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The symptoms of urethritis can include pain or a burning sensation upon urination (dysuria), a white/cloudy discharge and a feeling that one needs to pass urine frequently. For men, the signs and symptoms are discharge from the penis, burning or pain when urinating, itching, irritation, or tenderness. In women, the signs and symptoms are discharge from vagina, burning or pain when urinating, anal or oral infections, abdominal pain, or abnormal vaginal bleeding, which may be an indication that the infection has progressed to Pelvic Inflammatory Disease.
NGU is transmitted by touching the mouth, penis, vagina or anus by penis, vagina or anus of a person who has NGU.
NGU is more common in men than women. Men may have a discharge (strange liquid) from the penis, pain when urinating, and itching, irritation or tenderness around the opening of the penis. Women might not have any symptoms and may not know they have NGU until severe problems occur. Women might have discharge from the vagina, burning or pain when urinating, pain in the abdominal (stomach) area, or bleeding from the vagina that is not from a monthly period. (This may be an sign that NGU has become worse and turned into Pelvic Inflammatory Disease, or PID).
Urethritis can be caused by mechanical injury (from a urinary catheter or a cystoscope), or by an irritating chemical (antiseptics or some spermicides).
Urethritis is inflammation of the urethra. The most common symptom is painful or difficult urination. It is usually caused by infection with bacteria. The bacterial infection is often sexually transmitted, but not in every instance. Urethritis can be idiopathic.
In female patients, urethritis can be caused by pelvic inflammatory disease.
In males, thepenis and testicles may show signs of pain and swelling. The urethra is visually examined by spreading the urinary meatus apart with two gloved fingers, and examining the opening for redness, discharge and other abnormalities. Next, a cotton swab is inserted 1-4 cm into the urethra and rotated once. To prevent contamination, no lubricant is applied to the swab, which can result in pain or discomfort. The swab is then smeared onto a glass slide and examined under a microscope. A commonly used cut-off for the diagnosis of urethritis is 5 or more granulocytes per High Power Field, but this definition has recently been called into doubt. The physician sometimes performs a digital rectal examination to inspect the prostate gland for swelling or infection.
A urinary tract infection may cause similar symptoms.
Mucopurulent cervicitis (MPC) is characterized by a purulent or mucopurulent endocervical exudate visible in the endocervical canal or in an endocervical swab specimen. Some specialists also diagnose MPC on the basis of easily induced cervical bleeding. Although some specialists consider an increased number of polymorphonuclear white blood cells on endocervical Gram stain as being useful in the diagnosis of MPC, this criterion has not been standardized, has a low positive-predictive value (PPV), and is not available in some settings. MPC often is without symptoms, but some women have an abnormal vaginal discharge and vaginal bleeding (e.g., after sexual intercourse). MPC can be caused by "Chlamydia trachomatis" or "Neisseria gonorrhoeae"; however, in most cases neither organism can be isolated. MPC can persist despite repeated courses of antimicrobial therapy. Because relapse or reinfection with "C. trachomatis" or "N. gonorrhoeae" usually does not occur in persons with persistent cases of MPC, other non-microbiologic determinants (e.g., inflammation in the zone of ectopy) might be involved.
Patients who have MPC should be tested for "C. trachomatis" and for "N. gonorrhoeae" with the most sensitive and specific test available. However, MPC is not a sensitive predictor of infection with these organisms; most women who have "C. trachomatis" or "N. gonorrhoeae" do not have MPC.
Cervicitis can be caused by any of a number of infections, of which the most common are chlamydia and gonorrhea, with chlamydia accounting for approximately 40% of cases. As many half of pregnant women are asymptomatic with a gonorrhea infection of the cervix. "Trichomonas vaginalis" and herpes simplex are less common causes of cervicitis. There is a consistent association of M. genitalium infection and female reproductive tract syndromes. M. genitalium infection is significantly associated with increased risk of cervicitis.
Lower urinary tract infection is also referred to as a bladder infection. The most common symptoms are burning with urination and having to urinate frequently (or an urge to urinate) in the absence of vaginal discharge and significant pain. These symptoms may vary from mild to severe and in healthy women last an average of six days. Some pain above the pubic bone or in the lower back may be present. People experiencing an upper urinary tract infection, or pyelonephritis, may experience flank pain, fever, or nausea and vomiting in addition to the classic symptoms of a lower urinary tract infection. Rarely the urine may appear bloody or contain visible pus in the urine.
Most people infected with trichomonas vaginalis do not have any symptoms and can be undetected for years. Symptoms experienced include pain, burning or itching in the penis, urethra (urethritis), or vagina (vaginitis). Discomfort for both sexes may increase during intercourse and urination. For women there may also be a yellow-green, itchy, frothy, foul-smelling ("fishy" smell) vaginal discharge. In rare cases, lower abdominal pain can occur. Symptoms usually appear within 5 to 28 days of exposure.
