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Overview |
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Definition |
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Urethritis is infection and inflammation of the urethral lining caused by
bacterial infections, and may involve the bladder, prostate, and reproductive
organs. Urethritis can affect males and females of all ages; however, females
are at higher risk due to proximity of urethral opening to anus and vagina,
increasing the likelihood of bacterial contamination.
Sexually transmitted pathogens Chlamydia trachomatis, Neisseria
gonorrhoeae (co-infection common), and herpes simplex are primary causes of
urethritis, particularly in men; however, often no infection can be documented.
Vaginitis triggered by Candida albicans or Trichomonas vaginalis,
and bacterial vaginosis, are also contributing causes for women. In
bacteria-negative cultures, urethritis and vaginitis account for most urinary
disorders in women.
Of the organisms which cause nongonococcal urethritis (NGU), chlamydia is the
most common and most serious, with 75% of infected women and 50% of infected men
remaining asymptomatic. Left untreated, it can lead to permanent damage of
reproductive organs in both men and women. Implications tend to be more severe
in women due to the internal nature of the infection, which often goes without
notice until complications arise. |
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Etiology |
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- Bacteria and other organisms entering the urethra, including
Chlamydia trachomatis, Neisseria gonorrhoeae, Ureaplasma urealyticum,
Mycoplasma hominis, Candida albicans, Trichomonas vaginalis, and herpes
viruses
- Bruising during sexual intercourse (women)
- Infection reaching the urethra via venous system from prostate gland
or through the penis opening; in older men, classic urinary tract pathogens are
a more common cause than STDs
- Bacterial infection following course of antibiotics
- Reiter's syndrome
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Risk Factors |
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- Unprotected sex
- History of sexually transmitted diseases
- Multiple sex partners, or sexual relations with individual who has
multiple sex partners
- Urinary catheter or instrumentation
- Bacteria-resistant drugs
- Prior history of kidney stones, prostatitis, epididymitis, genital
injury
- Reiter's syndrome, which has a genetic predisposition
- Increased caffeine intake
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Signs and Symptoms |
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In both sexes but particularly women, the disease may be asymptomatic.
In men:
- Burning during urination
- Purulent or whitish-mucus urethral discharge
- Burning or itching around the penile opening
In women:
- Painful urination and/or unusual vaginal discharge
- Cervicitis
- Salpingitis
- Pelvic inflammatory
disease
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Differential
Diagnosis |
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- Reiter's syndrome
- Gonorrhea
- Allergic reactions
- Other urinary tract
infections
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Diagnosis |
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Physical Examination |
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- Watery and thin discharge (Chl. trachomatis)
- Purulent discharge (N. gonorrhoeae)
- Inflammation of penile
opening
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Laboratory Tests |
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- Presence of white blood cells in urine specimen
- Gram's stain of urethral discharge which shows >4 WBCs
per HPF
- Intracellular gram-negative diplococci strongly suggests
gonorrhea
- Absence of gram-negative cocci strongly suggests NGU (Gram's stains
are less than 100% sensitive for chlamydial infections)
- Syphilis and HIV serology to rule out other
STDs
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Pathology/Pathophysiology |
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- Unusual urethral/vaginal discharge in 50% to 75% of cases
- In males, possible inflammation and irritation at penis
opening
- Urethral strictures
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Other Diagnostic
Procedures |
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- Thorough medical and sexual history, including date of symptom onset
and prior history of STDs
- Genital examination
- Evaluation of laboratory evidence for infection (Chl. trachomatis
requires specimen of intracellular and urethral cellular material; collect
specimen with calcium alginate swab inserted two to three cm into
urethra)
- Evaluation of sexual partners may aid diagnosis in asymptomatic
disease
Chl. trachomatis:
- Immunofluorescent testing
- Enzyme-linked immunoassay
- DNA probing of cervical
samples
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Treatment Options |
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Treatment Strategy |
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- Therapy must often be administered presumptively.
- Antimicrobial therapy directed against etiologies.
- Chlamydial disease may persist even after successful treatment of
gonococcal component.
- Impress upon patient importance of treatment compliance.
- All sex partners should be treated.
