other STDs (eg, genital warts, herpes simplex, syphilis).

Examination of the urethra: The doctor will examine the lumen of the distal urethra for stricture (an abnormal narrowing of the urethra) or obvious discharge from the urethra; palpating along the urethra, determining the area of ​​fluctuation (fluid accumulation) or abscess.

Examination of the groin and testicles: The doctor will look for inflammation, swelling, tenderness to rule out diseases such as orchitis or epididymitis. The examination also includes a digital rectal examination.
In addition, at the appointment with the doctor, you need to honestly answer some questions that are important for making the correct diagnosis and subsequent treatment.

Sexual contacts: the doctor will tactfully ask about your sex life, this is necessary to identify the nature and to differentiate the disease.

Use of contraceptives: In some patients, the use of spermicides can cause chemical urethritis, which causes the same symptoms as infectious urethritis.

Age at first intercourse: With the exception of some religious groups that encourage marriage and monogamy at a younger age, many young people have a direct association with contracting STDs at their first intercourse.

Sexual preferences: Homosexual men have the highest rate of sexually transmitted diseases. They are followed by patients leading a promiscuous sex life.

Treatment urethritis

The goal of treatment is:

Elimination of symptoms;
- Prevention of development of complications;
- Eliminate the cause of the infection.

Most cases of urethritis are caused by infections, which often require the use of antibiotics to treat the disease. It must be remembered that inadequate antibiotic treatment can contribute to the transition of the disease to a chronic form.

The choice of drug for treatment and its dose completely depend on the cause of urethritis, therefore it is very dangerous to prescribe drugs for yourself without first consulting a doctor.

Antimicrobial therapy may include the following drugs:

Erythromycin 500 mg (used 4 times a day - at least 7 days, allowed during pregnancy).
- Tetracycline 500 mg (used 4 times a day - at least 7 days).
- Doxycycline 100 mg (used twice a day - 10 days).
- Ciprofloxacin 500 mg (used once a day).
- Ofloxacin 400 mg (used once a day).
- Clindamycin 300 mg (used orally 2 times a day - at least 7 days).
- Ceftriaxone 250 mg (used once a day).
- Acyclovir 400 mg (used orally 3 times a day - at least 10 days).
- Famciclovir 250 - 500 mg (used orally 2 times a day - at least 10 days).
- Metronidazole 2 g (used orally once a day, contraindicated during pregnancy).

Also drugs can be used:

Clotrimazole - antitrichomonas, antifungal and antibacterial action;
- Fluconazole (Diflucan) - in case of damage by a fungus of the genus Candida;
- Nystatin (Mycostatin) - with the defeat of the fungus of the genus Candida;
- Nitrofurantoin - for bacterial infections;
- Co-trimoxazole - a combination drug that includes sulfamethoxazole and trimethoprim - for bacterial infections.

The course of antibiotic treatment can be up to 14 days. In severe cases of the disease and complications that have arisen, hospitalization is required.

In cases of infection with sexually transmitted diseases, it is extremely important to use antibiotics regularly. In this case, all sexual partners must undergo treatment.

Sex without the use of condoms during treatment is unacceptable.

You should tell your doctor immediately if the condition worsens or symptoms return while taking antibiotics.
It is recommended to drink plenty of fluids to dilute the urine. This will reduce pain when urinating.

Non-steroidal anti-inflammatory drugs such as ibuprofen and acetaminophen (Tylenol) are used for pain relief.

The use of sitz baths is recommended to eliminate irritations caused by chemical urethritis. To do this, fill the bathtub with warm water so that it covers the genital area, while it is not recommended to use foam or other bath products. Do this procedure several times a day.

Acupuncture procedures are also useful in terms of strengthening the body's immune system and relieving pain from urethritis.

Nutrition and nutritional supplements for treatment urethritis

Appropriate nutrition, the use of herbs, homeopathic remedies, and acupuncture treatments can be effective in fighting infection, relieving pain, and strengthening the urinary system. Always tell your doctor about the herbs and supplements you are using.

