Urethral infection. Symptoms and treatment of urethritis. Methods for the treatment of male urethritis: therapy and drugs

Urethritis is an inflammatory process that is located in the urethra. This disease is very common, while the pathology develops regardless of the age and gender of the patient. In order to clearly understand what urethritis is in a man, what are the symptoms and methods of treating this pathology, it is necessary to clearly understand the anatomy of the male urethra.

Anatomical features and structure of the male urethra

The outlet in the bladder is the beginning of the urinary canal, which in medical and scientific circles is commonly called the urethra. This is a genital tube of small diameter, which has a length of 16 to 24 centimeters. It is worth noting that the urethra in women has a length of only 4 centimeters. It is these comparative characteristics that are the main reason for the differences in the manifestations of urethritis in representatives of different sexes, respectively, if in women urethritis can pass without visible pathological symptoms, then in males the disease has very intense symptoms and can manifest itself soon after direct infection and the development of the inflammatory process .

The male urinary canal consists of the following sections:

prostatic section. This is a part of the urethra, which is located in the prostate gland and is about 4 centimeters long. The prostatic department is also called the prostate;

membranous section. Also called webbed. Its length is 2 centimeters. The beginning of the department is located behind the prostate gland, and ends at the base of the penis. This gap of the male urethra is the narrowest;

spongy department, or spongy. It is the longest section of the urinary canal and is located inside the shaft of the penis. Compared with the membranous and prostatic, the spongy section is characterized by mobility. This section of the urethra ends with an outlet, which is called the meatus.

Classification of urethritis

The clinical picture and methods of therapy depend on the type of infectious agent that caused inflammation, the stage of neglect and intensity of the disease, the presence of concomitant diseases and provoking factors. That is why the appointment of effective and adequate treatment depends on the nature of the pathology.

In most cases, chlamydia and gonococci are the causative agent of urethritis, while in about 50% of cases it is not possible to detect these infectious agents when examining the material.

Symptoms of urethritis

After direct infection of the body, the symptoms of urethritis appear after some time, while the time interval from the moment of infection to the first signs of pathology directly depends on the incubation period of the pathogen. With allergic urethritis - it is several hours, with tuberculosis - several years, with viral - several months, with candidiasis and trichomoniasis - two to three weeks, with chlamydia - 7-14 days, with gonorrhea - 3-7 days.

The most typical symptoms of male urethritis are:

the presence of characteristic secretions that appear from the urethra;

burning, itching and pain when urinating.

Other symptoms characteristic of STDs, such as general weakness and hyperemia, are not observed with urethritis. However, the nature of the discharge may be different and depends on the type of pathogen that caused the urethritis. In most cases, a green or white discharge with an unpleasant odor appears, against which yellow crusts can form on the penis. Allocations are most noticeable in the morning.

In addition, along with the discharge, redness and sticking of the external opening of the urethra may be present. Pain in the lower abdomen can occur regardless of the type of urethritis, but even they are not a constant symptom of the pathology.

The process of urination is also disturbed, which in the initial stage is quite often accompanied by cloudy urine, pain, along with this, the number of daily urges to urinate increases. The end of this process may be accompanied by sharp pains and sometimes blood impurities.

If the disease has become chronic, then the symptoms of the disease may disappear altogether, there is no discharge, and the patient may be disturbed only by mild itching and discomfort in the urethra. More pronounced symptoms are observed only during periods of exacerbation of the disease.

With bacterial urethritis, purulent discharge is observed, with trichomoniasis - whitish, with gonorrheal urethritis - gray-yellow or greenish. Also, the discharge may be insignificant or completely absent, but the man will be disturbed by blood in the semen or urine, burning and itching at the time of urination, swelling of the penis, pain at the time of sexual intercourse.

The table shows the most characteristic symptoms of urethritis for its different types.

Treatment of urethritis in men

The choice of treatment for urethritis, like any other disease, is made on the basis of diagnostic data. First of all, laboratory test results are used. A general analysis of blood and urine, ureteroscopy data, examination of urethral smears, and bacteriological culture of urine are taken into account.

Medical procedures can be carried out on an outpatient basis, during treatment it is important to observe the systematic and accurate implementation of medical prescriptions, hospitalization is not required. If the intake of antimicrobials is interrupted, carried out irregularly, or during the period of therapy the patient consumes alcohol, the disease threatens to become chronic.

It is quite obvious that the selection of drugs for the medical treatment of male urethritis is carried out by a doctor, and the patient must follow the necessary rules throughout the entire period of treatment: drink plenty of fluids, do not use pickled, smoked foods, spices, spices, give up alcohol, observe personal hygiene rules, exclude sex life.

The selection of drugs is carried out purely individually. Any infectious urethritis is treated with antibiotics. The most pronounced effect is achieved with the use of an antibacterial drug selected on the basis of a sensitivity analysis. It is thanks to this study that you can choose the most effective remedy for treatment.

Treatment of bacterial, gonorrheal urethritis

Excellent results in the treatment of gonorrheal urethritis are demonstrated by antibiotics of the cephalosporin group. In addition to them, kanamycins, oletetrins, erythromycins, tetracyclines can be prescribed. In this case, kanamycins must be used with extreme caution, since these drugs are highly toxic. Long-acting drugs - bicillin-5 and bicillin-3 should be prescribed in short courses. In some cases, if gonorrheal urethritis is complicated by other infections, the simultaneous use of several antibacterial drugs is practiced. In such cases, it is best to use the complex "Gentamicin" and "Azithromycin" ("Ecomed", "Hemomycin", "Azitrox", "Azitsid", "Zi-factor", "Sumamed").