- Sexual abstinence recommended until treatment regimen is completed,
as disease can remain active even after symptoms have
disappeared.
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Drug Therapies |
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Urethritis:
- Tetracycline (500 mg qid for seven days)
- Erythromycin (500 mg qid for seven days; preferred in
pregnancy)
N. gonorrhoeae:
- Ceftriaxone (250 mg IM once a day)
- Ofloxacin (400 mg once a day)
- Ciprofloxacin (500 mg once a day)
Chl. trachomatis:
- Doxycycline (100 mg bid for 10 days)
- Ofloxacin (300 mg orally bid for 10 days)
Trichomonas urethritis/vaginitis:
- Metronidazole (2 g orally once a day; contraindicated in
pregnancy)
- Clindamycin (300 mg orally bid for seven
days)
Herpes simplex:
- Acyclovir (400 mg orally tid for 10 days)
- Famciclovir (250 to 500 mg orally bid for 10 days)
- Valacyclovir (1,000 mg orally bid for 10
days)
Persistent/recurrent disease:
- Retreatment with
antimicrobials
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Complementary and Alternative
Therapies |
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Nutrition, herbs, and homeopathic remedies are useful in fighting infection,
relieving pain, and tonifying the urinary system. |
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Nutrition |
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- Eliminate any known food allergens. Food allergies can be tested for
using an IgG ELISA food allergy panel, or by an elimination diet.
- Eliminate refined foods, fruit juices, caffeine, alcohol, and sugar,
which may compromise immune function and irritate the urinary tract.
- Cranberries and blueberries contain substances that inhibit the
adhesion of bacteria to the urinary tract.
- Vitamin C (1,000 mg tid) stimulates immune system and acidifies
urine, which inhibits bacterial growth.
- Beta-carotene (25,000 to 50,000 IU/day) is necessary for immune
function and mucous membrane integrity.
- Zinc (30 to 50 mg/day) supports immune
function.
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Herbs |
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Herbs are generally a safe way to strengthen and tone the body's systems. As
with any therapy, it is important to ascertain a diagnosis before pursuing
treatment. Herbs may be used as dried extracts (capsules, powders, teas),
glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless
otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water.
Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for
roots. Drink 2 to 4 cups/day. Tinctures may be used singly or in combination as
noted.
Herbal therapy should be instituted at the first sign of symptoms and
continued for three days beyond resolution of symptoms. Treatment of infectious
urethritis is best accomplished through teas because of the flushing action of
the additional fluid intake. Combine two herbs from each of the following
categories and drink 4 to 6 cups/day.
Urinary antiseptics are antimicrobial and include the
following.
- Uva ursi (Arctostaphylos uva ursi)
- Buchu (Agathosma betulina)
- Thyme leaf (Thymus vulgaris)
- Pipissewa (Chimaphila umbellata)
Urinary astringents tone and heal the urinary tract and include the
following.
- Horsetail (Equisetum arvense)
- Plantain (Plantago major)
- Cleavers (Galium aparine)
Urinary demulcents soothe the inflamed urinary tract and include the
following.
- Corn silk (Zea mays)
- Couch grass (Agropyron repens)
- Marshmallow root (Althaea officinalis) is best used alone in a
cold infusion. Soak 1 heaping tbsp. of marshmallow root in one quart of cold
water overnight. Strain and drink during the day in addition to the other
urinary tea.
For advanced or recurrent infections, prepare a tincture of equal parts of
goldenseal (Hydrastis canadensis) and coneflower (Echinacea purpurea).
Take 30 drops four to six times/day in addition to the urinary tea.
For noninfectious urethritis or for urethritis with severe pain and spasm,
add kava kava (Piper methysticum) to any of the above formulas.
A periwash may be helpful in reducing pain with urination. Place 1 tsp. of
the coneflower/goldenseal tincture in an 8-oz. peri bottle. Fill with water.
Rinse off after each urination. |
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Homeopathy |
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An experienced homeopath should assess individual constitutional types and
severity of disease to select the correct remedy and potency. For acute
prescribing use 3 to 5 pellets of a 12X to 30C remedy every one to four hours
until acute symptoms resolve.