The following tips may help reduce the symptoms of urethritis:

Eat foods high in antioxidants, including fruits, berries, and vegetables (such as blueberries, cherries, pumpkins, tomatoes, bell peppers).
- Try to eliminate potential food allergens. To do this, you may have to take a test to check your food sensitivity.
- Limit your intake of red meat, prefer leaner meats, fish or beans are also good for protein.
- If possible, eliminate refined foods such as white bread, sugar, pasta.
- It is important to use healthy edible oils such as olive or vegetable oils.
- Reduce or avoid commercial baked goods (cookies, cakes, crackers, french fries, doughnuts, margarine) due to their trans fatty acid content.
- Try to completely abandon the use of coffee, tobacco, alcoholic beverages and other stimulants.
- Drink at least 5 to 8 glasses of filtered water per day.
- Don't forget to exercise.

The following additions to your diet may also be helpful:

Nutrient and vitamin deficiencies in the diet can be replenished with a daily multivitamin containing antioxidant vitamins A, C, D, E, vitamins and minerals such as selenium, zinc, magnesium and calcium.
- Use probiotic supplements (containing lactobacillus acidophilus), 5 to 10 billion CFU (colony forming units) per day, to improve the functioning of the gastrointestinal tract and strengthen immunity. Probiotic supplements must be refrigerated before consumption.
- Consume omega-3 fatty acids to help reduce inflammation and boost immunity. They are found, for example, in fish such as salmon and halibut. A good option is to use fish oil - 1 - 2 capsules (1 tablespoon) 1 - 2 times a day. Fish oil also enhances the effects of certain blood-thinning drugs.
- It is useful to use grapefruit seed extract in the form of 100 mg capsules, which helps to strengthen the immune system and has antibacterial and antifungal activity.
- Methylsulfonylmethane 3000 mg twice a day is also used to reduce inflammation.

You can use natural hormone replacement therapy to treat chronic urethritis. Consult with your physician.

Herbs for the treatment of urethritis

Herbs are a relatively safe way to strengthen the tone of all body systems. They can be used in any form, as capsules, powders, extracts, tinctures, infusions, teas, etc.

Cranberry. Cranberry juice or fruit drink has a beneficial effect on the genitourinary system. Pharmacies also sell standardized cranberry extract.

Green tea. Green tea has an antioxidant, immunomodulatory, antitumor effect. However, it is best used without caffeinated products.

- "Cat claw". Antibacterial, antifungal and immuno-strengthening and antitumor activity has "Cat's Claw", sold as a standardized extract. It is necessary to take into account the fact that "Cat's Claw" may react with other drugs, therefore, when using it, a doctor's consultation is necessary.

Bearberry. For the treatment of diseases of the genitourinary sphere, bearberry is effective. It has a diuretic, anti-inflammatory, antimicrobial effect. It also helps thin the blood.

Complications urethritis

With proper diagnosis and adequate treatment, urethritis usually does not cause any complications.

For men, the following complications are typical:

Inflammation of the bladder (cystitis);
- Inflammation of the epididymis (epididymitis);
- Inflammation of the testicles (orchitis);
- Inflammation of the prostate (prostatitis);
- Kidney inflammation.

For women, the following complications are typical:

Bladder infections (cystitis);
- Kidney infections;
- Cervicitis;
- Inflammation of the pelvic organs (uterus, fallopian tubes or ovaries).

In addition, urethritis can lead to irreversible damage to the urethra, narrowing its lumen, and cause infertility.

Prevention urethritis

There are simple rules to maintain the health of the genitourinary system and prevent infection:

Maintain good personal hygiene;
- practice a safe sex life with one sexual partner;
- avoid using products that can irritate the genital area: soap, lotion, cologne, vaginal deodorants and aerosols;
- drink more fluids;
- Wear cotton underwear.

For menopausal women, estrogen replacement therapy may help prevent urinary tract infections.

There is an opinion that people are most susceptible to diseases of the genitourinary system, so the question arises, what is urethritis in men? 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.

As a rule, urethritis in men occurs from questionable sexual intercourse.

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, it is observed, the development of which was served by various harmful bacteria. In medicine, there are many classifications of urethritis.

Given the type of pathogen, they distinguish specific and. 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.

Urethritis is classified depending on the pathogen and the course of the disease.

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.

The cause of the disease h is an infection

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.

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, because it tends to quickly turn into a chronic one and proceed in a latent form. Such a deviation is difficult to treat and leads to the occurrence.