In order to prevent the occurrence of candidiasis, due to prolonged antibiotic therapy, Levorin, Fluconazole, Nystatin, Pimafucin and other antimycotic drugs are prescribed. The most important aspect of treatment is the individual selection of drugs. Quite often, men who suffer from gonorrheal urethritis ask acquaintances to “prick injections” and use antibiotics uncontrollably and without consulting a doctor. Such self-treatment is unacceptable, since long-term use of strong anti-inflammatory drugs without a clear treatment regimen and control of cure can lead to the transition of urethritis to a chronic form and the development of drug resistance of the pathogen.

In addition to antibiotics, the patient must take immunostimulating drugs and vitamins. To be completely convinced that the body has freed itself from gonococcus and is completely cured, it is necessary to pass control smears three times. Only after receiving negative test results can we assume that the patient is completely healthy.

Gardnerella, ureaplasma and mycoplasma urethritis

These types of urethritis are treated with the antibiotics lincosamines, fluoroquinolones, macrolides, and tetracyclines. The most effective is the tetracycline group, and specifically doxycycline. The macrolide group (clarithromycin) also gives excellent results. Immunostimulants are also prescribed.

With any specific urethritis, it is necessary to carry out simultaneous therapy of both sexual partners.

Trichomonas urethritis

If a man is diagnosed with trichomonas urethritis, when choosing drugs, they turn to metrogil, trichopolum and metronidazole. If urethritis is chronic, antibiotic therapy is added to the treatment. In case of inadequate treatment, infertility may develop.

Candida urethritis

Treatment of candidal urethritis in a man requires a completely different approach. The main drugs to combat this pathology are antimycotic agents, such as Pimafucin, Nystatin, Clotrimazole, Fluconazole. A well-chosen treatment of the underlying disease, which is the cause of candidal urethritis, is important.

Chlamydial urethritis

The only antibiotic that actively fights the causative agent of this infection is azithromycin. If you choose the wrong drug for chalmidia urethritis, serious complications can occur - inflammatory diseases, epididymitis, Reiter's syndrome, infertility. If the patient has an individual intolerance to azithromycin, alternatively use: doxycycline, levofloxacin, erythromycin, ofloxacin, clarithromycin. Also in the complex should be used immunostimulating drugs and vitamins.

Viral urethritis

Treatment is with antiviral drugs. The sooner treatment is started, the faster recovery will occur. Among antiviral drugs, preference is given to: Gerpevir, Famciclovir, Riboverin, Acyclovir. It is not advisable to use antibiotics for this form of pathology, since they are not able to fight viruses.

Nonspecific chronic urethritis

Treatment of nonspecific chronic male urethritis is not as fast as with infectious ones. The chronic course of the disease is quite often aggravated by concomitant pathologies, and the signs of the disease are mild or may be absent altogether. Therefore, the therapy of chronic urethritis should begin with the use of immunostimulants. Only this approach allows you to activate the body's defenses to fight infection. After receiving the result, antibiotic therapy is selected individually. The main feature of the treatment of nonspecific forms of urethritis is the absence of the need to treat the sexual partner.

Non-infectious urethritis

With allergic urethritis, it is necessary to use antihistamines. If urethritis is caused by stagnation of blood in the pelvic area (congestive), it is necessary to eliminate the cause of this stagnation. In traumatic urethritis, in addition to antimicrobial therapy, surgical intervention may also be required.

Antibiotics may be prescribed for:

installation of the drug by catheter injection into the urethra;

intravenous infusions in 0.2% of cases of acute urethritis;

intramuscular injections in 18%;

oral administration in 81%;

the use of only one antibiotic - monotherapy 41%;

two - 41%;

three - 13%;

four antibiotics - 5% of cases.

The most popular antibiotics for acute male urethritis, which are prescribed by a doctor, depending on the type of pathogen

Complementary Therapies

In addition to the basic course of treatment with antibacterial drugs that suppress the acute symptoms of the disease, other therapeutic methods are also widely used, which are related to local and physiotherapeutic procedures.

Local procedures involve the introduction of drugs directly into the opening of the urethra. Urethral installations are performed with the help of hydrocortisone, Dioxidin and Mirimistin. Local treatment gives a good result, subject to complex use with other drugs.

Physiotherapy treatment is used exclusively in cases of chronic urethritis, it is categorically contraindicated to use these methods in acute inflammatory processes. Magnetotherapy, laser therapy, UHF, electrophoresis can be prescribed. However, all these methods should be carried out only systematically and only under the supervision of specialists.

Causes of urethritis in men

genital infections - are the most common cause of urethritis in men who are sexually active. If sexual intercourse is performed without the use of barrier contraceptives, then the probability of penetration of the pathogen into the urethra is very high;

urolithiasis - much more often found in men than in women. Such a disease causes traumatic urethritis, for the reason that the stones, moving along the genitourinary tract, actively injure the mucosa and lead to the attachment of pathogenic microorganisms;

any trauma to the penis and heavy physical exertion can cause the development of urethritis;

hypothermia is one of the most important provocateurs of exacerbations of chronic diseases (including extrapulmonary tuberculosis, viruses, infections), since in this case the protective functions of the body are significantly reduced;

a general decrease in immunity - smoking, alcohol abuse, overwork, lack of sleep, malnutrition leads to a natural depletion of the body's defenses;

medical manipulations (bladder catheterization, smear) - carry the risk of injury to the urethral mucosa, and urethritis can also develop if the necessary disinfection measures are not followed;

nutrition - an abundance of acidic, spicy, salty foods leads to irritation of the mucous membranes, which contributes to the attachment of infection. The lack of fluid is the cause of rare urination, respectively, there is no natural washing of the genitourinary tract from harmful microorganisms that can accidentally enter the urethra.