In young children, the only symptom of a urinary tract infection (UTI) may be a fever. Because of the lack of more obvious symptoms, when females under the age of two or uncircumcised males less than a year exhibit a fever, a culture of the urine is recommended by many medical associations. Infants may feed poorly, vomit, sleep more, or show signs of jaundice. In older children, new onset urinary incontinence (loss of bladder control) may occur.
In men, those with a chlamydial infection show symptoms of infectious inflammation of the urethra in about 50% of cases. Symptoms that may occur include: a painful or burning sensation when urinating, an unusual discharge from the penis, testicular pain or swelling, or fever. If left untreated, chlamydia in men can spread to the testicles causing epididymitis, which in rare cases can lead to sterility if not treated. Chlamydia is also a potential cause of prostatic inflammation in men, although the exact relevance in prostatitis is difficult to ascertain due to possible contamination from urethritis.
Chlamydia may also cause reactive arthritis—the triad of arthritis, conjunctivitis and urethral inflammation—especially in young men. About 15,000 men develop reactive arthritis due to chlamydia infection each year in the U.S., and about 5,000 are permanently affected by it. It can occur in both sexes, though is more common in men.
Those with urogenital or extragenital infections caused by "M. hominis" have symptoms similar to other sexually transmitted infections and its presence cannot be determined by its symptoms. The precise role this organism plays in causing disease remains speculative. Diagnosis remains a challenge because the organism is difficult to culture in vitro. PCR-based techniques are still rare outside research scenarios.
The following conditions have been linked to Mycoplasma hominis:
- pyelonephritis
- cystitis
- Pelvic inflammatory disease (PID)
- endometritis
- chorioamnionitis
- surgical and nonsurgical wound infections
- bacteremia
- pneumonia
- meningitis
- salpingitis
- urethritis
- septic arthritis
- cervicitis
"Mycoplasma hominis" is often present in polymicrobial infections.
Symptoms in PID range from none to severe. If there are symptoms, then fever, cervical motion tenderness, lower abdominal pain, new or different discharge, painful intercourse, uterine tenderness, adnexal tenderness, or irregular menstruation may be noted.
Other complications include endometritis, salpingitis, tubo-ovarian abscess, pelvic peritonitis, periappendicitis, and perihepatitis.
MAGI includes infections (bacterial, viral, fungal etc) involving one or more of the following male genital organs or tracts:
- seminal vesicles (seminal vesiculitis)
- prostate gland (prostatitis)
- vas deferens
- epididymis (epididymitis)
- testicles (orchitis)
- urethra (urethritis)
- Cowper's glands
Research has shown a link between trichomoniasis and two serious sequelae. Data suggest that:
- Trichomoniasis is associated with increased risk of transmission and infection of HIV.
- Trichomoniasis may cause a woman to deliver a low-birth-weight or premature infant.
- The role of trichomonas infection in causing cervical cancer is unclear, although trichomonas infection may be associated with co-infection with high-risk strains of HPV.
- "T. vaginalis" infection in males has been found to cause asymptomatic urethritis and prostatitis. In the prostate, it may create chronic inflammation that may eventually lead to prostate cancer.
The exact role of Mycoplasma hominis (and to a lesser extent Ureaplasma) in regards to a number of conditions related to pregnant women and their (unborn) offspring is controversial. This is mainly because many healthy adults have genitourinary colonization with Mycoplasma, published studies on pathogenicity have important design limitations and the organisms are very difficult to detect. The likelihood of colonization with "M. hominis" appears directly linked to the number of lifetime sexual partners
Neonatal colonization does occur, but only through normal vaginal delivery. Caesarean section appears protective against colonization and is much less common. Neonatal colonization is transient.
The main infectious agents are Enterobacteriaceae (such as Escherichia coli and Klebsiella), Neisseria gonorrhoeae and Chlamydia trachomatis.
One study has shown that men with MAGI who have lower serum levels of total testosterone tend to have a more complicated form of MAGI, such as involving more than one site, than those with normal levels.
Pelvic inflammatory disease or pelvic inflammatory disorder (PID) is an infection of the upper part of the female reproductive system namely the uterus, fallopian tubes, and ovaries, and inside of the pelvis. Often there may be no symptoms. Signs and symptoms, when present may include lower abdominal pain, vaginal discharge, fever, burning with urination, pain with sex, or irregular menstruation. Untreated PID can result in long term complications including infertility, ectopic pregnancy, chronic pelvic pain, and cancer.