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

Diagnostics includes laboratory and instrumental methods

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.

Urethritis - inflammation of the mucous membrane of the urethra.

Urogenital bacterial infections are one of the most urgent problems of modern urology, venereology, gynecology and other branches of medicine.

Information about their frequency is contradictory, which is due to the dependence of this indicator on the characteristics of the examined contingent, the place and time of research, and the level of laboratory diagnostics.

ICD-10 code

N34.1 Nonspecific urethritis

N34 Urethritis and urethral syndrome

N34.2 Other urethritis

N37.0* Urethritis in diseases classified elsewhere

Causes of urethritis

The variety of clinical forms of nonspecific urethritis is due to various etiological factors. The occurrence of a significant part of them is associated with infection. According to modern concepts, urethritis can be caused by microorganisms that are usually present in the microbial flora of the lower genital tract or enter them from the outside during sexual intercourse or when the composition of the vaginal and urethral microflora changes in favor of virulent microorganisms.

Bacterial urethritis is a disease in which bacteria of the "banal" microflora of various genera are found: Escherichia coli, Klebsiella, Enterobacter, Serratia, Proteus, Citrobacter, Providenci, Staphylococcus aureus. The latter prevails and plays a role in the occurrence of urethritis not only as a monoculture, but also in microbial associations, which are associated with the persistent course of the disease in such patients.

The most common causative agents of urethritis in men are Chlamydia trachomatis and Neisseria gonorrhoeae. However, in a significant proportion of patients with urethritis (up to 50%), these microorganisms are not detected. In such cases, non-chlamydial non-gonococcal urethritis is diagnosed, which, nevertheless, is presumably referred to as an STI. Although, despite numerous studies, the prevailing role of any microorganism in the development of non-chlamydial non-gonococcal urethritis has not yet been proven.

The high incidence of Chlamydia trachomatis in patients with urogenital gonorrhea has led to recommendations for the prophylactic use of antichlamydia drugs in patients with gonorrhea.

Causing not only nonspecific urethritis, mycoplasmas can cause diseases of the kidneys and urinary tract. Research confirms. that infection with Mycoplasma genitalium is fairly common among men presenting to outpatient care with symptoms of urethritis. In patients with clinical symptoms of non-chlamydial non-gonococcal urethritis, M. genitalium was detected in 25% of cases. In patients without symptoms of urethritis, the frequency of isolation of M. genitalium was significantly lower and amounted to only 7% (p=0.006). The frequency of isolation of M. genitalium among men with gonococcal and chlamydial urethritis was 14 and 35%, respectively.

At the same time, the role of other intracellular pathogens, in particular Ureaplasma urealyticum, in the development of postgonococcal urethritis still remains unclear.

Trichomonas urethritis takes 2-3rd place after gonorrheal and chlamydial. In most cases, the disease occurs without clearly defined clinical symptoms and any features that distinguish it from urethritis of another etiology. The causative agent Trichomoniaea belongs to the genus Trichomonas, united in the class of flagella. Of all types of Trichomonas, Trichomonas vaginalis is considered pathogenic. In women, it lives in the urethra and in the vagina, in men - in the urethra, prostate and seminal vesicles. In 20-30% of patients, trichomonas infection can proceed according to the type of transient and asymptomatic carriage.

The causative agents of viral urethritis include herpes simplex type 2 viruses (genital) and genital warts. In recent years, there has been a trend towards their wide distribution. Both viruses cause disease only in humans. Infection occurs through close, intimate contact. At the same time, it is possible to become infected from an infected patient both in the presence of symptoms of the disease, and in their absence. Primary infection is often accompanied by severe symptoms, after which the virus goes into a latent state. Repeated exacerbation of the disease is observed in 75% of patients.

Fungal infections of the urethra most often occur in patients with immune and endocrine disorders (diabetes mellitus) or as a complication of long-term antibiotic therapy. Fungal infections include candidal lesions of the urethra, the cause of which is the yeast-like fungus Candida. It is found in the discharge from the urethra in the form of a large amount of pseudomycelium in thick dense mucus. In women, candidal urethritis occurs due to damage to the reproductive system of Candida due to the widespread use of antibacterial agents. In men, candidal urethritis is isolated, and infection occurs sexually.