Prevention of complications of urethritis

Statistics say that every second man on the planet after 50 years of age has prostatitis. Do not think that prostatitis can cause urethritis directly. However, quite often the occurrence of prostatitis occurs against the background of active infectious diseases of the genitourinary system. Urethritis can cause the development of Reiter's syndrome, infertility, sexual dysfunction, colliculitis, balanoposthitis, orchitis, vesiculitis. In order to minimize the risk of complications of urethritis, a man should:

avoid excessive and intense physical activity;

do not get involved in salty, spicy, fatty foods, alcohol;

empty the bladder at the first urge to urinate, try to “tolerate” less;

avoid hypothermia;

timely conduct therapy of any pathologies of a chronic nature;

conduct a decent sex life, observe the rules of intimate hygiene.

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

Symptoms of urethritis

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

The main symptoms of urethritis can be as follows:

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

Types of urethritis

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

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

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

According to the nature of the occurrence, the following types of urethritis are distinguished:

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

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

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

Features of the course of urethritis in men and women

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

Urethritis in men

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

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

Chronic urethritis in men occurs rarely, when the following conditions appear:

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

Urethritis in women

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

The main role in the disease of urethritis in women is played by various infections. Among the infectious types of urethritis in women, gonorrheal is most common. Up to 12 hours after infection, a woman may develop symptoms of acute urethritis. If it is not treated, then after 20 days the disease becomes chronic.

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

Candida urethritis in women may occur with prolonged use of antibacterial agents.

Usually, the first signs of the disease occur at the onset of menstruation, the abolition of contraceptives, or the onset of menopause.

Diagnosis and treatment of urethritis

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

An important diagnostic method is ureteroscopy.

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

Treatment of urethritis

The standard treatment program for urethritis consists of 3 stages:

• statement and specification of the diagnosis;
• drug therapy;
• re-examination.

Drugs for the treatment of urethritis

The usual treatment program for urethritis includes the use of the following drugs for the treatment of urethritis:

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

Self-medication in this case can lead to serious complications. Means for the treatment of urethritis can only be correctly selected by a urologist based on the results of the examination.

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

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Urethritis is a disease associated with the development of an inflammatory process in the wall of the urethra. It is one of the most common urological diseases.

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

Anatomy of the urethra in women and men

The male urethra can reach a length of 22 cm, and the width of its lumen is only 0.8 mm. In addition, it forms bends along its length. Therefore, the infection lingers in it more easily, and the inflammatory edema of the mucous membrane leads to a pronounced violation of the outflow of urine, up to acute urinary retention.

Parts of the urethra in men:

• Prostate. Passes through the thickness of the prostate (prostate gland). It has a length of 3-4 cm and is the widest segment of the male urethra.
• membranous part. It has a length of 1.5 to 2 cm. Passes from the prostate gland to the beginning of the penis. This part of the male urethra is the narrowest and practically does not stretch.
• Spongy part. Passes inside the penis. Unlike the prostatic and membranous parts rigidly fixed inside the pelvic cavity, the spongy part is mobile.

Causes of urethritis

Role of infection

Infectious urethritis is the most common and is caused by pathogenic microorganisms.

Non-infectious urethritis occurs when the urethra is irritated by non-infectious factors.

Causes of non-infectious urethritis:

• urolithiasis disease: small stones that form in the kidneys can move along with the flow of urine, penetrating the ureter, and then into the bladder and urethra, damaging and irritating its mucous membrane with their sharp edges;
• urinary tract injury during cystoscopy (endoscopic examination of the urethra and bladder), catheterization, during masturbation with the introduction of various objects into the lumen of the urethra;
• tumors of the urethra malignant neoplasms are almost always accompanied by inflammatory reactions;
• narrowing of the urethra(tumors, prostatitis, benign prostatic hyperplasia), which is accompanied by a narrowing of the urethra and stagnation of urine;
• stagnation of blood in the veins of the pelvis.

Pathogens that cause infectious urethritis

Nonspecific urethritis is a classic purulent inflammation. Its symptoms do not depend on the type of microorganisms with which it is caused.

Microorganisms that cause nonspecific infectious urethritis:

• less often others

Types of specific infectious urethritis:

Ways of infection with infectious urethritis

Sexual way realized during sexual contact with a sick person. This is how infection occurs most often.

Hematogenous and lymphogenous pathways are realized when the infection spreads through the blood or lymph from other foci of chronic inflammation in the body. For example, from inflamed tonsils or carious teeth.

Factors that contribute to the development of urethritis:

• decrease in the body's defenses as a result of serious illnesses, starvation and malnutrition, beriberi and other causes;


• inadequate personal hygiene;


• the presence of foci of chronic inflammation in the body;


• other concomitant diseases of the genitourinary system;


• hypothermia;


• genital trauma;


• alcohol abuse;


• frequent stress, malnutrition, hypovitaminosis, etc..