The disease is caused by bacteria that spread from the vagina and cervix. Infections by "Neisseria gonorrhoeae" or "Chlamydia trachomatis" are present in 75 to 90 percent of cases. Often multiple different bacteria are involved. Without treatment about 10 percent of those with a chlamydial infection and 40 percent of those with a gonorrhea infection will develop PID. Risk factors are similar to those of sexually transmitted infections generally and include a high number of sexual partners and drug use. Vaginal douching may also increase the risk. The diagnosis is typically based on the presenting signs and symptoms. It is recommended that the disease be considered in all women of childbearing age who have lower abdominal pain. A definitive diagnosis of PID is made by finding pus involving the fallopian tubes during surgery. Ultrasound may also be useful in diagnosis.
Efforts to prevent the disease include not having sex or having few sexual partners and using condoms. Screening women at risk for chlamydial infection followed by treatment decreases the risk of PID. If the diagnosis is suspected, treatment is typically advised. Treating a woman's sexual partners should also occur. In those with mild or moderate symptoms a single injection of the antibiotic ceftriaxone along with two weeks of doxycycline and possibly metronidazole by mouth is recommended. For those who do not improve after three days or who have severe disease intravenous antibiotics should be used.
Globally about 106 million cases of chlamydia and 106 million cases of gonorrhea occurred in 2008. The number of cases of PID however, is not clear. It is estimated to affect about 1.5 percent of young women yearly. In the United States PID is estimated to affect about one million people yearly. A type of intrauterine device (IUD) known as the Dalkon shield led to increased rates of PID in the 1970s. Current IUDs are not associated with this problem after the first month.
It had also been associated with a number of diseases in humans, including nonspecific urethritis, and infertility.
"Ureaplasma urealyticum" is a species in the genus "Ureaplasma" that can cause infection. Though most bacteria possess a cell wall, "U urealyticum" does not. It is found in about 70% of sexually active humans. It can be found in cultures in cases of pelvic inflammatory disease and is transmitted through sexual activity or from mother to infant during birth. It is not a commensal of the healthy uterine or amniotic microbiome. Infection with "U. realyticum" can contribute neonatal infection and negative birth outcomes.
The hallmark sign of urethral stricture is a weak urinary stream. Other symptoms include:
- Splaying of the urinary stream
- Urinary frequency
- Urinary urgency
- Straining to urinate
- Pain during urination
- Urinary tract infection
- Prostatitis
- Inability to completely empty the bladder.
Some patients with severe urethral strictures are completely unable to urinate. This is referred to as acute urinary retention, and is a medical emergency. Hydronephrosis and renal failure may also occur.
Urethral strictures most commonly result from injury, urethral instrumentation, infection, non-infectious inflammatory conditions of the urethra, and after prior hypospadias surgery. Less common causes include congenital urethral strictures and those resulting from malignancy.
Urethral strictures after blunt trauma can generally be divided into two sub-types;
- Pelvic fracture-associated urethral disruption occurs in as many as 15% of severe pelvic fractures. These injuries are typically managed with suprapubic tube placement and delayed urethroplasty 3 months later. Early endoscopic realignment may be used in select cases instead of a suprapubic tube, but these patients should be monitored closely as vast majority of them will require urethroplasty.
- Blunt trauma to the perineum compresses the bulbar urethra against the pubic symphysis, causing a "crush" injury. These patients are typically treated with suprapubic tube and delayed urethroplasty.
Other specific causes of urethral stricture include:
- Instrumentation (e.g., after transurethral resection of prostate, transurethral resection of bladder tumor, or endoscopic kidney surgery)
- Infection (typically with Gonorrhea)
- Lichen sclerosus
- Surgery to address hypospadias can result in a delayed urethral stricture, even decades after the original surgery.
Odynorgasmia, or painful ejaculation, is a physical syndrome described by pain or burning sensation of the urethra or perineum during or following ejaculation. Causes include infections associated with urethritis, prostatitis, epididymitis, as well as use of anti-depressants.
Neonatal herpes simplex is a HSV infection in an infant. It is a rare but serious condition, usually caused by vertical transmission of HSV-1 or -2) from mother to newborn. During immunodeficiency, herpes simplex can cause unusual lesions in the skin. One of the most striking is the appearance of clean linear erosions in skin creases, with the appearance of a knife cut. Herpetic sycosis is a recurrent or initial herpes simplex infection affecting primarily the hair follicles. Eczema herpeticum is an infection with herpesvirus in patients with chronic atopic dermatitis may result in spread of herpes simples throughout the eczematous areas.
Herpetic keratoconjunctivitis, a primary infection, typically presents as swelling of the conjunctiva and eyelids (blepharoconjunctivitis), accompanied by small white itchy lesions on the surface of the cornea.
Herpetic sycosis is a recurrent or initial herpes simplex infection affecting primarily the hair follicle.
Herpes simplex is divided into two types; HSV-1 causes primarily mouth, throat, face, eye, and central nervous system infections, whereas HSV-2 causes primarily anogenital infections. However, each may cause infections in all areas.