Gardnerella lesion of the urethra occupies a certain place among sexually transmitted diseases. In recent years, gardnerella infections have increasingly attracted the attention of researchers.

Gardnerella urethritis is currently being paid attention by various specialists who recognize the participation of gardnerella in the development of urethritis in women. so do men. The disease develops as a result of infection of the vagina with Gardnerella vaginalis, a non-motile gram-negative rod that is sexually transmitted. Mixed infection with chlamydia, ureaplasmas, protozoa, fungi and anaerobic microorganisms is often noted.

With the development of nonspecific urethritis, a significant role among the risk factors is played by the deterioration of the general condition of the body, alcohol intake, lack of physical activity, as well as venous congestion in the submucosal layer of the urethra, often due to sexual excesses.

Autoimmune processes play a significant role in the pathogenesis of nonspecific urethritis, especially in mixed specific and nonspecific infections, which often leads to low efficacy of antibiotic monotherapy and a long, persistent course of the disease.

Symptoms of urethritis

Infectious urethritis can be sexually transmitted and, while the incubation period is well known for gonorrhea and Trichomonas urethritis, it has not been definitively established for most non-specific urethritis. Its duration ranges from several hours (allergic urethritis) to several months (with viral and other urethritis). Clinically, according to the severity of the signs of the disease, there are three main forms of urethritis:

• sharp;
• torpid;
• chronic.

Symptoms of urethritis are characterized by the following features:

Acute urethritis is characterized by an abundance of discharge from the urethra on the glans penis, they can shrink into yellowish crusts. The lips of the urethra become bright red, edematous, the mucus of the urethra may turn outward somewhat.

On palpation, the urethra is thickened and painful, which is especially noticeable with periurethritis. The affected large paraurethral glands are found in the form of small, similar to large grains of sand formations. Subjective disorders are sharply expressed - burning and pain at the beginning of urination, its increase. The first portion of urine is turbid, may contain large filaments that quickly settle to the bottom of the vessel. With the defeat of the posterior urethra, the clinical picture changes - the amount of discharge from the urethra decreases, the frequency of urination increases sharply, at the end of the act of urination there is a sharp pain, sometimes blood.

Symptoms of torpid and chronic urethritis are approximately the same. Subjective symptoms of urethritis are mild, characterized by discomfort, paresthesia, itching in the urethra, especially in the navicular fossa. As a rule, there is no free discharge from the urethra, but there may be sticking of the sponges of the urethra. In some patients, symptoms of urethritis have a negative emotional connotation associated with the individual characteristics of the experience of the disease itself. In the first portion of urine, usually transparent, small threads can float and settle to the bottom.

With the above symptoms in the first 2 months, urethritis is called torpid, with a further course - chronic.

Forms

In clinical practice, it is customary to classify urethritis into two large groups.

• Infectious:
  • specific:
  • • tuberculosis;
    • gonorrheal;
    • trichomonas;
  • non-specific:
    • bacterial (caused by mycoplasmas, ureaplasmas, gardnerella, etc.);
    • viral (candilomatosis of the urethra);
    • chlamydial;
    • mycotic (candidiasis, etc.);
    • urethritis caused by a mixed infection (Trichomonas, latent, etc.);
    • transient short-term (with the spread of urogenital infection through the urethra into the prostate).
• Non-infectious:
  • allergic;
  • exchange;
  • traumatic;
  • congestive;
  • caused by diseases of the urethra.

Residual, psychogenic, iatrogenic inflammation of the urethra is also possible.

In addition, bacterial urethritis is often divided into gonococcal and non-gonococcal (non-specific). However, this classification is currently not used by most researchers. Separately, urethritis caused by a nosocomial (nosocomial) infection, which can be accidentally introduced into the urethra during various manipulations, should be distinguished:

• ureteroscopy;
• cystoscopy;
• bladder catheterization;
• installation.

With transient urethritis, we are talking about a lightning-fast course of urethritis during the passage of a urogenital latent infection (chlamydia, ureaplasma, mycoplasma, gardnerella, much less often - genital herpes virus type 2) during infection of the patient after intercourse with a sick partner. In such patients, clinical signs are barely perceptible. Such patients are identified among those who have had sexual intercourse with a questionable partner without a condom. As a rule, these are men with significant sexual experience, treated and fully recovered from latent and even sexually transmitted diseases.