Symptoms of urethritis

Patient's complaints

Almost 50% of cases of acute urethritis are asymptomatic. The patient does not make any complaints. Most often, this pattern occurs in women. Infection with an asymptomatic disease is quite capable of being transmitted sexually and leading to complications characteristic of urethritis.

Urethritis in men is characterized by a shorter incubation period, more rapid onset, and more severe symptoms.

In general, the differences between the symptoms of acute specific and nonspecific urethritis are not very pronounced.

Common signs of acute urethritis:

• itching and other discomfort during urination;
• pain in the pubic area - periodic, aching;
• in men - a violation of urination, difficulty in the outflow of urine, up to an acute delay;
• purulent discharge from the urethra;
• impurities of blood in the urine - hematuria;
• the external opening of the urethra is glued together in the morning.

With such complaints, as a rule, the patient visits a urologist. But most often they are not all present at the same time. Some of them are very pronounced, while others are completely absent. The course of acute urethritis can vary greatly.

Despite the fact that acute urethritis is an inflammatory disease, it is not accompanied by a violation of the general condition of the patient. Body temperature almost never rises.

With the transition to the chronic form, the symptoms of the disease subside or disappear altogether. In the future, they can occur periodically, that is, the disease constantly goes through stages exacerbations and remissions(temporary well-being).

Specificity in the symptoms of specific varieties of urethritis

Cause of specific urethritis	Specificity
Gonorrhea	Among women: In the acute stage, there are mainly pains and cramps during urination. In the chronic stage, there are no symptoms, only examination and laboratory methods help to diagnose the disease. In men: In the acute stage, the symptoms differ little from nonspecific urethritis. In the chronic stage, itching and burning during urination, purulent discharge from the urethra, which increase in the morning, after drinking alcohol, after sexual intercourse, are noted.
Trichomoniasis	The incubation period of the disease is about 10 days. Sometimes it is reduced to 5 days, and sometimes stretched to 1 - 2 months. Among women: Basically, there is itching and burning in the urethra and vulva. In 26% - 30% of cases, asymptomatic carriage is noted. In men: burning, itching, feeling of "crawling" in the area of ​​the external opening of the urethra; small white or gray discharge; impurities of blood in semen; pain and itching during urination, delay. If left untreated, after 3 to 4 weeks, all symptoms subside. The disease passes into a chronic stage, which resembles that of chronic gonorrheal urethritis.
Candidiasis	Candidal urethritis is a fungal infection, one of the conditions for the occurrence of which is a decrease in the body's defenses. The incubation period of the disease is 10-20 days. Symptoms in men and women are approximately the same. At the beginning of the disease, pain, burning, and other unpleasant sensations appear, mainly during urination. There are small whitish-pink discharges. They can be very viscous, thick. In men, inflammation often passes to the glans penis and foreskin - postitis and balanoposthitis develop. Symptoms in candidal urethritis from the very beginning are not as pronounced as in other types of acute urethritis. Therefore, it is often said that pathology initially develops in a subacute form.
Mycoplasmosis	The disease rarely begins acutely. Acute course is observed in no more than 5% of patients. Most often, it begins as subacute or chronic, symptoms are mild or absent. Among women: there is slight itching and discomfort during urination, small discharge from the urethra, which quickly passes. Most patients do not seek medical attention at all. In men: in acute form, the disease proceeds in the same way as gonorrhea. Then, when mycoplasmosis becomes chronic, its symptoms significantly decrease or disappear. There is only slight itching and burning during urination, small mucous discharge during squeezing in the morning.
Chlamydia	The incubation period for chlamydial urethritis is estimated to be 1 to 2 to 3 weeks. Symptoms practically do not differ from symptoms of urethritis of other origin. But they are less pronounced. In particular, the patient is much less worried about pain, itching and other unpleasant sensations. The reason for going to the doctor is most often the appearance of discharge from the urethra. They may be clear or purulent. After 2-3 weeks, the disease can go away on its own, without treatment. But it is highly likely that it will recur in the future.

What does the doctor reveal during the examination of a patient with urethritis?

• redness in the area of ​​​​the external opening of the urethra;
• in women, there is redness of the labia majora and labia minora, vulva;
• in men, if urethritis is accompanied by balanitis and balanoposthitis, redness of the head and foreskin of the penis is noted;
• when feeling the penis, it becomes hot and painful;
• the doctor can directly see the discharge from the urethra or the crusts that formed when they dried;
• palpation of the area of ​​​​the external opening of the urethra is most often painful.

In men, a digital examination of the prostate through the rectum can be performed: the doctor inserts the index finger into the rectum and probes the prostate gland through its wall. In this case, prostatitis is detected - the spread of inflammation to the prostate.

Diagnosis of urethritis

General urine analysis

In order for the study to show a reliable result, urine must be taken in the morning, the first portion, after the patient has not urinated for at least 4 hours.

Together with a general urine test, a general blood test is usually prescribed. It also determines the increased content of leukocytes.

Bacteriological culture of urine and the study of sensitivity to antibacterial drugs

The essence of the technique

Urine collected for research is delivered to a microbiological laboratory, where it is placed on a nutrient medium favorable for the growth of microorganisms. If the nonspecific nature of urethritis is assumed, then agar is used as a nutrient medium. If the inflammation is specific, then special nutrient media are used.