- Staphysagria for urinary infections associated with sexual
intercourse
- Apis mellifica for stinging pains that are exacerbated by
warmth
- Cantharis for intolerable urging with "scalding"
urine
- Sarsaparilla for needing to stand to urinate, with burning
after urination
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Acupuncture |
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May be helpful in enhancing immune function. |
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Patient Monitoring |
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- Recurrent or persistent symptoms require careful reevaluation and
re-treatment with antimicrobials when urethral discharge tests positive or
demonstrates increased numbers of polymorphonuclear leukocytes.
- Monitor general condition/medications.
- Encourage patient self-care.
- Monitor closely for treatment compliance, particularly for
STD-related urethritis.
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Other
Considerations |
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Treat patient's sexual partner(s) if STD-related. |
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Prevention |
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- Wipe from front to back following bowel movement, wash genitalia with
soapy water, shower rather than bath (for women only).
- Drink eight glasses of water daily.
- Protected sex with latex condom when outside of a monogamous
relationship
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Complications/Sequelae |
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- When left untreated, gonococcal
urethritis—common in men—may
cause urethral stricture with increased risk of periurethral abscess; may
perforate the peritoneal scrotum, causing urethral fistula.
- Untreated chlamydia increases risk of acquisition/transmission of
HIV, causes pelvic inflammatory disease (PID) in women,
and—in men—affects the
testicles, which leads to complications and possible infertility.
- Infection spread to
ureters/kidneys
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Prognosis |
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- When associated with low-grade infection and treated appropriately,
seldom produces long-term illness; however, recurrence is common.
- STDs or NGU can be effectively treated with antibiotic medication.
When asymptomatic or left untreated,
complications—including
infertility—may result, and disease transmission to sex
partners is inevitable.
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Pregnancy |
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NGU:
- Permanent damage to reproductive organs/infertility in both
sexes.
- Difficulties during pregnancy, premature delivery, low birth
weight.
- Ear, eye, and lung infections in newborns. (Resultant neonatal
conjunctivitis can permanently damage eyesight.)
- Nutritional guidelines are safe to follow in pregnancy. Herbal
therapies should be used only with physician supervision.
- Avoid
tetracyclines.
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References |
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Bartram T. Encyclopedia of Herbal Medicine. Dorset, England: Grace
Publishers; 1995:436-437.
Berkow R, Beers MH. The Merck Manual of Diagnosis and Therapy. Rahway,
NJ: Merck and Company; 1992.
Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic
Guide to Herbal Medicines. Boston, Mass: Integrative Medicine
Communications; 1998:432.
Bowie WR. Approach to men with urethritis and urologic complications of
sexually transmitted diseases. Med Clin North Am. 1990;74:1543-1557.
Accessed at www.thriveonline.com.
Hoffman D. The New Holistic Herbal. New York, NY: Barnes & Noble
Books; 1995:109-110.
Kruzel T. The Homeopathic Emergency Guide. Berkeley, Calif: North
Atlantic Books; 1992:98-102.
Shealy CN. The Illustrated Encyclopedia of Healing Remedies. Boston,
Mass: Element Books Limited; 1998.
Tierney LM Jr, et al., ed. Current Medical Diagnosis & Treatment 1999.
38th ed. Stamford, Conn: Appleton & Lange; 1999.
Virtual Hospital: University of Iowa Family Practice Handbook. 3rd ed.
Available at www.vh.org. |
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Copyright © 2000 Integrative Medicine
Communications This publication contains
information relating to general principles
of medical care that should not in any event be construed as specific
instructions for individual patients. The publisher does not accept any
responsibility for the accuracy of the information or the consequences arising
from the application, use, or misuse of any of the information contained herein,
including any injury and/or damage to any person or property as a matter of
product liability, negligence, or otherwise. No warranty, expressed or implied,
is made in regard to the contents of this material. No claims or endorsements
are made for any drugs or compounds currently marketed or in investigative use.
The reader is advised to check product information (including package inserts)
for changes and new information regarding dosage, precautions, warnings,
interactions, and contraindications before administering any drug, herb, or
supplement discussed herein. |