In recent decades, there has been an increase in the number of patients with nonspecific urethritis, the number of which, in relation to all other types of urethritis, has increased, according to various venereal clinics, by 4-8 times.

Diagnosis of urethritis

The main methods for diagnosing urethritis:

• bacterioscopic;
• bacteriological;
• immunological, including serological;
• clinical.

The initial and one of the most important stages of the etiological diagnosis of infections of the genitourinary system is the collection and transportation of biological material.

Basic rules for taking material from women:

• the material is collected no earlier than one hour after urination;
• discharge from the urethra is collected with a sterile cotton swab;
• if the material cannot be obtained, then a thin sterile “urethral” tampon is inserted into the urethra to a depth of 2-4 cm, gently rotated for 1-2 s, removed, placed in a special transport medium and delivered to the laboratory.

Basic rules for collecting material from men:

• the material is collected no earlier than 2 hours after urination;
• a thin sterile swab is inserted into the urethra to a depth of 2-4 cm, gently rotated for 1-2 s, removed, placed in a special transport medium and delivered to the laboratory.

In torpid and chronic forms of urethritis, material for research can be obtained by careful scraping from the mucous membrane of the anterior urethra with a Volkmann spoon.

The bacterioscopic method includes the study of discharge from the urethra using staining (according to Gram, Romanovsky-Giemsa, etc.) and is designed to detect microbes (primarily gonococcus) and protozoa. To detect Trichomonas use the study of native drugs

This method allows you to identify, in addition to microbes and protozoa, cellular elements - leukocytes, epithelial cells, as well as various variants of associations of microorganisms. In addition to the detection of direct causative agents of urethritis, it is also indicated by the detection of 5 or more polymorphonuclear leukocytes in the field of view.

The bacterioscopic method not only allows to establish the presence of an infectious process in the urethra, but helps to determine its etiology, as well as further patient management. In the absence of signs and symptoms of urethritis or polymorphonuclear leukocytes during bacterioscopic examination, therapeutic and sometimes additional diagnostic measures are postponed.

In clinical practice, for the diagnosis of gonorrhea, in addition to the bacterioscopic method, bacteriological methods are used, less often immunofluorescence, immunochemical and serological tests. Bacterioscopy of smears from the urethra reveals gram-negative diplococci. located intracellularly, characterized by polychromasia and polymorphism, as well as the presence of a capsule. Bacteriological examination consists in isolating a pure culture of gonococcus on meat-peptone agar.

The diagnosis of Trichomonas urethritis is made on the basis of clinical signs of the disease and the detection of Trichomonas in the test material. For this purpose, a bacterioscopy of an unstained fresh preparation and a study of a Gram-stained preparation are carried out, less often bacteriological examination is performed using solid nutrient media.

Diagnosis of gardnerellosis urethritis is based on bacterioscopic examination of native preparations, as well as Gram-stained preparations. In native preparations, squamous epithelial cells are found, to the surface of which gardnerella are attached, giving them a characteristic "peppered" appearance. This is considered a pathognomonic sign of gardnerellosis. The cytological picture in stained smears is characterized by the presence of separate leukocytes scattered in the field of view, a significant number of small gram-negative rods located on epithelial cells.

Clinical manifestations of urethritis, in which various variants of staphylococci, streptococci, Escherichia coli, enterococci and some other conditionally pathogenic microorganisms are found, depend on the localization of the pathological process and cannot be differentiated from infections caused by other pathogens. In these cases, it is mandatory to conduct a multi-glass urine sample. Bacteriological methods make it possible to determine the number of pathogens in 1 ml of fresh urine, their species and type, as well as sensitivity to antibiotics.

Clinical research methods also include ureteroscopy, which is indicated to clarify the nature of the lesion of the mucous membrane of the urethra, complications of prostatitis, vesiculitis, etc.

The basic principles for diagnosing chlamydial infection are the same as for other bacterial diseases. Test procedures include:

• direct visualization of the agent in clinical specimens by bacterioscopic staining;
• determination of specific chlamydial antigens in samples of clinical material;
• direct isolation from the tissues of the patient (bacteriological method):
• serological tests in which antibodies are determined (demonstration of changing titers);
• determination of specific chlamydial genes in samples of clinical material.