Bacteriological research can be not only qualitative (positive/negative), but also quantitative. The number of pathogens is measured in CFU - colony forming units. This is the number of bacteria or fungi that can give rise to a new colony. Quantification makes it possible to judge the severity of the infection and the inflammatory process.

Sensitivity to antibiotics

In order to determine the sensitivity of the identified pathogens to the action of antibiotics, antibacterial drugs are introduced into the nutrient medium with grown colonies. If the antibiotic inhibits the growth of the colony, then it will be effective in this patient.

How to collect and donate urine for bacteriological examination with urethritis?

For bacteriological examination, the morning average portion of urine is collected in the amount of 3-5 ml. It is collected in a plastic sterile container, which is obtained in advance from the laboratory. Then it must be delivered to the laboratory within 2 hours.

Examination of smears from the urethra

Types of studies of smears obtained from the urethra:

• microscopic examination: the material is examined under a microscope, while an increased content of leukocytes is detected in it;


• bacteriological examination and determination of sensitivity to antibacterial drugs: carried out similarly to the corresponding urine tests.

The material is taken by the urologist using a special sterile spoon (Volkmann spoon) or a probe (“brush”). The procedure is quite unpleasant, especially for men. The material is collected in a sterile container and immediately sent to the laboratory.

Preparation for taking a smear from the urethra:

• exclude sexual contacts within 12 hours before sampling;


• it is advisable not to take any antibacterial drugs a week before the study;


• do not urinate for 2 hours

Examination of discharge from the urethra

PCR (polymerase chain reaction)

As a material for research, urine or a smear from the urethra is used. In the laboratory, a polymerase chain reaction is carried out, as a result of which the genetic material of the pathogen (DNA or RNA) is repeatedly reproduced in large quantities. This makes it much easier to spot it.

Three glass sample

A three-glass test is carried out in order to establish the localization of the pathological process, when it is necessary to conduct a differential diagnosis between urethritis, cystitis, prostatitis, pyelonephritis.

Study preparation

Before conducting a three-glass test, the patient should not urinate for 3 to 5 hours. The study is carried out in the morning.

Research progress

The patient urinates into three containers:

• in the first - about 1/5 of all urine;


• in the second - about 3/5 of all urine;


• in the third - the remaining 1/5 of urine.

Evaluation of results after a three-glass urine test:

• increase in content only in the first portion of urine- urethritis, moreover, there is a lesion in the main part of the anterior part of the urethra;
• increase in leukocytes only in the third portion of urine- prostatitis and, possibly, posterior urethritis (damage to that part of the urethra that passes through the thickness of the prostate gland);
• increase in leukocytes in the first and third portions of urine- a combination of urethritis and prostatitis;
• an increase in the content of leukocytes in all three portions of urine- most likely, there is cystitis (inflammation of the mucous membrane of the bladder) or pyelonephritis (inflammation of the pyelocaliceal system of the kidneys).

Read more about this method of examination in the article: Three glass test.

ureteroscopy

Preparation for ureteroscopy:

• before the study, a weekly course of antibiotic treatment is usually carried out;
• immediately before the manipulation, an injection of a strong antibiotic is made in order to prevent the spread of the inflammatory process;
• before ureteroscopy, the patient should urinate;
• for young children, especially restless children, ureteroscopy is performed under general anesthesia.

• examination of the mucous membrane of the urethra from the inside;
• the ability to perform a biopsy (take a small piece of the mucous membrane of the urethra for examination under a microscope);
• the ability to carry out manipulations: eliminate the narrowing of the urethra, remove a tumor or scar, etc.

• dry- at the same time, the doctor inserts a ureteroscope lubricated with petroleum jelly into the patient's urethra and can examine the urethra throughout;


• irrigation- at the same time, a flushing fluid is constantly supplied into the urethra, due to which it is stretched, and it is possible to examine its posterior sections.

Additional studies for urethritis, which are prescribed by a doctor according to indications:

• Ultrasound examination of the pelvic organs.


• Voiding cystourethrography An X-ray examination in which a radiopaque substance is injected into the cavity of the bladder.


• Urethrocystoscopy- endoscopic examination, in which not only the urethra, but also the bladder are examined using special equipment - a urethrocystoscope

Treatment of urethritis

Antibiotic therapy

The choice of antibiotic for urethritis should be carried out only by the attending physician. If the antibacterial drug is chosen incorrectly, then it will not work on the pathogen and can lead to side effects. The correct selection of antibiotic therapy is possible after bacteriological examination and determination of the sensitivity of microorganisms to antibiotics.

Ways to use antibacterial drugs for urethritis:

• in the form of tablets;


• in the form of intravenous and intramuscular injections;


• in the form of vaginal suppositories;


• in the form of instillations (infusion of a medicinal substance) into the urethra using a special catheter.

Source of information: M. D. Mashkovsky “Medications. A guide for doctors.” 15th edition, revised, revised and enlarged. Moscow, New Wave, 2005.
In acute nonspecific urethritis, most often only the appointment of antibacterial drugs is sufficient. Treatment can last from 5 to 10 days.

• limit the consumption of fatty, spicy, sour, highly salty foods;
• drink enough liquid during the day, at least 1.5 liters
• avoid hypothermia
• refrain from sexual intercourse until complete recovery
• carefully follow the rules of personal hygiene

Treatment of chronic urethritis

Directions for the treatment of chronic urethritis:

• use of antibacterial drugs- the same as in acute urethritis, taking into account the sensitivity of microorganisms to antibiotics (periodic control is carried out - swabs are taken from the urethra for bacteriological examination and determining the sensitivity of microorganisms to antibacterial agents);
• instillation (rinsing) urethra with antiseptic solutions, for example, furacillin;
• immunocorrectors- drugs that increase the body's defenses;
• vitamin and mineral complexes- necessary to maintain the protective forces and restore the mucous membrane of the urethra.

• In chronic gonorrheal urethritis - instillation of antibiotics into the lumen of the urethra.
• With soft granulations (growths of the mucous membrane of the urethra), a solution of silver nitrate and collargol is injected into the lumen of the urethra.
• With hard granulations and growths of scars - bougienage of the lumen of the urethra (expansion by alternately introducing bougie of different diameters).
• With pronounced granulations - cauterization with a 10% - 20% solution of silver nitrate.

Additional methods of treatment of trichomonas urethritis

Additional treatments for chlamydial urethritis

Folk ways to treat urethritis

Folk remedies used in the treatment of urethritis:

• Parsley. Soak a tablespoon of crushed plant leaves in 500 ml of cold water. Insist during the night, then take 3 tablespoons of the resulting infusion every 2 hours.


• Zelenchuk yellow. Brew a teaspoon of herbs in 1 cup of boiling water. Insist for some time, then drink. Drink 1 glass of infusion in the morning, afternoon and evening.


• Black currant. This plant has a pronounced anti-inflammatory effect on the organs of the genitourinary system. Pour 500 ml of boiling water over three teaspoons of leaves, take as a tea.


• blue cornflower. Take flowers without baskets. Pour 200 ml of boiling water. Take 2 tablespoons of infusion in the morning and evening, before meals.

Possible complications of urethritis (as a rule, with a long course and the absence of adequate treatment):

• prostatitis- especially often develops with urethritis caused by chlamydia


• cystitis- inflammation of the bladder


• inflammation of the male gonads: testes, seminal vesicles


• vulvovaginitis, vaginitis- inflammation of the vagina


• orchitis- testicular inflammation


• inflammation of the female internal genital organs: colpitis, endometritis, adnexitis



• male and female infertility

The main manifestations of urethritis are urinary problems and pain. It appears due to the fact that there is inflammation in the channel.

Both women and men can suffer from urethritis.

It occurs due to the fact that the urinary tract becomes infected with a fungus, bacteria or virus.

The duration of the incubation period can vary from five to thirty days.

The most common cause is sexually transmitted diseases that are transmitted during sexual intercourse, and non-compliance with the simplest rules of hygiene. Very often, urethritis is the first symptom of an infectious disease. One of the reasons is the presence of chronic inflammatory diseases or impaired metabolic processes.

The walls of the urinary tract can also be irritated due to nutrition: alcohol, foods high in salt and spices. As a result, they become inflamed.

The disease urethritis symptoms are not acute, they appear some time after the infection has occurred. In addition, in half of the cases, acute urethritis may have no symptoms, the patient has no complaints. But, despite this, sexual transmission is possible, in addition, complications may appear.

In males, urethritis has a shorter incubation period, a more violent onset, and more severe symptoms.

The main manifestations of urethritis are:

• itching during urination;
• difficulties with the outflow of urine;
• pain in the pubic region;
• discharge of pus from the urethra;
• the appearance of blood in the urine.

Despite the inflammatory nature of the disease, the general condition of the patient is not disturbed. Most often, patients go to a urologist, but all symptoms may not be. Some of them may be very pronounced, and some may be completely absent.

It is worth noting

When the disease approaches the chronic form, the symptoms may disappear. Their further occurrence may be periodic.

In female representatives, the length of the urethra is small, about a couple of centimeters, but it is quite wide. Due to the anatomical structure of the female urethra, pathogens easily penetrate the bladder. Even if the mucous membrane of the urethra swells slightly, the outflow of urine is disturbed.

It's important to know

Despite the absence of a threat to life, urethritis leads to discomfort, in addition, complications are dangerous for women's health. Often, women suffer from a parallel course of two diseases: urethritis and cystitis.

In this case, cystitis is the simplest complication that causes urethritis. Therefore, the disease must be treated in time, otherwise the development of an ascending infection is possible, the complications of which are difficult to cope with.

During pregnancy, the development of the inflammatory process occurs faster, so the symptoms of urethritis are more pronounced. You should consult a doctor if you experience pain and itching during urination, the appearance of pus in the urine, redness of the external genitalia.

Often, the bladder can become inflamed after childbirth. When the fetus moves through the genital tract, squeezing and injury to the pelvic organs occurs. The damage may or may not be noticeable. In a nursing mother, the disease may occur due to bladder catheterization, which is performed after childbirth. Despite the fact that sterilized instruments are used during manipulation, the mucous membrane is damaged, and bacteria enter through micro-scratches. Immediately after childbirth, a heating pad with ice is often placed on the stomach, which leads to hypothermia and a decrease in immunity.

Should be understood

For such reasons, cystitis cannot develop in a healthy woman, which means that either hygiene is violated, or there is a chronic infection.

Sometimes urethritis occurs in children, but less often than in adults. Diagnosis is usually quite difficult, since the manifestations are not particularly pronounced.

In boys, the disease is characterized by:

• burning during urination;
• the appearance of blood in the urine;
• white or purulent mucous secretions;
• itching and burning of the penis.