The bacterioscopic method for detecting chlamydia involves the identification of the morphological structures of chlamydia in the affected cells. Currently rarely used due to low sensitivity (10-20%).

Both direct and indirect immunofluorescent methods can be used to detect chlamydia antigens in clinical samples during bacterioscopic studies. With direct immunofluorescence, the preparation is treated with specific mono- or polyclonal antibodies labeled with fluorescein. In the indirect immunofluorescent method, the preparation is treated first with an immune serum containing unlabeled anti-Chlamydial antibodies, and then with an anti-species fluorescent serum. Viewing is carried out with a fluorescent microscope. The sensitivity of this bacterioscopic study is 70-75% for cervical mucus in women and 60-70% for scraping from the urethra in men.

The bacteriological method for diagnosing chlamydial infection is based on the isolation of chlamydia from the test material by infecting primary or transplanted cell cultures, since chlamydia does not multiply on artificial nutrient media. In the process of cultivation, the pathogen is identified and sensitivity to antibiotics is determined. The method of diagnostic isolation of chlamydia in cell culture can be used during the entire period of the disease, with the exception of the period of antibiotic therapy, and within a month after it. However, at present, this method is mainly used in the control of cure to identify chlamydia capable of carrying out a full development cycle. The sensitivity of the method ranges from 75 to 95%.

Methods for the serological diagnosis of chlamydia are based on the determination of specific antibodies in the blood serum of patients or those who have had chlamydial infection. Serological tests for the determination of IgG in blood serum are informative in generalized forms of infection, as well as in cases where infected organs are not available for direct examination (for example, pelvic organs). With a localized urogenital infection, it is informative to study the indicators of local immunity (in cervical mucus in women, in prostate secretion and seminal plasma in men). When examining infertile couples, the IgA indicator in these media is more informative than when examining blood serum. However, IgA appear in these environments some time after the onset of the inflammatory process, and therefore these tests are not suitable for diagnosing acute chlamydial infection.

Indicators of local immunity (IgA in secrets) are usually comparable in significance to those of humoral immunity (IgG in blood serum) in women and do not statistically significantly coincide in men, apparently due to the presence of a hemato-testicular barrier. Serological tests should not be used as a cure monitoring study, as the antibody titer remains quite high for several months after treatment. However, they are informative in the differential diagnosis of chlamydia. The value of this method is especially high in chronic asymptomatic forms of chlamydial infection of the pelvic organs. The sensitivity and specificity of such test systems for detecting antibodies to chlamydia is at least 95%.

Nucleic acid amplification methods (DNA diagnostic methods) are based on the complementary interaction of nucleic acids, which makes it possible to identify the nucleotide sequence in the genes of the desired microorganism with almost 100% accuracy. Of the numerous modifications of this method, PCR has become widespread in clinical practice. Any material of tissue origin is suitable for the diagnosis of chlamydial infection by nucleic acid amplification. The great advantage of the method is the possibility of studying the material obtained in a non-invasive way, for example, the study of the first portion of morning urine. It should be noted that this study is more informative in men than in women (it is better to use cervical samples).

Determination of nucleic acids of chlamydia should not be used as a control of cure, since it is possible to determine nucleic acid fragments of non-viable microorganisms within several months after treatment. As noted above, for this purpose, the method of cultural diagnostics should be used. The advantage of PCR is the ability to detect a wide range of pathogens in one clinical sample, i.e. obtain complete information about the presence of all pathogens in the studied clinical sample (Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma parvum and Ureaplasma urealyticum). At the same time, it should be remembered that the use of the method of molecular biological diagnostics in itself cannot be considered a guarantee against obtaining erroneous results. The high sensitivity of PCR necessitates strict adherence to special requirements for the mode of operation of the laboratory.

Treatment of urethritis

Treatment of urethritis, first of all, should be etiotropic and pathogenetic. Unlike other urological diseases, in the treatment of bacterial and viral urethritis, much depends on epidemiological measures to sanitize the focus of re-infection, which can be caused by sexual partners if they were not treated at the same time.