Girls are characterized by:

• pain in the abdomen and when urinating;
• frequent urge to go to the toilet.

Forms and types of urethritis

There are many different types of urethritis, one of them is trichomonas. It is caused by Trichomonas, a pear-shaped pathogen that reproduces by longitudinal division. In the case of women, pathogenic microorganisms live in the vagina, and with males, in the prostate gland and seminal vesicles. The most common inflammation of the urethra. Sexual contact leads to primary infection.

In large numbers, vaginal trichomonas lead to a moderate inflammatory reaction, and in 20-35% of cases, those infected are asymptomatic carriers. But, if there are symptoms of urethritis, then they will appear in ten days. Sometimes there are cases of reduction of the incubation period to a couple of days or lengthening to two months. Men most often experience the acute form of Trichomonas urethritis, while women are most often asymptomatic.

In the initial stage, the patient suffers from itching around the urethra. In men, there is a little discharge from the urethra, which is gray or whitish. Sometimes there is a burning sensation during urination, which remains for a while.

If trichomonas urethritis is not treated, remission will occur in about a month, all symptoms will completely disappear. Nevertheless, this does not lead to the disappearance of the focus of infection, and the disease eventually becomes chronic.

The aggravation can be sudden, the reason can be the simplest:

• active sexual intercourse;
• exposure to cold;
• alcoholic drinks in large quantities.

It will be easier to treat trichomonas urethritis in the initial stage. To do this, the body is completely examined by a doctor, and scraping from the urethral mucosa is also performed. But obtaining reliable information is possible only with the help of a fresh smear.

Effective therapy can only be called if two partners go through it, even if one of them has no symptoms.

Given the form of the course of the disease, the doctor prescribes drugs and dosage. The duration of the course is no more than five to seven days. Very often they use not only local methods of treatment, but also use antibacterial and disinfectant preparations. Despite this, not all patients recover, so additional washes may be prescribed.

Quite common is chronic urethritis (gonococcal). They can be infected not only during sexual contact, but also through everyday contact. The duration of the incubation period is from three days, although in some cases the first symptoms of urethritis may appear after twelve hours.

The main symptoms of this type are the appearance of pus from the urethra, which has a pale yellow or yellowish green color. If the disease occurs in an acute form, the discharge is abundant, there is swelling of the urethra, burning and pain during urination. In addition, the patient complains of frequent urge to urinate, severe pain in the urethra, and fever.

To treat chronic urethritis is quite long and laborious. First of all, the urethra is examined in detail, various tests are given. After confirming the diagnosis, immunotherapy and antibacterial drugs are prescribed. When trichomonas and gonococcus act on the body, acute urethritis develops. It can also appear due to trauma or chemical irritants.

The main symptoms of gonococcal urethritis:

• pain and burning in the urethra;
• frequent urge to go to the toilet;
• urethra with inflammation and swelling;
• purulent discharge.

In some cases, the external opening in the urethra swells. In this case, the canals are opened, since due to urinary retention, urogenital fistulas or paraurethral abscesses may occur.

It is worth noting

For the treatment of acute urethritis, anti-inflammatory therapy is used, consisting of antibiotics, sulfonamides, warm baths, drinking and rest. In addition, in the presence of acute urethritis, sexual intercourse should be abandoned.

Infectious urethritis caused by gardnerella, streptococcus, gonococcus, staphylococcus and Escherichia coli.

In this form, urethritis manifests itself in the following symptoms:

• pain and cramps when urinating;
• morning discharge, having an unpleasant odor and consisting of mucus and pus, the color is blue-green;
• in the case of men, the lips of the external opening of the urethra may stick together, redness appears on them;
• in women, there are no discharges, there are unpleasant sensations when urinating.

Most often, with infectious urethritis, antibiotic therapy is performed. First of all, it is determined how sensitive the pathogen is to different types of antibiotic. Then the desired dosage and duration of administration are prescribed. The duration of the course ranges from several days to several weeks. The patient should drink a significant amount, exclude fried foods, foods with salt and spices from the diet.

As a topical treatment, drugs are infused into the urethra. If the case is without complications, it is treated at home, but if severe purulent complications have developed, hospitalization will be required.

When certain microorganisms enter the urethra, it develops bacterial nonspecific urethritis. Most often it is caused by Escherichia coli, staphylococci, streptococci, enterococci. They can often live on the mucous membrane of the urinary tract, but not always because of this, a disease will develop.

There are a number of factors predisposing to the disease, which are presented:

• injuries of the urethra;
• cystoscopy;
• bladder catheterization;
• the release of small stones;
• congestion in the pelvic organs.

It's important to know

The primary cause of bacterial urethritis can be specific pathogenic microorganisms, due to which local protection is reduced and opportunistic flora is activated.

In the treatment of bacterial urethritis, probable pathogens are taken into account and antibiotic therapy is prescribed in combination with uroantiseptics. The pathogenic effect of yeast-like fungi of the genus Candida leads to the development of an infectious disease - candidal urethritis. The shape of these unicellular microorganisms is round. The cell consists of a shell, protoplasm, nucleus and inclusions. The method of reproduction of yeast-like fungi is budding. They have the ability to elongate cells, which leads to the formation of pseudomycelium.

At candidal urethritis quite a large distribution, but most often they become infected with women. Quite often, the process becomes chronic, while the symptoms of urethritis are unexpressed. In addition, yeast-like fungi have the ability to quickly form drug-resistant forms.