With microbial forms of urethritis, etiotropic therapy is possible only with bacteriological detection of the pathogen. Viral nonspecific urethritis is treated taking into account the sensitivity of pathogens. With candidal urethritis, therapy should be antifungal. For metabolic nonspecific urethritis, etiotropic measures should be considered aimed at eliminating metabolic disorders (phosphaturia and oxaluria, uraturia, cystinuria). Traumatic and "tumor" urethritis can be cured by eliminating etiological factors, i.e. trauma and tumors.

Pathogenetic treatment of urethritis is to eliminate the anatomical and other factors predisposing to the development of this disease. Among them are strictures of the urethra, purulent diseases of individual paraurethral glands located in the submucosal layer of the urethra and in the valvulae fossae navicularis in the hanging part of the urethra in men. In women, damage to the paraurethral passages and large glands of the vestibule of the vagina. Measures aimed at increasing the immunoreactivity of the body, which can be general and specific, should also be considered pathogenetic.

Therapy for nonspecific urethritis should be general and local. The use of one or another type of treatment largely depends on the phase and stage of the disease. In the acute phase, general therapies should predominate or be the only ones; in the chronic phase of the disease, topical treatment can be added.

Treatment of nonspecific urethritis

Treatment of nonspecific urethritis is divided into:

• medication;
• operational;
• Physiotherapy.

Antibacterial therapy of bacterial urethritis should be carried out taking into account the sensitivity of the isolated microorganism, giving preference to semi-synthetic penicillins and cephalosporins in coccal flora, and to aminoglycosides and fluoroquinolones in non-negative flora. Some tropism of tetracyclines and macrolides to the male genital organs should be taken into account. When choosing drugs for the treatment of nonspecific urethritis, it is necessary to take into account the possibilities of nitrofurans, especially furazolidone. They are quite active in relation to the simplest, Trichomonas. The greatest difficulties arise in the treatment of staphylococcal urethritis, when there are strains of bacteria that are resistant to all antibiotics and chemotherapy drugs. Such patients are treated with staphylococcal toxoid, staphylococcal γ-globulin (human antistaphylococcal immunoglobulin), administered intramuscularly, and if it is ineffective, an autovaccine should be obtained and administered twice.

With Reiter's syndrome, when joint damage is so pronounced. which lead to the development of ankylosis, therapy with glucocorticoids is indicated. They also prescribe drugs that improve microcirculation (dipyridamole), NSAIDs (indomethacin, diclofenac, etc.).

Antibacterial treatment for chronic forms of urethritis should be supplemented with methods of nonspecific immunotherapy.

It is possible to prescribe pyrogenal, and since all patients with urethritis are usually treated on an outpatient basis, its daily administration is possible in a day hospital in a polyclinic. Instead of pyrogenal, prodigiosan can be used intramuscularly.

Non-specific immunological treatment of chronic urethritis can be supplemented by the introduction of prostate extract (prostatilen) 5 mg diluted in 2 ml of sterile isotonic sodium chloride solution or 0.25% procaine solution intramuscularly 1 time per day, a course of 10 injections, with a possible repetition after 2- 3 months

In the chronic phase of urethritis, and less often in subacute, local treatment of urethritis is sometimes indicated. When introducing medicinal substances into the urethra, it must be remembered that due to the good vascularization of the submucosal layer, its mucous membrane has a significant absorption capacity. Washing of the urethra is carried out with solutions of nitrofural (furatsilina) 1:5000. mercury oxycyanide 1:5000, silver nitrate 1:10000, protargol 1:2000. Recently, instillations into the urethra and its washing began to be performed with a 1% solution of dioxidine or miramistin, as well as hydrocortisone 25-50 mg in glycerin or vaseline oil. However, the attitude to local treatment should be restrained.

It is advisable to carry out a combined treatment of urethritis, which should also include physiotherapeutic methods (ultravohigh-frequency exposure, diathermy, electrophoresis of antibiotics, hot baths, etc.). Physiotherapy is especially indicated for complications (prostatitis, epididymitis). In the treatment of nonspecific urethritis, sexual intercourse, the use of alcoholic beverages, spices, hot spices are prohibited.

Hospitalization of patients with urethritis is indicated in the development of complications (acute urinary retention, acute prostatitis, epididymitis, epididymorchitis, acute cystitis, etc.).