The main mode of transmission of candidal urethritis is sexual contact. The source of the disease is represented not only by patients, but also by candida carriers. Often the infection can be mixed.

Often, urethritis can appear as a complication of urolithiasis. With it, stones appear in the urinary tract, which become the cause of the inflammatory process. As in the case of gout, with urolithiasis, the formation of salts of phosphoric, oxalic and uric acids occurs. Prolonged irritation of the mucous membrane of the urethra leads to its inflammation. In addition, sand and stones with urine may enter the urethra, its walls are injured, which leads to urethritis.

Be sure to take into account that the course of urethritis can be asymptomatic or they can be very mild, which is especially true for women. At the first sign of discomfort during urination, you should seek help from a specialist.

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

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

Anatomical features of the urethra

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

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

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

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

Video: urethritis and its consequences in medical animation

Clinical forms of urethritis

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

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

Urethritis nonspecific and specific

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

Urethritis caused by an infection that is sexually transmitted is called specific, all the rest are nonspecific.

Nonspecific urethritis is caused by bacteria for which sexual transmission is not the main one. Bacterial non-specific urethritis can be obtained by household contact (through linen or a towel, toilet paper, “public” solid soap), if the usual hygiene rules are not followed, or when an infection spreads from an inflammation site inside the body. The main pathogens are strepto- and staphylococci, Escherichia coli, Klebsiella, Haemophilus influenzae.

Manifestations of gonorrheal (gonococcal) urethritis

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

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

Among women diagnosed with gonococcal urethritis, more than 70% experience no urethral discomfort. Drawing pains in the lower abdomen, slight irritation and hyperemia (redness) of the labia minora are possible. Discharge from the urethral canal is scarce, often women do not notice them at all. Sometimes the disease is determined quite late, when the inflammation affects the internal genital organs - the vagina, uterus and fallopian tubes.

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

Chlamydial urethritis

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

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

Complications: inflammation can result in the formation of persistent narrowing or partial adhesions of the walls of the urethra, lead to female and male infertility, sexual dysfunction.

Candidal and viral urethritis

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

Candida urethritis manifests itself with direct (sexual or domestic) infection with yeast fungi of the genus Candida, as well as a complication after antibiotic treatment or with a decrease in the body's immune defenses. Often combined with vaginal candidiasis, commonly known as. Characterized by abundant liquid discharge, grayish plaque in the area of ​​the external opening of the urethra.

Viral urethritis is caused by a simple human. The reproduction cycle of this virus is only 14 hours, it is transmitted mainly through sexual contact. So the patients' suspicions that urethritis appeared after sex are quite justified. Symptoms can develop quickly, during the day, especially against the background of stress or hypothermia. In men, the discharge from the urethra is mucous, mostly noticeable in the morning in the form of a drop. During urination, a tingling sensation is felt, then the pain intensifies. Inguinal lymph nodes may increase, body temperature may rise.

Distinctive visible signs of viral urethritis are the appearance of small vesicles, erosions and sores, grouped around the external opening of the urethra. The elements of the rash can merge, eventually forming yellowish-crusted lesions with uneven edges. The duration of viral urethritis is up to 2 weeks, relapses are possible at intervals from a month to several years.

Trichomonas urethritis

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

Inflammation is moderate, but the waste products of Trichomonas are toxic to the human body: they loosen the surrounding tissues, contributing to the spread of the process. A distinctive feature of Trichomonas urethritis is constant itching. In men, at the onset of the disease, a sensation of "goosebumps" may appear in the area of ​​\u200b\u200bthe head of the penis, on the first day - small watery discharge of a grayish-white color, semen with an admixture of blood. Within a month, these manifestations subside, then torpid urethritis develops, which is aggravated by alcohol intake, after sexual intercourse, with general and local hypothermia.

Local complications of trichomonas urethritis are erosions and ulcers on the genitals, resembling when. Ulcers often have a clean bottom of a bright red color, less often - with a purulent coating, and soft, tucked edges of irregular outlines.

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

Urethritis in pregnant women

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

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

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

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

The risk to the mother is preterm birth, spontaneous abortion and bleeding.

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

Diagnosis of urethritis

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

The diagnosis is made after evaluating the data obtained as a result of examinations. A correctly executed diagnosis should fit into the medical history (or outpatient card) in Latin and contain an indication of the location of the process - urethritis, the clinical form - acute, subacute or chronic, and the pathogen. In the Russian version, the diagnosis looks somewhat different, in the first place - the form, then - the pathogen, at the end - urethritis. For example, acute gonococcal urethritis.

Principles of treatment of urethritis

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

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

Used to reduce inflammatory and reactive edema non-steroidal anti-inflammatory drugs(aspirin), antihistamines (suprastin), antispasmodics (no-shpa, papaverine) and diuretics.

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

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

Enzyme Therapy: prescribe enzymes that break down proteins. Action - anti-inflammatory, immunomodulatory.

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

Bougienage- instrumental expansion of the urethra with the development of strictures of the urethra.

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

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

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

You can treat urethritis at home, only patients with an acute form of the disease are hospitalized. Home treatment allows you to take medications, use vaginal suppositories, use therapeutic baths, adhere to a regimen and a therapeutic diet. All manipulations (injections, instillations, bougienage) are carried out in a hospital.

Video: folk remedies useful for urethritis

Prevention of urethritis

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

Video: urethritis in the program “Live great!”